Add or Modify a Claim Modifiers Library

Help Guide for NextGen® Enterprise PM 8

Hide a Claim Modifier

You can hide a claim modifier, if needed. A hidden modifier is no longer applied to claims in NextGen® Enterprise PM, even if the modifier is still in effect and not expired. For example, a charge meets all criteria defined for a hidden modifier, and the date of service on the charge falls within the modifier's effective date range. When the encounter is billed, the modifier change is not applied to the claim for the charge because the modifier is hidden. Open File Maintenance. Select Libraries, and then Claim Modifiers. The Claims Modifiers List window opens. Select a library from the list, and then select the open menu button . Select Open. The Claim Modifiers Library Maintenance window opens. From the Claim Modifiers list, select a modifier to hide and then do one of the following: Select Open Menu and then select Hide. Right-click and then select Hide. Double-click to open the modifier, then select the Hide check box, and then select OK. A prompt appears asking you to confirm hidin

Help Guide for NextGen® Enterprise PM 8

Select a Default Claim Modifiers Library

A Claim Modifiers library can be selected at the practice-level to be used for all payers, or at the payer-level to be used for specific payers only. A payer-level library overrides the default practice-level library for that payer. To select a default library for a practice, do the following: Open NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Practice. The Practice Preferences window opens. In the Preferences List, select Libraries. In the Claim Modifiers Library field, select the default library to be used for the practice. To save changes and close the window, select OK. To select a default library for a payer, Access File Maintenance Select System Master Files, then PM, and then Payers. The Payer List window opens. From the list, double-click to open a payer. The Modify Payer Information window opens. Select the Practice tab, and then the Libraries sub-tab. In the Modifiers Library field, select the Claim Modifiers library to be used for the payer. To sa

File Maintenance Help for NextGen® Enterprise

Add or Modify a Claim Modifiers Library

The Claim Modifiers library can be used by practices for different payers. You can enter charges for specific modifiers and SIM types during charge posting. You can either add a modifier to the claim or remove a modifier from the claim during the billing process. The practice-level default Claim Modifiers library selected in Practice Preferences > Libraries is used for all payers. A payer-level library selected in the Libraries sub-tab under the Practice tab in the Payers master file overrides the practice-level library for that payer. Open File Maintenance. Select Libraries, and then select Claims Modifiers. The Claims Modifiers List window opens. To add a claim modifier, select Open Menu, and then select New. The Add Claim Modifiers window opens. Enter a value in the Claim Modifiers Library field. Select Open Menu, and then select New. The Add/Modify Claim Modifiers window opens. Enter the desired values in the Modifier, Effective Date, Expiration Date fields, and then select OK. Not

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Modifiers for Non-Time Based Service

Use the following procedure to set up a claim modifier for Non-Time Based service: Access the Add/Modify Claim Modifiers window. In the Modifier field, enter a two-character modifier. This field is required and cannot be modified after the modifier is saved In the Effective Date field, enter a start date for the modifier. This field is required. Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3. In the Expiration Date field, enter an end date for the modifier. This field is required. Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3. In the Modifier Change for Claims field, select one of the following options to add or remove the modifier on claims. The modifier is added or removed when the claim is created during the billing process in NextGen® Enterprise PM. <none>: Leave this field blank to include the modifier on the claim for charges that were entered with the modifier. Add if <Credential>: Selec

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Modifiers for Rental Billing

Use the following procedure to set up a claim modifier for Rental SIM codes: Access the Add/Modify Claim Modifiers window. In the Modifier field, enter a two-character recurring rental modifier. This field is required and cannot be modified after the modifier is saved. For example: KH: Initial claim, purchase or first month rental KI: Second or third monthly rental KJ: Capped rental months four to fourteen KR: Partial month In the Effective Date field, enter a start date for the modifier. This field is required. Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3. In the Expiration Date field, enter an end date for the modifier. This field is required. Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3. In the Modifier Change for Claims field, select one of the following options to add or remove the modifier on claims. The modifier is added or removed when the claim is created during the billing process

Help Guide for NextGen® Enterprise PM 8

Claim Modifiers Library

The Claim Modifiers library can be used by practices when the modifier usage differs from payer to payer. During charge posting, add units to a charge when a specific modifier is entered on the charge for specific SIM types. During the billing process, add a modifier to the claim if the modifier was not entered on the charge. During the billing process, remove a modifier from the claim if the modifier was entered on the charge. Note: For a claim modifier to be applied, the charge service date must fall within the effective date and expiration date defined for the modifier, and the charge must meet all Modifier Change for Claims criteria defined for the modifier. The practice-level default Claim Modifiers library selected in Practice Preferences > Libraries is used for all payers. A payer-level library selected in the Libraries sub-tab under the Practice tab in the Payers master file overrides the practice-level library for that payer. You can generate Claim Modifiers report from the Cl

Add or Modify a Claim Modifiers Library

Recommendations

Hide a Claim Modifier

Select a Default Claim Modifiers Library

Add or Modify a Claim Modifiers Library

Set Up Claim Modifiers for Non-Time Based Service

Set Up Claim Modifiers for Rental Billing

Claim Modifiers Library

Hide a Claim Modifier

Select a Default Claim Modifiers Library

Add or Modify a Claim Modifiers Library

Set Up Claim Modifiers for Non-Time Based Service

Set Up Claim Modifiers for Rental Billing

Claim Modifiers Library