Claim Options Field Descriptions

Field	Description
Force Claim Break when Place of Service is	Selects one or more Place of Service codes that cause charges with the selected POS to break for a separate claim.
Always send unit count as 1 on claim charge lines	If this field is enabled, claim edit #273 CPT4(s) cannot be in excess of a particular number of units should be disabled in File Maintenance > Libraries > Claim Edits.
Always send one line item per claim	You can select this option if claims should only include 1 line item. If an encounter has three charges. Two of the charges roll-up and the third charge is not part of the roll-up. If you select this option, two claims will be created for the encounter, each with 1 line item.
Secondary Claims Roll-up lines view	Manages the billing options for the roll-up charge amount on secondary claims. Sum of roll-up less prior payer transactions: Sends the charge amount on claims for the secondary payer as the sum of the roll-up charges minus any payment or adjustment transaction amounts already posted from the primary payer. Sum of roll-up: Sends the charge amount on claims for the secondary payer as the sum of the roll-up charges.
Secondary Claims Always bill as primary when prior payer is	You can select the Open Folder to select one or more payers. If one of the selected payer is primary on the encounter, the claim for the secondary payer appears as a primary claim.
Tertiary Claims Roll-up lines view	You can select one of the following billing options for the roll-up charge amount on tertiary claims: Sum of roll-up less prior payer transactions: Sends the charge amount on claims for the tertiary payer as the sum of the roll-up charges minus any payment/adjustment transaction amounts already posted from the primary and secondary payers. Sum of roll-up: Sends the charge amount on claims for the tertiary payer as the sum of the roll-up charges.
Tertiary Claims Always bill as primary when prior payer is	You can select the Open Folder to select one or more payers. If one of the selected payer is secondary on the encounter, the claim for the tertiary payer appears as a primary claim.

File Maintenance Help for NextGen® Enterprise

Claim Options Field Descriptions

Use the following table to setup claim options. Field Description Force Claim Break when Place of Service is Selects one or more Place of Service codes that cause charges with the selected POS to break for a separate claim. Always send unit count as 1 on claim charge lines If this field is enabled, claim edit #273 CPT4(s) cannot be in excess of a particular number of units should be disabled in File Maintenance > Libraries > Claim Edits. Always send one line item per claim You can select this option if claims should only include 1 line item. If an encounter has three charges. Two of the charges roll-up and the third charge is not part of the roll-up. If you select this option, two claims will be created for the encounter, each with 1 line item. Secondary Claims Roll-up lines view Manages the billing options for the roll-up charge amount on secondary claims. Sum of roll-up less prior payer transactions: Sends the charge amount on claims for the secondary payer as the sum of the roll-up

Help Guide for NextGen® Enterprise PM 8

Claim Options Field Descriptions

Use the following table to setup claim options. Field Description Force Claim Break when Place of Service is Select one or more Place of Service codes that will cause charges with the selected POS to break to a separate claim, if applicable. Always send unit count as 1 on claim charge lines Select this check box if the number of charge units should always be sent as 1 on claims, regardless of the actual charge units. For example, the number of units based on time for a charge is 3. If this option is selected, the number of units on the claim for that charge will be 1. Note: If enabled, claim edit #273 “CPT4(s) cannot be in excess of a particular number of units” should be disabled in File Maintenance > Libraries > Claim Edits. Always send one line item per claim Select this check box if claims should only include 1 line item. For example, an encounter has three charges. Two of the charges roll-up and the third charge is not part of the roll-up. If this option is selected, two claims wi

File Maintenance Help for NextGen® Enterprise 8

Claim Options Field Descriptions

Use the following table to setup claim options. Field Description Force Claim Break when Place of Service is Select one or more Place of Service codes that will cause charges with the selected POS to break to a separate claim, if applicable. Always send unit count as 1 on claim charge lines Select this check box if the number of charge units should always be sent as 1 on claims, regardless of the actual charge units. For example, the number of units based on time for a charge is 3. If this option is selected, the number of units on the claim for that charge will be 1. Note: If enabled, claim edit #273 “CPT4(s) cannot be in excess of a particular number of units” should be disabled in File Maintenance > Libraries > Claim Edits. Always send one line item per claim Select this check box if claims should only include 1 line item. For example, an encounter has three charges. Two of the charges roll-up and the third charge is not part of the roll-up. If this option is selected, two claims wi

Help Guide for NextGen® Enterprise PM 8

Charge Options Field Descriptions

Use the following table to setup charge options. Field Description Disable Variance Calculation This check box controls whether or not a variance will be calculated for payers using this library. To enable variance calculations, leave this check box blank and complete all remaining fields on the tab. During the billing process, variance will be calculated, and a variance SIM will be added to the encounter if a positive or negative variance exists. To disable variance calculations, select this check box. All remaining fields on the tab become unavailable. During the billing process, variance will not be calculated, and a variance SIM will therefore not be added to the encounter. Note: If selected, the Claim Production Status report in NextGen® Enterprise PM displays the following green message when the encounter passes claim edits: Behavioral health variance charge not inserted due to library settings. Insert SIM with Variance Amount on Roll-up Charges Service Item # Select the SIM code

File Maintenance Help for NextGen® Enterprise 8

Charge Options Field Descriptions

Use the following table to setup charge options. Field Description Disable Variance Calculation This check box controls whether or not a variance will be calculated for payers using this library. To enable variance calculations, leave this check box blank and complete all remaining fields on the tab. During the billing process, variance will be calculated, and a variance SIM will be added to the encounter if a positive or negative variance exists. To disable variance calculations, select this check box. All remaining fields on the tab become unavailable. During the billing process, variance will not be calculated, and a variance SIM will therefore not be added to the encounter. Note: If selected, the Claim Production Status report in NextGen® Enterprise PM displays the following green message when the encounter passes claim edits: Behavioral health variance charge not inserted due to library settings. Insert SIM with Variance Amount on Roll-up Charges Service Item # Select the SIM code

File Maintenance Help for NextGen® Enterprise

Charge Options Field Descriptions

Use the following table to setup charge options. Field Description Disable Variance Calculation Controls the variance calculated for payers using this library. To enable variance calculations, do not select Disable Variance Calculation. If a positive or negative variance exists during the billing process, variance is calculated and a variance SIM is added to the encounter. To disable variance calculations, select Disable Variance Calculation. All remaining fields on the tab become unavailable. During the billing process, variance will not be calculated, and a variance SIM will therefore not be added to the encounter. Insert SIM with Variance Amount on Roll-up Charges Service Item # Adds the SIM code to the encounters as an additional charge during the billing process when there is a variance in units for timed behavioral health charges that roll-up. Note: The SIM code must first be created in the SIM Library with a $0.00 price. Variance Calculation When Secondary Calculates the varianc

Claim Options Field Descriptions

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