Assign a Submitter Group to a Payer at the Provider Level

File Maintenance Help for NextGen® Enterprise

Create a Submitter Group

To use Submitter Groups, you must: Create one or more Submitter Groups for a Submitter Profile. Assign each Submitter Group to a payer. Set the Break claim file based on submitter ID (GS02) option in the Submitter Profile to use Submitter Groups. Open File Maintenance and select Libraries > Submitter Profiles. The Submitter Profile List window opens. Right-click a submitter profile from the list and then select Submitter Group. The Submitter Group List window opens. Select the open menu button and select New. The Submitter Group window opens. Enter values in all the fields and select OK. Parent topic: Set Up Submitter Profiles

File Maintenance Help for NextGen® Enterprise

Group Information Setup for a Provider

Group information is set up for the rendering provider for each service location. Each provider has a default group information record that is automatically included for generic use. However, you can set up specific information for a payer. If you have group information set up for a specific payer, then it becomes the default information for box 33 of the HCFA 1500. Note: If you do not have group information set up for the payer or the default level, then the provider information in the top half of the window is printed in box 33 of the HCFA 1500. To set up group information: On the Add/Modify Provider Information window, select the Practice tab. Under Service Location, select a location. A list of payers for that location displays in the Group Information section. If you want to copy the information for one payer to other locations in the Service Locations list, right-click the payer and then select one of the following: Copy to All Locations to copy the payer to all other locations.

File Maintenance Help for NextGen® Enterprise 8

Assign a Submitter Group to a Payer at the Provider Level

Before you can use a Submitter Group with a Submitter Profile, you must associate the Submitter Group with a payer at the provider level. In the File Maintenance window, select Master Files - System > Providers. Double-click a provider. On the Modify Provider Information window, select the Practice tab. Select the Rendering provider at this practice check box. Select a location from the Service Location field. Do one of the following: Double-click a payer listed in the Payer Name column. Right-click anywhere in the Group Information list, then select New. The Add/Modify Provider Practice Payer window opens. In the Submitter Group field, select the Submitter Group that you want to associate with the payer displayed in the Payer Name field. Select OK. Parent topic: Using Submitter Groups Parent topic: Providers Practice Tab

File Maintenance Help for NextGen® Enterprise

Set Up Submitter Profiles

The information in a submitter profile includes a combination of your submitter information and electronic file options that are specified by the clearinghouse and direct payer, which allow the electronic claim to be accepted and processed without rejection. The Submitter Profile Library Maintenance security right enables users to access the Submitter Profile library and to create and modify submitter profiles. Note: If you want electronic claims to be created for certain payers, payer-specific submitter profiles must be attached at the payer master level. Open File Maintenance and select Libraries > Submitter Profiles. The Submitter Profiles List window opens. Select the open menu button and then select New The Submitter Profile window opens. Note: You can double-click an existing submitter profile to modify the values. Enter a library name in the Submitter Profile Library field. Select the appropriate version from the ANSI X12 Version list. Configure the following tab options: Common

File Maintenance Help for NextGen® Enterprise 8

Create a Submitter Group

You can create multiple Submitter Groups for a Submitter Profile. From the File Maintenance window, select Libraries > Submitter Profiles. The Submitter Profile List window opens. Right-click a Submitter Profile in the list and then select Submitter Group. The Submitter Group List window opens. Select open menu button and select New. The Submitter Group window opens. Enter a name for the Submitter Group in the Submitter Group Library field. Enter the submitter number in the Setting field for the Submitter Number option. Enter the contact information for the Submitter Group. Select OK. Parent topic: Using Submitter Groups

File Maintenance Help for NextGen® Enterprise

Attach Contract Subgroupings to a Provider

In File Maintenance, select Master Files > Systems > Providers. The Providers List window opens. Select a provider's name, select Open Menu , and then select Open. The Modify Provider Information window opens. Select the Practice tab. Select Contract Subgrouping, and then select the contract categories to associate with the provider. Note: The Contract Subgrouping field label you see might be named differently. This provider becomes a participating provider for the payer. You can see these providers in the Payer master file. If you open a payer and select the contract on the Payer master file Libraries tab, these participating providers are automatically selected in Participating Providers. Likewise, if you clear Contract Subgrouping, then the providers name is removed from the Payer master file Libraries > Participating Providers. Parent topic: Setting Up a New Contract Exception

Assign a Submitter Group to a Payer at the Provider Level

Before you begin

Recommendations

Create a Submitter Group

Group Information Setup for a Provider

Assign a Submitter Group to a Payer at the Provider Level

Set Up Submitter Profiles

Create a Submitter Group

Attach Contract Subgroupings to a Provider

Create a Submitter Group

Group Information Setup for a Provider

Assign a Submitter Group to a Payer at the Provider Level

Set Up Submitter Profiles

Create a Submitter Group

Attach Contract Subgroupings to a Provider