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NextGen Behavioral Health Suite Help 5.5

Service Code Grouping

The Grouping functionality in the Service Code Mapping panel enables your practice to automatically group service codes for the same patient, same day, and same service code to submit on one encounter. For some programs, it is common to meet with a client multiple times a day. Each interaction is documented on a separate encounter and charges are submitted on that encounter. Some payers require that a service code only be submitted on one encounter per day for the client. When mapping service codes, you can select the Grouping checkbox to group the service codes on one encounter. The charges automatically are grouped on the first encounter for submission and the staff does not need to manually move the service codes from one encounter to another. When you configure a charge for service code mapping for SIM Grouping on the BH Foundation Configuration template and the charge is grouped into the first encounter instance of that service for that client for that date of service, a Y indicat

NextGen Behavioral Health Suite Help 5.5

Configure Service Code Mapping

The fields across the top of the Service Code Mapping panel correspond directly with the data grid. For service code mapping, you must fill all the fields except Practice, Program, and Location. Open NextGen® Enterprise EHR. Select File > System \ Practice Template. The Select Template window opens and displays the system-related templates. Select the Practice tab, and then select All to display all the practice templates. Select BH Foundation Configuration, and then select OK. In the BH Foundation Configuration template, expand the Service Code Mapping panel. Service Code Mapping panel displaying the list of configured codes To map a code to a specific practice, select a practice. Note: If the code you are mapping is not practice-specific, leave this field blank. To map a code to a specific contract or payer, select Contract/Payer, and then select the payer or contract. Note: The displayed list pulls data from either the Contract library or the Payers master file in File Maintenance.

NextGen Behavioral Health Suite Help 5.5

Service Code Mapping

Service code mapping is a core component of Behavioral Health billing on BH templates for version 3.5 and above. Service codes can be mapped by practice, billing contract or payer, location, and program, credentials, templates, and threshold durations. This mapping promotes cleaner billing on the front end by limiting staff to only the approved codes for their credential level, location, or program. Since codes can be mapped to individual BH templates, this gives you the added ability to map only those codes appropriate for a workflow. For example, the Progress Note template may only have codes mapped to it that are appropriate for this type of activity and then can be further limited by the credential level of the staff member completing the template. The fields across the top of the Service Code Mapping panel correspond directly with the data grid below it. For example, when you select the field directly above the Practice column, the Practice picklist appears. The Practice, Program,

File Maintenance Help for NextGen® Enterprise 8

Service Item Library Maintenance Qualifying Encounter Descriptions

Use the following table when setting up your qualifying SIMs. Field Description Qualifying Encounter for All Payers Select this check box if the SIM code is considered a face-to-face encounter with a qualified provider for patients with insurance and it should be counted as a Health Center "qualifying encounter". Note: The check box available only if the Enable Qualifying Encounter Billing check box is selected in Practice Preferences > Claims. Self Pay Qualifying Encounter Select this check box if the SIM code is considered a face-to-face encounter with a qualified provider for patients with no insurance and it should be counted as a Health Center "qualifying encounter". Note: The check box available only if the Enable Qualifying Encounter Billing check box is selected in Practice Preferences > Note: Claims. Sliding Fee Qualifying Encounter Select this check box if the SIM code is considered a face-to-face encounter with a qualified provider for patients on a sliding fee schedule and

NextGen® Adaptive Content Engine Help Enterprise 8

Determining the Correct Service Code

Determining the Correct Service Code Determining the Correct Service Code In run time, the stored procedure associated with the Service Code Mapping template runs when the Service performed by check box is selected in the Behavioral health billing section. The system performs one or more of the following actions based on the information documented in the encounter and the code's configuration on the Service Code Mapping system template: Populates the Service description and Service code fields Displays an alert if an E&M code or any additional code is required Launches the Bh Coding Select template if multiple codes are returned Sends start/stop times to the procedure module for codes configured as a time based Once the charges are submitted to the Superbill module, the service code information is sent to NextGen® Enterprise PM. NextGen Enterprise PM uses the submitted data to determine if the total of the duration times can be rolled up into a single line item charge. Templates with t

NextGen Behavioral Health Suite Help 5.5

Submit a Charge for Group Visit

Use the Charges panel to bill for services rendered during the encounter. From the Group section of the Charges panel, enter the Start time and End time for the group. To carry the Start time and End time forward to each client, select Copy Forward. From the Individual section of the Charges panel, make any updates to the Start Time and End Time specific to the client. For example, if the Group Start time was 6:00 PM but the client arrived at 6:10 PM, you can update the Individual Start Time to 6:10 PM. Note: If the end time is earlier than the start time, an Alert appears prompting you to re-enter the start/stop time. This also occurs if the total duration is more than 12 hours. Select the Service Code field and then select a service code. The Units field display based on the service code selected. Note: Service codes, units, and duration are configured in the Service Code Mapping panel on the BH Foundation Configuration template. If any of these fields are blank, the selected code ma

Return SIMs for the 1st Payer Match

Recommendations

Service Code Grouping

Configure Service Code Mapping

Service Code Mapping

Service Item Library Maintenance Qualifying Encounter Descriptions

Determining the Correct Service Code

Submit a Charge for Group Visit