Working with Service Packages in NextGen® Enterprise PM

Help Guide for NextGen® Enterprise PM 8

Setting Up Service Packages

To use Service Packages in NextGen® Enterprise PM, you must setup the following: System Administrator File Maintenance: Service Package Library Practice Preferences System Administrator for Service Packages Service Package Library Practice Preferences for Service Packages Parent topic: Service Packages in NextGen Enterprise PM

Help Guide for NextGen® Enterprise PM 8

Service Unit Authorizations

When a payer authorizes a service package with unit limitations for a patient, and those packaged services may be rendered within a date range defined by the payer, you can enter the authorization in NextGen® Enterprise PM as a Service Unit Authorization. Note: Service Unit Authorizations are available only if a Service Package Library is selected in Practice Preferences > Libraries. For more information on Encounter Mode and Units Mode authorizations, refer to the Encounter Maintenance User Guide for NextGen® Enterprise PM. Access Authorizations for a Patient's Insurance Add or Modify Service Unit Authorization You can add or modify a service unit authorization. Delete a Service Unit Authorization Parent topic: Working with Service Packages in NextGen Enterprise PM

Help Guide for NextGen® Enterprise PM 8

Service Packages in NextGen® Enterprise PM

Practices may provide services to their patients or clients based on the various service packages authorized by payers. Each service package includes groupings of specific CPT4 code and modifier combinations with defined service unit limitations. A patient's authorized package services may be used within a specific time frame determined by the payer. For example, in a Behavioral Health practice, a payer may authorize a patient for a package that includes the following services: Addiction counseling not to exceed 40 hours within 90 days; Individual therapy not to exceed 50 units within 180 days; Group therapy not to exceed 60 units within 180 days; Medication management not to exceed 70 hours within 180 days. The service package functionality in NextGen® Enterprise PM enables you to do the following: Set up service packages with service unit and duration limitations. Enter service unit authorizations for payers that authorize packaged services for patients. Generate reports for patients

Help Guide for NextGen® Enterprise PM 8

Service Unit Authorization Report

The Service Unit Authorization report in NextGen® Enterprise PM enables you to review and monitor patients with service unit authorizations to determine whether they have met or exceeded the maximum number of packaged services authorized by their insurance, and whether those services were provided within the time frame authorized by the payer. You can also use the report to determine if patients with upcoming appointments are nearing their service limit so an authorization for additional units or days can be requested and obtained from their insurance. This encounter-based report is available only if a Service Package Library is selected in Practice Preferences > Libraries. For more information on Service Packages and Service Unit Authorization, go to the NextGen Healthcare Success Community and download the Behavioral Health Billing User Guide for NextGen® Enterprise PM The Service Unit Authorization report includes patients with a service unit authorization that have encounters with

Help Guide for NextGen® Enterprise PM 8

Service Unit Authorizations

A payer can provide an authorization for the patient to have a specific service package with unit limitations, and those packaged services may be rendered within a date range defined by the payer. This type of authorization is entered in NextGen® Enterprise PM as a service unit authorization. From the Service Unit Limitation Maintenance window, you can enter a service unit authorization with the following information: Free-text description Authorization code (required) Start and stop dates (required) Assessment date Package (required) Add-on packages Additional free-text notes Note: Service Unit Authorizations are available only if a Service Package Library is selected in Practice Preferences > Libraries. For more information on Service Packages and Service Unit Authorizations, NextGen® Enterprise EHR, go to the NextGen Healthcare Success Community and download the Behavioral Health Billing User Guide forNextGen® Enterprise PM. Parent topic: About the Authorizations Tab in Insurance Ma

Help Guide for NextGen® Enterprise PM 8

Generate a Service Unit Authorization Report

Access NextGen® Enterprise PM. From the Reports menu, select General, then Authorizations, and then Service Unit Authorization. The Service Unit Authorization - Enhanced Report Mode window opens. From the Configuration Options list, select columns, filters and sorting options for the report. To generate the report, select Refresh Report. The report appears on screen. Parent topic: Service Unit Authorization Report

Working with Service Packages in NextGen® Enterprise PM

Recommendations

Setting Up Service Packages

Service Unit Authorizations

Service Packages in NextGen® Enterprise PM

Service Unit Authorization Report

Service Unit Authorizations

Generate a Service Unit Authorization Report

Setting Up Service Packages

Service Unit Authorizations

Service Packages in NextGen® Enterprise PM

Service Unit Authorization Report

Service Unit Authorizations

Generate a Service Unit Authorization Report