Practice Preferences for Setting Libraries Linked to Payers

Field	Description
Diagnosis Codes Library	Select a library to create a subset of the full International Classification of Diseases - Clinical Modification (ICD-CM) list to simplify the coding process. You can add frequently used codes to a library.
Service Items Library	Select a library containing the services performed by the practice. Each service or SIM code includes defined parameters that affect charge posting, billing, claims, and reports in NextGen® Enterprise PM.
Claim Modifiers Library	Select a library to override the default Claim Modifiers library selected in practice preferences.
NDC Library	Select a library to create a National Drug Code (NDC) drug product list to help you manage the billing for drugs prescribed in the clinic.
Claim Edits Library	Select a library to override the default Claim Edits library selected in the practice preferences for libraries.
Self-Pay SIM Exception	Select a library that is applicable at the practice and location levels to use for self-pay encounters when patients have no insurance.
Eligibility Profile Library	Select a library to set up rules to automatically complete the required fields and additional data for the batch mode that you manually enter when checking eligibility status in real time.
Behavioral Health Billing Library	Select a library to use when no specific Behavioral Health Billing library is defined at the payer level.
Claim Print Library	Select a library to configure settings that determine the information printed on claim forms. You must create and associate a Claim Printing library with a practice at the practice preference level to generate a paper claim.
Remittance Profile Library	Select a library that is applicable to all electronic remittance advice (ERA) payers within the practice. This library defines ERA import profiles in the remittance profiles, ensuring that your system accurately interprets the ERA information received from payers or clearinghouses, where applicable.
Claim Status Profile Library	Select a library for submitting claim-status inquiries and setting rules for automatically filling in the necessary fields and additional data for batch mode processing.
Non-Coordinated SIM Library	Select a library to set up billing rules for payer-specific service items. This includes service items that are only reimbursed by specific payers, such as a state plan, special grant program, or Medicaid, which is not reimbursed if billed to other payers.
Anesthesia Library	Select a library to define rules that apply to different types for payers: specific payers, all payers, and self-payers.
Consolidated Services Claim	Select a library to select the Consolidated Services Claim (CSC) to combine eligible claims automatically.
Institutional Billing Library	Select a library to set the payer-specific and claim rules. If you do not select a library, legacy Uniform Billing (UB) logic is used in NextGen® Enterprise PM.
EDI Claim Profile Library	Select a library to provide support for the 2400 loops and segments requested by payers when the 2300 loop details are different per charge or the same per charge.
Service Package Library	Select a library to define various sets of packaged services that payers authorize for patients. Each service package includes groupings of specific CPT4 code and modifier combinations with defined service unit limitations.
Service Swap Library	Select a library to dynamically swap SIM codes based on programs, payers, and service items to optimize reimbursement without changing charge amounts on claims for secondary and tertiary payers.

File Maintenance Help for NextGen® Enterprise

Practice Preferences for Setting Libraries Linked to Payers

You can select the default libraries that your practice uses. The selected libraries apply to all payers that do not have a different library assigned at the payer level. You can override these practice-level default libraries by selecting different libraries for specific payers. The following libraries are available at the practice level only, and you cannot select and override library at the payer level: Anesthesia Consolidated Services Claim Institutional Billing NDC Non-Coordinated SIM Service Package . Field Description Diagnosis Codes Library Select a library to create a subset of the full International Classification of Diseases - Clinical Modification (ICD-CM) list to simplify the coding process. You can add frequently used codes to a library. Service Items Library Select a library containing the services performed by the practice. Each service or SIM code includes defined parameters that affect charge posting, billing, claims, and reports in NextGen® Enterprise PM. Claim Modif

