Claim Edits Library for Behavioral Health Billing

Help Guide for NextGen® Enterprise PM 8

Claim Edits Library for Behavioral Health Billing

Two claim edits are available that may be enabled and set up for Behavioral Health billing, though they may also be used for non-behavioral health billing purposes. Each edit is configurable with specific CPT4 codes. 273 CPT4(s) cannot be in excess of a particular number of units Select this edit if specific CPT4 codes cannot exceed a specified number of units during charge posting. 274 CPT4(s) only valid for certain primary dx Select this edit if specific CPT4 codes can only be used with specified primary ICD codes during charge posting. Example: When billing a state behavioral health program (payer) for a drug and alcohol abuse CPT4, the primary ICD code must be drug or alcohol related. Claim Edit Library Maintenance window; Claim Edits 273 and 274 The claim edits fail when a charge for a specified CPT4 code exceeds the defined number of units (#273), or a charge for a specified CPT4 code does not have one of the defined ICD codes as the primary diagnosis (#274). Claim Productions St

Help Guide for NextGen® Enterprise PM 8

Behavioral Health Billing

In NextGen® Enterprise PM, you can setup the billing requirements for Behavioral Health Billing. Behavioral health SIM codes are set up in the Service Items Library with a base minute value of 15, 30, 60, 240, or a custom value. In addition, the price per time unit is defined for each SIM code. During charge posting, behavioral health SIM codes prompt for the entry of a start and stop time, and then total time units for the charge are calculated based on the times entered. Payers are set up in the Payers master file with a base minute rounding method that is used to round the total time entered on each charge up or down when calculating time units. When multiple behavioral health charges on a single encounter have the same CPT4 code, the same modifiers, the same base minutes and the same unit price, those charges roll-up, or bundle, into a single line item on the claim. The total units on the claim for the roll-up line item is calculated using the total time entered on all of the indiv

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Options

The Claim Options tab is used to configure specific parameters that affect claims for Behavioral Health charges. Options to always send unit count as 1 on claim charge lines, and to always send one line item per claim are available. On secondary and tertiary claims, charges can bill as the total sum of the roll-up charges, or as the total sum minus transactions posted from the prior payer. Also, secondary and tertiary claims can be billed as a primary claim depending on the prior payer. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Claim Options tab. Behavioral Health Billing Library Maintenance window; Claim Options tab Complete the fields to set up Claim Options. For more information on each field, see Claim Options Field Descriptions. To save changes and close the window, select OK. Claim

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Options

The Claim Options tab is used to configure specific parameters that affect claims for Behavioral Health charges. Options to always send unit count as 1 on claim charge lines, and to always send one line item per claim are available. On secondary and tertiary claims, charges can bill as the total sum of the roll-up charges, or as the total sum minus transactions posted from the prior payer. Also, secondary and tertiary claims can be billed as a primary claim depending on the prior payer. Open File Maintenance. Select Libraries, and then select Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the library. The Behavioral Health Billing Library Maintenance window opens. Select Claim Options. Enter the Claim Options fields to set up the claim options for behavioral health billing. Select OK. Claim Options Field Descriptions You can set up claim options for behavioral health charges. Parent topic: Add or Modify a Behavioral Health Billing Libra

File Maintenance Help for NextGen® Enterprise

Set Up Claim Options

The Claim Options tab is used to configure specific parameters that affect claims for Behavioral Health charges. Options to always send unit count as 1 on claim charge lines, and to always send one line item per claim are available. On secondary and tertiary claims, charges can bill as the total sum of the roll-up charges, or as the total sum minus transactions posted from the prior payer. Also, secondary and tertiary claims can be billed as a primary claim depending on the prior payer. Open File Maintenance. Select Libraries, and then select Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the library. The Behavioral Health Billing Library Maintenance window opens. Select Claim Options. Enter the Claim Options fields to set up the claim options for behavioral health billing. Select OK. Claim Options Field Descriptions You can set up claim options for behavioral health charges. Parent topic: Add or Modify a Behavioral Health Billing Libra

File Maintenance Help for NextGen® Enterprise 8

Set Up Claim Options

The Claim Options tab is used to configure specific parameters that affect claims for Behavioral Health charges. Options to always send unit count as 1 on claim charge lines, and to always send one line item per claim are available. On secondary and tertiary claims, charges can bill as the total sum of the roll-up charges, or as the total sum minus transactions posted from the prior payer. Also, secondary and tertiary claims can be billed as a primary claim depending on the prior payer. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Claim Options tab. Complete the fields to set up Claim Options. For more information on each field, see Claim Options Field Descriptions. To save changes and close the window, select OK. Claim Options Field Descriptions Parent topic: Behavioral Health Billing Libra

Claim Edits Library for Behavioral Health Billing

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