Set Up Claim Modifiers for Behavioral Health Billing
Use the following procedure to set up a claim modifier for Behavioral Health SIM codes.
Access the Add/Modify Claim Modifiers window.
In the Modifier field, enter a two-character behavioral health modifier. This field is required and cannot be modified after the modifier is saved.
For example:
AF: Services provided by a Psychiatrist
AH: Services provided by a Psychologist
AJ: Services provided by a Licensed Clinical Social Worker
HQ: Services provided in a group setting
In the Effective Date field, enter a start date for the modifier. This field is required.
Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3.
In the Expiration Date field, enter an end date for the modifier. This field is required.
Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3.
In the Modifier Change for Claims field, select one of the following options to add or remove the modifier on claims. The modifier is added or removed when the claim is created during the billing process in NextGen® Enterprise PM.
<none>: Leave this field blank to include the modifier on the claim for charges that were entered with the modifier.
Add if <Credential>: Select this option to add the modifier to the claim for charges with a specific ICD code that are rendered by providers with a specific credential on the Credentialing tab on the Modify Provider Information window.
When selected, the Credential field and ICD Selection section become enabled.
In the Credential field, select the appropriate credentials for the modifier.
In the ICD Selection section, select the appropriate ICD codes for the modifier from the Available section on the left and then select the right arrow to move the ICD codes to the Included section on the right.
Note: The modifier is added to the claim only if the provider's credential is in effect (not expired) for the date of service on the charge
Add if <Department> on SIM: Select this option to add the modifier to the claim for charges with a SIM code assigned to a specific Department on the General tab of the Service Item Library Maintenance window.
When selected, the Departments field becomes enabled. Select the appropriate departments for the modifier.
Add if <Encounter in a Series>: Select this option to add the modifier to the claim for charges on encounters that fall within a specific series range. For example, entering a range of 1 to 3 adds the modifier to claims for the first three encounters in a series.
When selected, the Encounter in a Series fields become enabled. Enter the appropriate encounter from/to range for the modifier.
Add if <ICD> on Charge: Select this option to add the modifier to the claim for charges with a specific ICD code.
When selected, the ICD Selection section becomes enabled. Select the appropriate ICD codes for the modifier from the Available section on the left and then select the right arrow button to move the ICD codes to the Included section on the right.
Add if <Primary Credential> and <Other Credential>: Select this option to add the modifier to the claim for charges with a specific ICD code that are rendered by providers with a specific primary credential and other credential on the Credentialing tab of the Modify Provider Information window.
When selected, the Provider Primary Credential field, Provider Other Credential field and ICD Selection section become enabled.
In the Provider Primary Credential field, select the appropriate credential for the modifier.
In the Provider Other Credential field, select the appropriate credential for the modifier.
In the ICD Selection section, select the appropriate ICD codes for the modifier from the Available section on the left and then select the right arrow button to move the ICD codes to the Included section on the right.
Note: The modifier is added to the claim only if the provider's primary credential and other credential are both in effect (not expired) for the date of service on the charge.
Add if <Program>: Select this option to add the modifier to the claims for charges on encounters with a specific Program on the General tab of the Encounter Maintenance window.
When selected, the Program field becomes enabled. Select the appropriate programs for the modifier.
Add if <Provider Type>: Select this option to add the modifier to the claim for charges that are rendered by providers with a specific Provider Type on Practice tab of the Modify Provider Information window.
When selected, the Provider Type field becomes enabled. Select the appropriate provider types for the modifier.
Add if <Specialty> is Rendering: Select this option to add the modifier to the claim for charges that are rendered by providers with a specific specialty on the Practice tab of the Modify Provider Information window.
When selected, the Specialties field becomes enabled. Select the appropriate specialties for the modifier.
Remove: Select this option to remove the modifier from the claim for charges that were entered with the modifier.
In the SIM Type field, select Behavioral Health to indicate the modifier applies to SIM codes with Behavioral Health selected in the SIM Type field in the Service Items library. This field is required.
The Unit Value field defaults to 0 and is disabled when Behavioral Health is selected in the SIM Type field. This field does not apply to behavioral health modifiers.
In the Anesthesia Concurrency Functionality section, the Billing button is selected by default and should not be changed. This section applies to anesthesia modifiers only.
Do one of the following:
To add SIM codes for the modifier, search and select the codes from the Available section on the left, and then select the right arrow to move the codes to the Included section on the right.
To remove SIM codes from the modifier, select the codes from the Included section on the right, and then select the left arrow to move the codes to the Available section on the left.
To save changes and close the window, select OK.
Set Up Claim Modifiers for Behavioral Health Billing
