Set Up Payers for Roll-Up Billing by CPT4 Code

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Codes for Roll-Up Billing by CPT4 Code

To set up a SIM code for roll-up billing by CPT4 code, do the following: Access File Maintenance. Select Libraries, and then Service Items. The Service Items List window opens. From the list, select a library and then select Open Menu and select Open. The Service Item Library Maintenance window opens. Do one of the following: To add a SIM code, select Open Menu and select New. To modify a SIM code, search for the code and then select the code from the list on the left. Select the General tab. Each SIM code that is to roll-up to a single line item on the claim must have the following parameters defined. Revenue Code: Select the appropriate revenue code for UB/837I claims. This is the default revenue code for all UB payers. If the roll-up payer requires a different revenue code, the Alt Rev code must be defined on the Payer tab for the roll-up payer. Form: Select 1500. This is the default type of form for all payers. If the roll-up payer requires a different form (e.g. UB), additional se

Help Guide for NextGen® Enterprise PM 8

Set Up CPT4 Codes for Roll-Up Billing

Verify that the appropriate CPT4 codes exist that are needed on UB claims in Field Locator 44 for the roll-up payer. The CPT4 codes are linked to SIM codes as the Alternate CPT4 in the SIM library. To set up a CPT4 code for roll-up billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then CPT4 Codes. The CPT4 Code Search window opens. Do one of the following: To add a CPT4 code, select Open Menu and select New. To modify a CPT4 code, search for the code, then select the code from the list, and then select Open Menu and select Open. The Add/Modify CPT4 Code Information window opens. In the Code field, enter the CPT4 code. This field is required. In the Description field, enter a descriptive name for the code. This field is required. In the Type of Service field, select Medical Care. To save changes and close the window, select OK. Parent topic: Setting Up Roll-Up Billing by CPT4 Code

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code requires specific settings in the Payers master file. Each payer that is to roll-up to a single CPT4 code line on the claim must have the CPT on Rev Code Roll-up option selected so that the CPT4 code appears in Field Locator 44 on UB claims. Also, the Ignore modifiers on roll-up option must be selected so that modifiers entered on charges are ignored for the roll-up. To set up a payer for roll-up billing by CPT4 code, do the following: Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. Do one of the following: To add a payer, select Open Menu and select New. To modify a payer, select the payer from the list, and then select Open Menu and select Open. The Add/Modify Payer Information window opens. Select the Defaults-2 tab. Select the CPT on Rev Code Roll-up check box. Add Payer Information Select the Practice tab, and then select the Other sub-tab. Select the Ignore modifiers on roll-up check box. To

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code requires a specific setting in the Payers master file. Each payer that is to roll-up to a single revenue code line on the claim must have the Ignore modifiers on roll-up option selected so that modifiers entered on charges are ignored for the roll-up. To set up a payer for roll-up billing by revenue code, do the following: Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. Do one of the following: To add a payer, select Open Menu and select New. To modify a payer, select the payer from the list, and then select Open Menu and select Open. The Add/Modify Payer Information window opens. Select the Practice tab, and then select the Other sub-tab. Select the Ignore modifiers on roll-up check box. To save changes and close the window, select OK. Parent topic: Setting Up Roll-Up Billing by Revenue Code

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code requires a specific setting in the Payers master file. Each payer that is to roll-up to a single revenue code line on the claim must have the Ignore modifiers on roll-up option selected so that modifiers entered on charges are ignored for the roll-up. To set up a payer for roll-up billing by revenue code, do the following: Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. Do one of the following: To add a payer, select Open Menu and select New. To modify a payer, select the payer from the list, and then select Open Menu and select Open. The Add/Modify Payer Information window opens. Select the Practice tab, and then select the Other sub-tab. Select the Ignore modifiers on roll-up check box. Modify Payer Information To save changes and close the window, select OK. Parent topic: Setting Up Roll-Up Billing by Revenue Code

Help Guide for NextGen® Enterprise PM 8

Set Up CPT4 Codes for Roll-Up Billing

Verify that the appropriate CPT4 codes exist that are needed on UB claims in Field Locator 44 for the roll-up payer. The CPT4 codes are linked to SIM codes as the Alternate CPT4 in the SIM library. To set up a CPT4 code for roll-up billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then CPT4 Codes. The CPT4 Code Search window opens. Do one of the following: To add a CPT4 code, select Open Menu and select New. To modify a CPT4 code, search for the code, then select the code from the list, and then select Open Menu and select Open. The Add/Modify CPT4 Code Information window opens. In the Code field, enter the CPT4 code. This field is required. In the Description field, enter a descriptive name for the code. This field is required. In the Type of Service field, select Medical Care. To save changes and close the window, select OK. Add CPT4 Code Information Parent topic: Setting Up Roll-Up Billing by CPT4 Code

Set Up Payers for Roll-Up Billing by CPT4 Code

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