Configure Service Item Library for CPT II Claims-Based Reporting

NextGen® Adaptive Content Engine Help Enterprise 8

Configuring Settings for CPT II Claims Based Reporting

You can enable the CPT II reporting feature by configuring a set of prerequisites. You must complete the following common configurations to enable CPT II code claims-based reporting. Download the latest CPT code set. For more information about downloading the latest CPT code set, go to NextGen Healthcare Success Community, and download the latest CPT4 Utility Guide forNextGen®Enterprise. Configure each CPT II code in Service Item Library Maintenance to enable the submission of a $0 charge claim. Review the mapping or add additional measures on the Coded Results Mapping template. Configure and assign measures to providers on the Provider CQM Maintenance template. Configure CPT II codes for claims-based reporting in Service Item Library. After you complete the required configurations, you must complete the configurations specific to the CPT II code submission option (manual or automated) that your practice uses. See the corresponding section in this document for the remaining configurati

Help Guide for NextGen® Enterprise PM 8

Set Up the Service Item Library

In Libraries, select Service Items. Double-click on the applicable Service Item Library or select open menu button, and then select New. The Service Item Library Maintenance window opens. Complete the fields to set up the library. Service Item Library Maintenance Field Descriptions You can set up your Service Item Library by setting up CPT4 codes for each practice, along with the prices and claims. Parent topic: Service Items Library

NextGen® Enterprise EHR Help

Add SIM Items to a SIM Library

After you have created a SIM library, you need to add service items and pricing information to the library. Select File Maintenance > Libraries > Service Items. From the Service Items List window, select the library to update. The Service Item Library Maintenance window opens. Select the open menu and select New. The three service item fields turn red. In the CPT4 Code field, enter a CPT4® code from your list of service items and then select Enter. The details for that CPT4® Code appears. In the General tab, do the following: In Eff Date, enter the effective date. In Exp. Date, enter the expiration date. In Non-Facility Price, enter the non-facility price in dollars. In Facility Price, enter the facility price in dollars. If you have more items to add, select Enter and repeat steps 4 to 6 for all service items you wish to add. Select OK when you are finished adding all your service items. The service items that you added display in the left panel. Parent topic: Using Advanced Service I

NextGen® Adaptive Content Engine Help Enterprise 8

Configuring Claim Edits for CPT II Claims-Based Reporting

You must configure the claim edits from the Claims Edit Library for CPT II codes. For payers who require a diagnosis code on the CPT II code, you must activate one of the following claim edits in the Claim Edits Library in NextGen® Enterprise PM: 91-Charge Primary Diagnosis 117-CPT4(S) required specific Diagnosis Code(s) For more information about Claim Edit Library, go to NextGen Healthcare Success Community, and download the latest Claims Guide for NextGen® Enterprise PM. Submitting Procedure Coded Measures You can select and submit a procedure code to satisfy a claims-based measure. Parent topic: Manually Submitting CPT II Codes for Claims-Based Reporting

NextGen® Enterprise EHR Help

Verify the CPT4 Code in the Service Item Library

Prior to selecting and ordering Immunizations, verify the CPT4® in the SIM Library. Select File Maintenance > Libraries > Service Items. The Service Items List window opens. Double-click the default Service Item Library for your practice. Note: The default Service Item Library is indicated by a green color check mark under the Practice Default column. Enter the CPT4® code in the Search field. If the code exists, it appears in CPT4 Code. To verify if your alternate Medicare Billing code exists, enter the Q code in the Search field. Note: If the CPT4® code or Q code does not exist, you must set up the Service Item Library. For more information about setting up the Service Item Library, go to the NextGen Healthcare Success Community and download the latest System Administrator Guide for NextGen Enterprise. Parent topic: Using Advanced Service Item Library Mode

File Maintenance Help for NextGen® Enterprise 8

Service Items Library

The Service Items library is the center of the billing functions. Within the Service Items library you can set up CPT4 codes for each practice, along with prices, and claim form designations. You can also group Service Items together under one main number or name. Libraries are available enterprise-wide, but each practice must designate which Service Items library to use by selecting it in the Libraries Practice Preferences. You can generate the Service Item Library Listing report from the Service Items library. For more information go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Set Up the Service Item Library You can set up your Service Item Library by setting up CPT4 codes for each practice, along with the prices and claims. General Tab Other Tab - SIM Library Payer Tab - SIM Library Labels Tab - SIM Library Notes/Significant Events Tab - SIM library Drugs Tab - SIM library Add a New Service Item Editing the Provider

Configure Service Item Library for CPT II Claims-Based Reporting

Recommendations

Configuring Settings for CPT II Claims Based Reporting

Set Up the Service Item Library

Add SIM Items to a SIM Library

Configuring Claim Edits for CPT II Claims-Based Reporting

Verify the CPT4 Code in the Service Item Library

Service Items Library

Configuring Settings for CPT II Claims Based Reporting

Set Up the Service Item Library

Add SIM Items to a SIM Library

Configuring Claim Edits for CPT II Claims-Based Reporting

Verify the CPT4 Code in the Service Item Library

Service Items Library