General Tab of Contract Library Maintenance

Help Guide for NextGen® Enterprise PM 8

Contract Defaults

The Contract Defaults section contains options that enable you to set informational alerts, information about co-payments, co-pay amounts, and a default percentage for expected reimbursement, among other options. Field Contract Defaults - Contractor and Co-Pay Options Descriptions Co-Payment on Office Encounters To require a co-payment, select this check box. When you attach insurance to an encounter, an alert reminds you that the contract requires a co-pay for all encounters. Default Co-Pay Amount Indicates the dollar amount of the default co-payment for all office encounters. This amount becomes the default in the Insurance Maintenance window for any patients that have insurance associated with this contract. When entering insurance information for the patient, you will be warned that a co-payment is required. Also, when you attach the insurance to the encounter, you will be given another warning. Co-Pay Origin Select either Allowed or Reimbursed to determine whether the co-pay perce

Help Guide for NextGen® Enterprise PM 8

General Information fields

The General tab of Contract Library Maintenance window consists of the following sections: Contract Information Contract Defaults Alerts and Edits Allowed and FFS/Balance Distribution Automatic Adjustments Contract Information Field Contract Information Descriptions Contract Name Indicates the contract name. Effective Date Indicates the date that the contract becomes effective. Expiration Date Indicates the date that the contract becomes expired. Contract Defaults Field Contract Defaults - Contractor and Co-Pay Options Descriptions Co-Payment on Office Encounters Requires a co-pay for the contract while attaching insurance to an encounter. Default Co-Pay Amount Indicates the dollar amount of the default co-payment for all office encounters. This amount becomes the default in the Insurance Maintenance window for any patients that have insurance associated with this contract. When entering insurance information for the patient, you will be warned that a co-payment is required. Also, when

Help Guide for NextGen® Enterprise PM 8

Allowed and FFS/Balance Distribution

Field Allowed and FFS/Balance Distribution Descriptions Fee for Service Enter the percentage of the full fee that you expect to get for participating and non-participating physicians. % of Allowed Amount for Participants Enter the percentage of the allowed amount a participating provider expects to be reimbursed. A provider is a participant when the contract is selected for it in the Providers master file. % of Allowed Amount for Non-Participants Enter the percentage of the allowed amount a non-participating provider expects to be reimbursed. Prorate Insurance Balance If this option is selected and it is also selected on Other tab (of Practice in the Add/Modify Payer Information window) then: The patient's charges will be prorated between the Primary Insurance and the Secondary or Patient bucket. The proration is based on the Fee for Service percentages. The prorated balances can be viewed in the patient's Balance Control window. Note: If you prorate the patient's charges, you can get

Help Guide for NextGen® Enterprise PM 8

Alerts and Edits

Field Alerts and Edits Descriptions Referring Physician Required If the contract calls for a referring physician, select this check box. An alert displays when you enter charges for an encounter. Enable Build Level Edits Select this check box to have Contract Edits display on the Claim Production Status report as Build or Warning level claim edits when an encounter is billed. The Enable Build Level Edits option turns some contract edits from a warning to required during the billing process. When the edits are not passed, a claim will not be created. This option works with the Contract Edit options in Practice Preferences. Authorization Required If the contract calls for authorization, select this check box. When you enter charges for an encounter, an alert displays to warn you that the contract for the payer requires an authorization for all CPT4 codes. Parent topic: General Tab of Contract Library Maintenance

Help Guide for NextGen® Enterprise PM 8

Automatic Adjustments

The Automatic Adjustments section enables you to automatically adjust charges to the expected allowed amount at the time they are entered. This section is used in conjunction with the Fee Schedule tab. Field Automatic Adjustments Descriptions Automatically adjust charges Select this check box so that adjustments are automatically made for the items at the time charges are entered on the Charge Posting window. This check box enables the remaining fields in the section. Adjustable Allowed Amount Select this check box to determine the write off (auto adjustment) based on the patient co-pay plus the contract reimbursement amount. If you select this option, the Co-Pay Origin field changes to Reimbursed and, on the Fee Schedule tab, the Allowed column becomes disabled. Default Auto-Adj Transaction Select the transaction code to associate with the automatic transactions. Note: The codes listed are set up in the Transaction Codes master file as an Adjustment type and have the source as Third p

Help Guide for NextGen® Enterprise PM 8

Access Contract Library Maintenance

You can set up contracts for payers to indicate the reimbursed amount for the procedures, and for authorization or referral requirement. For other contract specific, you can attach payers to the contract or create contract subgroupings for reporting purposes. In File Maintenance, select Libraries, and then select Contract. The Contracts List window opens. Double-click the library. The Contract Library Maintenance window opens. General Tab of Contract Library Maintenance Parent topic: Contracts Library

General Tab of Contract Library Maintenance

Recommendations

Contract Defaults

General Information fields

Allowed and FFS/Balance Distribution

Alerts and Edits

Automatic Adjustments

Access Contract Library Maintenance

Contract Defaults

General Information fields

Allowed and FFS/Balance Distribution

Alerts and Edits

Automatic Adjustments

Access Contract Library Maintenance