Claim Edit Columns

Field	Description
Active	Activates the claim edit, the claim edit will run when an encounter is billed and a claim is created using this Claim Edits Library.
ID	Displays a unique ID number that corresponds to each claim edit in the library. These ID numbers cannot be changed. If you sort by the ID number, it makes it easier to reference when new claim edits are added to the library.
Claim Edit	Displays the claim edits that are available in the Claim Edits Library.
Help Text	Displays the help text that corresponds to each of the claim edits. The text in these fields can be changed to display help text for a claim edit that best meets your needs when troubleshooting claim edit errors on the Claims Status report.
Applicable To	Indicates the area in the application where the applicable claim edit information is located. Knowing where in the application the claim edits information applies helps troubleshoot any claim edit errors.
Severity	Displays the list that enables you to set the severity for the claim edits. The selections in the list include: Warning – The default level. The claim edit displays in blue and enables you to create a clean claim Build – Indicates an error and results in a bad claim. The claim edit displays in red. Critical – Indicates an error and results in a bad claim. The claim edit displays in red. Custom – Not currently being used. Required – Indicates an error and results in a bad claim. The claim edit displays in red.
Claim Field	Displays the claim fields in the 837 electronic claims that the claim edit affects.
Task Type	You can select a specific task type for a claim edit. This allows you to generate a Worklog task when the claim edits process is run from an appointment or an encounter. The task type must be set up with a source type of appointment or encounter. The selection overrides the default task type.

File Maintenance Help for NextGen® Enterprise

Configure Claim Edits

Some claim edits display in blue when they are active and require additional parameters to set up the description. If the parameters are not set up, then the claim edit displays in red and the library cannot be saved. In addition, several claim edits have variable numeric values that can be changed. Typically, these claim edits display in black and do not require changes because the value in the description is valid. If the claim edit line item charge is equal to $0.00, it does not require a change because zero is a valid value. In File Maintenance, select Libraries, and then select Claim Edits. The Claim Edits List window opens. Double-click the claim edit or select the Open Menu, and then select New. The Claim Edit Library Maintenance window opens. Right-click the claim edit description that displays with blue text, and then select Open. Claim Edit Library Maintenance Window The Claim Edit Options window opens. The parameters that display on this window depends on the claim edit desc

File Maintenance Help for NextGen® Enterprise

Set Up the Claim Edits Library

In File Maintenance, select Libraries, and then select Claim Edits. The Claim Edits List window opens. Select Open Menu, and then select New. The Claim Edit Library Maintenance window opens. In Claim Edit Library, enter the name of the library. In Default Severity, select a severity level to be used as the default value for new claim edits. The severity of the new claim edit matches your selection in the Default Severity field. The severity level can be manually changed for the edit. The new field does not apply to edits that are already enabled. Note: Do not use the Quick Start field on the Claim Edit Library Maintenance window to avoid incorrect results. Parent topic: Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Claim Edit Columns

The following columns appear in the Claim Edit Library Maintenance window: Field Description Active Activates the claim edit, the claim edit will run when an encounter is billed and a claim is created using this Claim Edits Library. ID Displays a unique ID number that corresponds to each claim edit in the library. These ID numbers cannot be changed. If you sort by the ID number, it makes it easier to reference when new claim edits are added to the library. Claim Edit Displays the claim edits that are available in the Claim Edits Library. Help Text Displays the help text that corresponds to each of the claim edits. The text in these fields can be changed to display help text for a claim edit that best meets your needs when troubleshooting claim edit errors on the Claims Status report. Applicable To Indicates the area in the application where the applicable claim edit information is located. Knowing where in the application the claim edits information applies helps troubleshoot any claim

File Maintenance Help for NextGen® Enterprise 8

Claim Edit Columns

The columns in the Claim Edit Library Maintenance window have the following flexibility: You can sort columns alphabetically or numerically in ascending or descending order. You can adjust most column widths to display more or less information. The following columns appear on the Claim Edit Library Maintenance window: Active – The fields in this column can be checked or unchecked at your discretion. When the field is checked, the claim edit that it corresponds to is considered Activated, which means that the claim edit will run when an encounter is billed and a claim is created using this Claim Edits Library. ID – The fields in this column display a unique ID number that corresponds to each claim edit in the library. These ID numbers cannot be changed. If you sort by the ID number, it makes it easier to reference when new claim edits are added to the library. Claim Edit – The fields in this column display the claim edits that are available in the Claim Edits Library. Help Text – The fi

Help Guide for NextGen® Enterprise PM 8

Claim Edit Columns

The columns in the Claim Edit Library Maintenance window have the following flexibility: You can sort columns alphabetically or numerically in ascending or descending order. You can adjust most column widths to display more or less information. The following columns appear on the Claim Edit Library Maintenance window: Active – The fields in this column can be checked or unchecked at your discretion. When the field is checked, the claim edit that it corresponds to is considered Activated, which means that the claim edit will run when an encounter is billed and a claim is created using this Claim Edits Library. ID – The fields in this column display a unique ID number that corresponds to each claim edit in the library. These ID numbers cannot be changed. If you sort by the ID number, it makes it easier to reference when new claim edits are added to the library. Claim Edit – The fields in this column display the claim edits that are available in the Claim Edits Library. Help Text – The fi

File Maintenance Help for NextGen® Enterprise

Claim Edits Library

The Claim Edits Libraries enable you to select the claim edits to run when billing encounters and generating claims. A default Claim Edits Library must be created and attached at the Practice Preferences level before you can bill encounters and generate claims. After, a default library is created and attached at the Practice Preferences level, you can then create payer-specific Claim Edits Libraries and attach them at the Payer Master level. These payer-specific claim edits libraries override the default Claim Edits Library. The application maintains a list of available claim edits in the Claim Edits Library, which you can access within File Maintenance. From the list of claim edits, you can do the following: Choose the edits you want to activate Customize the text of the edit messages Set a severity level for each edit You can set up multiple Claim Edit Libraries to use for different payer requirements. Reference: For a listing of claim edit options, refer to the section on Claim Edit

Claim Edit Columns

Recommendations

Configure Claim Edits

Set Up the Claim Edits Library

Claim Edit Columns

Claim Edit Columns

Claim Edit Columns

Claim Edits Library

Claim Edit Columns

Configure Claim Edits

Set Up the Claim Edits Library

Claim Edit Columns

Claim Edit Columns

Claim Edit Columns

Claim Edits Library