Set Up Contract Exceptions for Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Set Up the Contract Library for Courtesy Claims

Select the Contract Library that is associated with the payer. On the General tab of the Contract Library Maintenance window, enable the following check boxes: Prorate Insurance Balance Create Zero Dollar Claim Ensure that there is a detail record set up for the CPT4 for participating providers. Parent topic: Generating Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Entering a Courtesy Charge for a Claim

When you enter the charge for a courtesy claim, ensure that you are using the payer with the contract and contract exception on the encounter. Note: The rendering on the encounter is Non-Par, so the Benefits Not Assigned display in red bold text in the Verification section of the Encounter/Insurance tab on the patient's chart. In the charge window, the INS1 bucket is checked to bill and the full balance is in the Patient bucket. You can generate the claim immediately after the charge is entered by selecting on the Bill icon in the charge window. Parent topic: Generating Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Set Up Contract Exceptions for Courtesy Claims

To generate courtesy claims for a payer, access the Contract library list and right-click on the applicable payer and then select Contract Exceptions. The Contract Exception Maintenance window opens. Enter the name of the type of extension in the Contract Exception Name (required) field. In the exception, select the CPT4 code for generating a courtesy claim. Enter the full charge in the Allowed column. Enter the full charge in the Co-Pay Amount column. Note: For more information about setting up contract exceptions, go to NextGen Healthcare Success Community and download the latest File Maintenance Libraries Guide forNextGen® Enterprise. Parent topic: Generating Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Generating Courtesy Claims

A courtesy claim is a claim that you, the provider, does not submit to a payer (because you are non-par with the patient’s contract) for charges related to services you have rendered on the patient. It is a claim that you generate, but do not send. Instead, you give it to the patient so they can submit it. The example in this section shows how a courtesy claim can be generated. This example assumes that some providers in your office are par with the contract and the services are to be billed. Set Up the Payer Master Set Up the Contract Library for Courtesy Claims Set Up Contract Exceptions for Courtesy Claims Entering a Courtesy Charge for a Claim Parent topic: Generating and Submitting Claims

Help Guide for NextGen® Enterprise PM 8

Set Up the Contract Library for Courtesy Claims

Select the Contract Library that is associated with the payer. On the General tab of the Contract Library Maintenance window, enable the following check boxes: Prorate Insurance Balance Create Zero Dollar Claim Ensure that there is a detail record set up for the CPT4 for participating providers. Parent topic: Generating Courtesy Claims

Help Guide for NextGen® Enterprise PM 8

Contracts Library

Contracts can be set up for payers to indicate: The amount you expect to be reimbursed for procedures. When an authorization is required. When a referral is required. Other contract specific items, for example, the ability to send $0.00 claims such as capitated with contracts, you can: Attach payers to the contract. Create contract subgroupings for reporting purposes. For more information on contract subgrouping, go to NextGen Healthcare Success Community and download the latest File Maintenance Libraries Guide for NextGen® Enterprise, and refer to the Contract Subgrouping section. Access Contract Library Maintenance You can use the Contract Library Maintenance window to create contract defaults, co-payments, deductibles, physician referrals and authorizations. Set Up a Fee Schedule for Contract Payers The fee schedule enables you to indicate the amount that you expect to be reimbursed for specific procedures that fall outside of the contract defaults. Add or Modify Contracts Contract

Set Up Contract Exceptions for Courtesy Claims

Recommendations

Set Up the Contract Library for Courtesy Claims

Entering a Courtesy Charge for a Claim

Set Up Contract Exceptions for Courtesy Claims

Generating Courtesy Claims

Set Up the Contract Library for Courtesy Claims

Contracts Library

Set Up Contract Exceptions for Courtesy Claims

Set Up the Contract Library for Courtesy Claims

Entering a Courtesy Charge for a Claim

Set Up Contract Exceptions for Courtesy Claims

Generating Courtesy Claims

Set Up the Contract Library for Courtesy Claims

Contracts Library