Map Payers to Performing Entities

NextGen® Enterprise EHR Help

Defining Payer Carve Out

The Payer Carve Out function associated with the Orders module allows you to map payers to performing entities. The default value for new orders is the performing test entity. When you create a new order, the system looks at the insurance (payer) for that order. From the insurance, it finds the performing entity, which is set up in File Maintenance from the Orders module tab on the Payers window. If the performing entity is set for that insurance, then the order is created for this performing entity. You need to set up different performing entities for Lab orders and Radiology orders. Note: Payer carve outs override the practice's default performing entity. For example, if you normally use Labcorp for your tests, but in your state Blue Cross requires you to use Quest Diagnostics, you can make this payer carve out for Blue Cross and leave Labcorp as your default testing entity for all other insurers. The next time a new order is created for this payer, the default value for the order is

NextGen® Enterprise EHR Help

Map Payers to Performing Entities

When a performing entity is set for a payer, then the order is created for that performing entity. Open File Maintenance. Select System > Payers.The Payers List window opens. Select an insurance from the list of available payers.The Modify Payer Information window for the selected payer opens. Select Order Module. In the Preferred Performing Entities section, select corresponding to either Lab or Radiology.The Map Payers to Performing Entities window opens. Select to select a performing entity from the System list in the left pane. Select the right-arrow to move the selected entity to the Included pane on the right. Select OK. The selected performing entity appears in the Preferred Performing Entities section on the Modify Payer Information window of the selected payer. Select OK to save the value and exit the Modify Payer Information window. Parent topic: Defining Payer Carve Out

NextGen® Enterprise EHR Help

Defining Payer Carve Out

The Payer Carve Out function associated with the Orders module allows you to map payers to performing entities. The default value for new orders is the performing test entity. When you create a new order, the system looks at the insurance (payer) for that order. From the insurance, it finds the performing entity, which is set up in File Maintenance from the Orders module tab on the Payers window. If the performing entity is set for that insurance, then the order is created for this performing entity. You need to set up different performing entities for Lab orders and Radiology orders. Note: Payer carve outs override the practice's default performing entity. For example, if you normally use Labcorp for your tests, but in your state Blue Cross requires you to use Quest Diagnostics, you can make this payer carve out for Blue Cross and leave Labcorp as your default testing entity for all other insurers. The next time a new order is created for this payer, the default value for the order is

NextGen® Enterprise EHR Help

Configure Performing Entity for Location Preferences

You can configure the location preference settings for both laboratory and radiology order items for a selected location. Open File Maintenance. From Master Files, select EHR, and then select Locations. The Locations List window opens. Double-click a location. The Location Information window opens. Select the Order Module tab. To display the laboratory or radiology performing entities, select the details icon in the Selected Performing Entities section. The Performing Entities window opens. To add and remove the laboratory and radiology performing entities, use the right and left arrow icons. Select OK. The Selected Performing Entities list is applicable for both the Preferred Performing Entity and In-House Performing Entity lists. If you change a value in Selected Performing Entities, the change also appears in In-House Performing Entity with a notification. If there are no Selected Performing Entities at the location level, the system uses the selected performing entities set at the

NextGen® Enterprise EHR Help

Configure Performing Entity for Location Preferences

You can configure the location preference settings for both laboratory and radiology order items for a selected location. Open File Maintenance. From Master Files, select EHR, and then select Locations. The Locations List window opens. Double-click a location. The Location Information window opens. Select the Order Module tab. To display the laboratory or radiology performing entities, select the details icon in the Selected Performing Entities section. The Performing Entities window opens. To add and remove the laboratory and radiology performing entities, use the right and left arrow icons. Select OK. The Selected Performing Entities list is applicable for both the Preferred Performing Entity and In-House Performing Entity lists. If you change a value in Selected Performing Entities, the change also appears in In-House Performing Entity with a notification. If there are no Selected Performing Entities at the location level, the system uses the selected performing entities set at the

NextGen® Enterprise EHR Help

Configure Performing Entity for Practice Preferences

You can configure the Practice Preferences settings for both laboratory and radiology order items for a selected practice. Open File Maintenance. Under Master Files, select EHR, and then select Practices. The Practices List window opens. Double-click a practice name. The Modify Practice Information window opens. Select Preferences. The Practice Preferences window opens. Under Preference List, select Orders Module. Select the Lab/Rad tab. To display the laboratory or radiology performing entities, select the details icon in the Selected Performing Entities section. Note: The Selected Performing Entities list is applicable to both the Preferred Performing Entity and In-House Performing Entity lists. If you change a value in Selected Performing Entities, the new value also appears in In-House Performing Entity with a notification. The Performing Entities window opens. To add and remove the laboratory and radiology performing entities, use the right and left arrow icons. Select OK. Select

Map Payers to Performing Entities

Recommendations

Defining Payer Carve Out

Map Payers to Performing Entities

Defining Payer Carve Out

Configure Performing Entity for Location Preferences

Configure Performing Entity for Location Preferences

Configure Performing Entity for Practice Preferences

Map Payers to Performing Entities

Defining Payer Carve Out

Map Payers to Performing Entities

Defining Payer Carve Out

Configure Performing Entity for Location Preferences

Configure Performing Entity for Location Preferences

Configure Performing Entity for Practice Preferences