Assign Default SIM Pricing Region Libraries to Payers

File Maintenance Help for NextGen® Enterprise 8

Advanced Service Item Library Mode

When you need to maintain pricing for several locations that are grouped into different regions, the Enable Advanced Service Item Library Mode allows you to set pricing based on how various payers divide the country into geographical regions. For example, Medicare has different regional groupings than Aetna, and pricing would be determined accordingly. With Enable Advanced Service Item Library Mode, you can also use SIM Pricing Templates to manage prices in the Service Item libraries. Note: Once you enable Advanced Service Item Library Mode, you cannot disable it. You can create a SIM Pricing Regions Library to support setting prices based on geographical regions that may vary by payer. For more information on SIM Pricing Regions Library see, File Maintenance Libraries Guide for NextGen® Enterprise. You can assign default pricing regions for the enterprise and payers by setting up additional pricing in the Service Items library for claim printing. You can assign permissions in the Syst

File Maintenance Help for NextGen® Enterprise 8

SIM Pricing Regions Library

The SIM Pricing Regions library enables you to set prices based on geographical regions that vary by payer. The library contains a group of pricing regions, the Service Item library for each pricing region, and the specific locations that belong to each pricing region. After you set up the library, you can attach it to: A payer in the Payers master file > Payer Defaults - 1 tab > Pricing Regions Library field. Enterprise Preferences > Libraries tab > Default Pricing Region Library field. Enterprise Preferences > Libraries tab > Pricing Region Library for Self Pay field NextGen® Enterprise PM determines the SIM library to use based on the following conditions: If the encounter has a payer, then it uses the SIM Pricing Regions Library specified in the Payer master file. If the encounter has a payer with no pricing region selected (the Pricing Regions Library field in the Payer master file > Payer Defaults-1 tab is blank), then it uses the library specified in the Enterprise Preferences >

NextGen® Enterprise EHR Help

Using Advanced Service Item Library Mode

The Advanced Service Item Library Mode feature provides the ability to set pricing for tests and services based on how various payers divide the country into geographical regions. If you need to set up test pricing for your practice that is based on regions, the Advanced Service Item Library Mode is the way to accomplish this. You can set prices by configuring locations into payer centric groupings. As an example, Medicare may have different regional groupings than Aetna, and pricing is determined accordingly. In addition, the concept of SIM Pricing Templates was introduced to support the management of prices using parent/child relationships between libraries.If you do not need to set up payment based on pricing regions, do not use this parameter. Advanced Service Item Library Mode implementation in the Orders module uses File Maintenance, master files and libraries to assign a SIM code to a lab order test specimen charge. It does not allow you to assign the library at the same time be

File Maintenance Help for NextGen® Enterprise 8

Select a Default SIM Pricing Region Library for an Enterprise

The system uses a pricing region associated with the enterprise only when there is no pricing region associated with the payer or if the encounter is self pay. Access the Enterprise Preferences > Libraries tab. Select a default region in the following fields: Pricing Region Library for Self Pay field – The system uses this pricing region if an encounter is self-pay and, therefore, has no payer. Default Pricing Region Library field – The system uses this pricing region if the encounter has a payer but no pricing region is selected for the payer (the Pricing Regions Library field in the Payer master file > Payer Defaults-1 tab is blank). This pricing region is also used when the Pricing Region Library for Self Pay field is blank. Select OK. Parent topic: SIM Pricing Regions Library

File Maintenance Help for NextGen® Enterprise 8

Set Up a SIM Pricing Region

Create a Service Item library to use with the SIM Pricing Region Library. In the Libraries list, select SIM Pricing Region. The Pricing Regions Library List window opens. Select open menu button , and then select New. The Add Pricing Regions Library window opens. Enter a name in the Pricing Regions Library Name field. Select open menu button , and then select New. The Add Pricing Region window opens. Note: When you modify an existing region, the name of the window will be Pricing Regions Library Maintenance. Enter a name in the Pricing Region Description field, and then select a SIM library to use for the pricing region. Select open menu button , and then select New. The Add Pricing Region Location window opens. Select a location, and then enter the effective and expiration dates that control when the pricing region can use the location. Note: You cannot attach the same location to multiple pricing regions if the effective and expiration date time periods overlap. The effective and exp

NextGen® Enterprise EHR Help

Enable Advanced Service Item Library Mode

When you Enable Advanced Service Item Library Mode it turns on all enterprise-wide features that allow you to set prices by configuring locations into payer-centric groupings. CAUTION: Once you select the Enable Advanced Service Item Library Mode check box, you cannot disable it. Select File Maintenance > Master Files > System > Enterprises. The Enterprises List window opens. Double-click an enterprise in the list. The Modify Enterprise Information window opens. Select Preferences. The Enterprise Preferences window opens. Select the Libraries tab, and then select Enable Advanced Service Item Library Mode check box. Select OK to close the Enterprise Preferences window. Select OK to close the Modify Enterprise Information window. Parent topic: Using Advanced Service Item Library Mode

Assign Default SIM Pricing Region Libraries to Payers

Recommendations

Advanced Service Item Library Mode

SIM Pricing Regions Library

Using Advanced Service Item Library Mode

Select a Default SIM Pricing Region Library for an Enterprise

Set Up a SIM Pricing Region

Enable Advanced Service Item Library Mode

Advanced Service Item Library Mode

SIM Pricing Regions Library

Using Advanced Service Item Library Mode

Select a Default SIM Pricing Region Library for an Enterprise

Set Up a SIM Pricing Region

Enable Advanced Service Item Library Mode