Payers Master File for Dental Billing

Help Guide for NextGen® Enterprise PM 8

Payers Master File for Dental Billing

Three areas in the Payers master file must be set up for dental claims. These setup requirements are on the following tabs of the Payers master file: Payer Defaults - 2: Used to set up a payer for dental billing and ADA claims. System: Used to set up provider secondary references. Practice: Used to set up electronic claims. Defaults-2 Tab System Tab Practice Tab Parent topic: Dental Billing

Help Guide for NextGen® Enterprise PM 8

Defaults-2 Tab

To enable a payer for dental billing, the Dental payer check box must be selected on the on the Modify Payer Information window on the Defaults-2 tab. To bill dental SIMs and create ADA dental claims, a dental payer must be attached to the encounter. Note: If an encounter is billed with dental service items and a dental payer is not attached to the encounter, then those charges automatically skip the payers attached to the encounter and become the patient’s responsibility. If this check box is selected and the appropriate insurance is selected for an encounter, the plan is marked as Dental on the ADA form. Parent topic: Payers Master File for Dental Billing

Help Guide for NextGen® Enterprise PM 8

System Tab

To set up provider secondary references, use the ADA Claims tab on the Claims sub-tab on the System tab of the Modify Payer Information window. Use the following table to set up your Provider Secondary References for dental payers. Provider Secondary Reference Qualifier / Data Element Billing Tab Employer ID Number (EI) / Tax ID Referring Tab <none> / <none> Rendering Tab <none> / <none> Service Facility Tab <none> / <none> Payer Billing Tab <none> / <none> Note: For more information on provider secondary references, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise, and then refer to the Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs section. Parent topic: Payers Master File for Dental Billing

Help Guide for NextGen® Enterprise PM 8

Defaults-2 Tab

To enable a payer for dental billing, the Dental payer check box must be selected on the on the Modify Payer Information window on the Defaults-2 tab. Modify Payer Information To bill dental SIMs and create ADA dental claims, a dental payer must be attached to the encounter. Note: If an encounter is billed with dental service items and a dental payer is not attached to the encounter, then those charges automatically skip the payers attached to the encounter and become the patient’s responsibility. If this check box is selected and the appropriate insurance is selected for an encounter, the plan is marked as Dental on the ADA form. Parent topic: Payers Master File for Dental Billing

Help Guide for NextGen® Enterprise PM 8

System Tab

To set up provider secondary references, use the ADA Claims tab on the Claims sub-tab on the System tab of the Modify Payer Information window. Modify Payer Information Use the following table to set up your Provider Secondary References for dental payers. Provider Secondary Reference Qualifier / Data Element Billing Tab Employer ID Number (EI) / Tax ID Referring Tab <none> / <none> Rendering Tab <none> / <none> Service Facility Tab <none> / <none> Payer Billing Tab <none> / <none> Note: For more information on provider secondary references, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise, and then refer to the Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs section. Parent topic: Payers Master File for Dental Billing

File Maintenance Help for NextGen® Enterprise 8

Defaults 2 Sub-Tab

The following table describes the options and settings available on the Defaults 2 tab in the Defaults - 2 tab for a payer. Field Description Diag Codes (Diagnosis Codes) Enter one of the following: Y to indicate that the payer requires diagnosis codes. N to indicate that the payer does not require diagnosis codes. Lab Fac Enter the laboratory facility. Rad Fac Enter the radiology facility. Def Accpt Asgn This is Default Accept Assignment, the default assignment of benefits for the provider. Enter one of the following: Y to pay the provider. N to pay the guarantor. Def Deductible Enter the default deductible amount that must be met before benefits can be paid. Formulary Provider Enables you to add a formulary to the payer. Note Enter additional information, if needed. Cross-over If this check box is enabled, the payer is identified as a Medicare secondary automatic crossover payer if set up as secondary payer. The payer may also serve as the primary payer. Disable diagnosis claim break

Payers Master File for Dental Billing

Recommendations

Payers Master File for Dental Billing

Defaults-2 Tab

System Tab

Defaults-2 Tab

System Tab

Defaults 2 Sub-Tab

Payers Master File for Dental Billing

Payers Master File for Dental Billing

Defaults-2 Tab

System Tab

Defaults-2 Tab

System Tab

Defaults 2 Sub-Tab