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

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

NextGen® Enterprise EHR Help

Select Performing Entity

Before you begin Ensure that you have configured the performing entities in File Maintenance. For more information, see Configure Performing Entity for Preferences and Configure Performing Entity for Location Preferences. You can select performing entities for laboratory and diagnostic order items. Open NextGen® Enterprise EHR and select a patient from Patient Lookup window. Open CPOE. Open the COMMON ORDERS, SEARCH RESULTS, or FAVORITES list. From the Performing Entity list, select the performing entities under Laboratory Performing Entity and Diagnostic Performing Entity. The order items that the selected performing entities support, appear. Parent topic: Managing Lab Orders and Immunizations Related tasks Configure Performing Entity for Practice Preferences Configure Performing Entity for Location Preferences Select Order Items from Favorites Search for Orders Items Select Common Orders

NextGen® Enterprise EHR Help

Set Up Practice Preferred Performing Entities

Using File Maintenance Practice Preference settings, you can select a default value for the performing entity to use for both lab tests and radiology orders for a selected practice. You can also set up In-House Performing Entity by which the laboratory and diagnostic order items mapped to this entity are displayed in the list of Common Orders in NextGen® Enterprise CPOE. Select File Maintenance > System > Practices. Select a practice. Select Preferences. Select Order module in the Preference List. To display the Lab or Radiology performing entities, select the Open Record button. The list of performing entities appears. Using the right and left arrows, select the Lab and Radiology performing entities. In the Performing Entities window, select OK. Select the Lab Preferred Performing Entity and the In-House Performing Entity from the list. Select the Radiology Preferred Performing Entity and the In-House Performing Entity from the list. Select OK to save your preferences. Note: You can a

NextGen® Enterprise EHR Help

Set Up Performing Entities for Locations

You can set up preferred performing entities for your locations. Select File Maintenance > System > Locations. Access the Location Information window for the appropriate location, by one of the following methods: Double-click the location. Select the location, select the Open Menu button, and then select Open. Select Orders Module. The Location Information window opens. Note: If you have set up performing entities for the practice (in Practice Preferences), they appear in the Selected Performing Entities sections under Lab and Radiology. You can further filter this list when selecting the performing entities for the location. In the Lab or Radiology (Selected Performing Entities) section, select the Open Record button. Using the right or left arrows, select or de-select the appropriate performing entities and select OK. The selected performing entities appear. From the Preferred Performing Entity list, select a performing entity. From the In-House Performing Entity list, select an in-h

Map Payers to Performing Entities

Recommendations

Defining Payer Carve Out

Configure Performing Entity for Location Preferences

Configure Performing Entity for Practice Preferences

Select Performing Entity

Set Up Practice Preferred Performing Entities

Set Up Performing Entities for Locations

Defining Payer Carve Out

Configure Performing Entity for Location Preferences

Configure Performing Entity for Practice Preferences

Select Performing Entity

Set Up Practice Preferred Performing Entities

Set Up Performing Entities for Locations