NextGen Knowledge Center

Assigning Exceptions for the Provider, Payer, and Location

A provider can have exceptions to how charges are normally paid. To be able to apply these exceptions to a charge, you must assign them to the provider for each service location/payer combination. For each combination, you can assign one contract exception and one SIM exception. You can attach a SIM and a contract exception to the provider at a specific location for all payers or for specific payers. A SIM or contract exception for a specific payer overrides the default exception.

To assign exceptions to the provider, payer, and location:

  1. From the Master Files - System list, select Providers.
  2. Double-click on a provider from the list or highlight the provider and select the Open Menu button.
    The Modify Provider Information dialog box displays.
  3. Select the Practice tab.
  4. Under Service Location, select the applicable location.
    A list of payers displays in the Group Information section.
  5. If you want to set the default for all payers, double-click the Default row in the Group Information section.
    OR

    If you want to set the default for a specific payer, double-click the desired payer row in the Group Information section.

    The Modify Provider Practice Payer dialog box displays. This dialog box enables you to change the values in the service location, payer, and exception fields for the provider you selected when accessing this dialog box.
  6. Select the appropriate exceptions in the SIM Exception and Contract Exception fields.

  7. Select OK to return to the Modify Provider Information dialog box.
    The exceptions you selected display in the appropriate columns for the payer row.