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Claim Options Field Descriptions

Use the following table to setup claim options.

FieldDescription
Force Claim Break when Place of Service isSelects one or more Place of Service codes that cause charges with the selected POS to break for a separate claim.
Always send unit count as 1 on claim charge linesIf this field is enabled, claim edit #273 CPT4(s) cannot be in excess of a particular number of units should be disabled in File Maintenance > Libraries > Claim Edits.
Always send one line item per claimYou can select this option if claims should only include 1 line item. If an encounter has three charges. Two of the charges roll-up and the third charge is not part of the roll-up. If you select this option, two claims will be created for the encounter, each with 1 line item.
Secondary Claims Roll-up lines viewManages the billing options for the roll-up charge amount on secondary claims.
  • Sum of roll-up less prior payer transactions: Sends the charge amount on claims for the secondary payer as the sum of the roll-up charges minus any payment or adjustment transaction amounts already posted from the primary payer.
  • Sum of roll-up: Sends the charge amount on claims for the secondary payer as the sum of the roll-up charges.
Secondary Claims Always bill as primary when prior payer isYou can select the Open Folder to select one or more payers. If one of the selected payer is primary on the encounter, the claim for the secondary payer appears as a primary claim.
Tertiary Claims Roll-up lines viewYou can select one of the following billing options for the roll-up charge amount on tertiary claims:
  • Sum of roll-up less prior payer transactions: Sends the charge amount on claims for the tertiary payer as the sum of the roll-up charges minus any payment/adjustment transaction amounts already posted from the primary and secondary payers.
  • Sum of roll-up: Sends the charge amount on claims for the tertiary payer as the sum of the roll-up charges.
Tertiary Claims Always bill as primary when prior payer isYou can select the Open Folder to select one or more payers. If one of the selected payer is secondary on the encounter, the claim for the tertiary payer appears as a primary claim.
Claim Options Field Descriptions