File Maintenance Help for NextGen® Enterprise 8

Libraries Practice Preferences Descriptions

Default Libraries Select the following libraries for the practice as needed. Diagnosis Code Library: Select the Diagnosis Codes library to be used in the practice. Service Item Library: Select the Service Items library to be used in the practice. Claim Modifiers Library: Select the default Claim Modifiers library to be used for all payers in the practice, if applicable. Payer-specific libraries are linked to the payer in the Payers master file Practice tab > Libraries sub-tab. NDC Library: Select the NDC library to be used in the practice. Claim Edits Library: Select the default Claim Edits library to be used for all payers in the practice. Payer-specific libraries are linked to the payer in the Payers master file > Practice tab > Libraries sub-tab. Self Pay SIM Exception: Select the SIM Exception to be used for all self-pay patients in the practice, if applicable. Eligibility Profile Library: Select the default Eligibility Profiles library to be used for all RTS payers in the practice

File Maintenance Help for NextGen® Enterprise

Libraries

NextGen® Enterprise PM provides some default libraries. These libraries are a subset of preloaded code sets or diagnosis codes. You can select the codes for your practice or enterprise and set them up in a library. Multiple practices in an enterprise can subscribe to an existing library instead of each practice setting up a new library that contains the same information. You can print a list of the libraries by selecting the open menu button , then select Print. The report filter for the library opens. Select your report settings, and then select OK. A Diagnosis Code Library is a subset of the full ICD9CM list in master files. This subset can simplify the selection and maintenance of codes. Open the Libraries You can use the libraries in File Maintenance for default settings and user-defined data. Default Practice Libraries You can set some libraries as default libraries to be used by a practice. Copy Libraries If you have a library with similar records, you can copy the original libra

Help Guide for NextGen® Enterprise PM 8

Anesthesia Library

The Anesthesia library is used by practices that do Anesthesia Concurrency Billing in NextGen® Enterprise PM. It is not typically used by practices using Basic Anesthesia Billing. The Anesthesia library enables you to define rules that apply to specific payers only, rules that apply to all other payers, and rules that apply to self-pay. Each set of rules may include one or more of the following: Medical Direction: These rules determine whether modifiers are added to charges based on the level of medical direction and whether charges will split between Medical Directors and CRNAs. Concurrency Rules: These rules define specific parameters, such as the maximum number of concurrent procedures allowed, whether a Medical Director can perform and direct at the same time, and split-charge percentages for Medical Directors vs CRNAs. Claim Options: These rules define specific claim parameters, such as whether or not surgical procedure codes are included on claims, and how claims break by renderi

Help Guide for NextGen® Enterprise PM 8

Claim Modifiers Library

The Claim Modifiers library can be used by practices when the modifier usage differs from payer to payer. During charge posting, add units to a charge when a specific modifier is entered on the charge for specific SIM types. During the billing process, add a modifier to the claim if the modifier was not entered on the charge. During the billing process, remove a modifier from the claim if the modifier was entered on the charge. Note: For a claim modifier to be applied, the charge service date must fall within the effective date and expiration date defined for the modifier, and the charge must meet all Modifier Change for Claims criteria defined for the modifier. The practice-level default Claim Modifiers library selected in Practice Preferences > Libraries is used for all payers. A payer-level library selected in the Libraries sub-tab under the Practice tab in the Payers master file overrides the practice-level library for that payer. You can generate Claim Modifiers report from the Cl

File Maintenance Help for NextGen® Enterprise 8

Libraries Practice Preferences

The Libraries Practices Preferences enable you to select default libraries used by the practice. The selected libraries apply to all payers that do not have a different library assigned at the payer level. You can override these practice-level default libraries by selecting different libraries for specific payers. Note: The following libraries are available at the practice-level only, and you do not have the option of selecting an override library at the payer-level: Anesthesia, Consolidated Services Claim, Institutional Billing, NDC, Non-Coordinated SIM and Service Package. Libraries Practice Preferences Descriptions Parent topic: Practice Preferences

Practice Preferences for Setting Libraries Linked to Payers

Recommendations

Practice Preferences for Setting Libraries Linked to Payers

Libraries Practice Preferences Descriptions

Libraries

Anesthesia Library

Claim Modifiers Library

Libraries Practice Preferences

Practice Preferences for Setting Libraries Linked to Payers

Libraries Practice Preferences Descriptions

Libraries

Anesthesia Library

Claim Modifiers Library

Libraries Practice Preferences