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CHC Setup Requirements
Required Setup:
Sliding Fee Schedules
Encounter Rate Billing (or Roll-Up Billing) for Medicare/Medicaid
UDS Reporting
Optional Setup:
Custom Reports
Proprietary Claim Formats
CHC Setup Requirements
Help Guide for NextGen® Enterprise PM 8
RHC Setup Requirements
Required Setup: Encounter Rate Billing (or Roll-Up Billing) for Medicare/Medicaid UDS Reporting Optional Setup: Sliding Fee Schedules Custom Reports Parent topic: Health Center Setup Requirements
Help Guide for NextGen® Enterprise PM 8
FQHC Setup Requirements
Required Setup: Sliding Fee Schedules Encounter Rate Billing (or Roll-Up Billing) for Medicare/Medicaid UDS Reporting Optional Setup: Custom Reports Proprietary Claim Formats Parent topic: Health Center Setup Requirements
Help Guide for NextGen® Enterprise PM 8
CHC Look-a-Like Setup Requirements
Optional Setup: Sliding Fee Schedules Proprietary Claim Formats (For example, Planned Parenthood in Texas is required to use a proprietary form for filing their family planning claims to the state.) Encounter Rate Billing (or Roll-up Billing) UDS Reporting (required if federally funded) Title X Report (California) Other Custom Reports Parent topic: Health Center Setup Requirements
Help Guide for NextGen® Enterprise PM 8
IHS Setup Requirements
Required Setup: Encounter Rate Billing (or Roll-Up Billing) for Medicare/Medicaid Patient Information: Tribal Affiliation Blood Quantum IHS Eligibility Status Classification/Beneficiary Descendancy Optional Setup: Sliding Fee Schedules Other Custom Reports Proprietary Claim Formats Reports available from NextGen Technical Consulting Services: GPRA (Government Performance and Results Act) CHRS (Contract Health Referral System) NDW (National Data Warehouse) DAR (Diabetic Audit Report) Parent topic: Health Center Setup Requirements
Help Guide for NextGen® Enterprise PM 8
Health Center Setup Requirements
This section provides instructions on configuring NextGen® Enterprise PM to accommodate the specialized needs of Health Centers. CHC Setup Requirements FQHC Setup Requirements RHC Setup Requirements IHS Setup Requirements CHC Look-a-Like Setup Requirements Setting Up Master Lists for Health Centers Set Up Client Defined Fields for Health Centers
Help Guide for NextGen® Enterprise PM 8
Charge and Billing Options for Health Centers
In most cases, the special setup for Health Centers applies only to Medicare and Medicaid. This includes Managed Care programs for Medicare and Medicaid which are often considered to be commercial payers. Blue Cross Blue Shield and Commercial payers typically bill as Fee-for-Service on a 1500 claim form just like at other private practices. No special setup is required for these payers. However, every state has potential for exceptions. Therefore, any payer can be setup for encounter rate or roll-up billing if needed. Encounter Rate Billing: This is an option for payers such as Medicare (FQHC / RHC) and Medicaid that have unique and specific billing and claim requirements, and that reimburse at a flat encounter rate. Encounter Rate Billing provides the ability to automatically adjust charges so that the balance reflects the payer’s expected encounter reimbursement rate/amount. In addition, an encounter rate code required by the payer on claims can be automatically inserted onto each en
