Create a Submitter Group

File Maintenance Help for NextGen® Enterprise

Assign a Submitter Group to a Payer at the Provider Level

Before you begin Before you can use a Submitter Group with a Submitter Profile, you must associate the Submitter Group with a payer at the provider level. Open File Maintenance and select Master Files > System > Providers. The Providers List window opens. Select and open a provider. The Modify Provider Information window opens. Select the Practice tab and then select the Rendering provider at this practice check box. Select a location from the Service Location list. 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. From the Submitter Group list, select the Submitter Group that you want to associate with the payer displayed in the Payer Name field. Select OK. Parent topic: Set Up Submitter Profiles Parent topic: Providers Practice Tab

File Maintenance Help for NextGen® Enterprise 8

Using Submitter Groups

You can define a Submitter Group for a Submitter Profile. A Submitter Group enables you to use multiple submitter numbers for the same Submitter Profile. 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. Create a Submitter Group Assign a Submitter Group to a Payer at the Provider Level Parent topic: Set Up Submitter Profiles

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

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

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

Help Guide for NextGen® Enterprise PM 8

Attach a Submitter Profile to the Payer Master

A submitter profile must be attached to each Payer master file. Note: 837 electronic files cannot be created for payers that do not have a submitter profile set up in their payer master file. In addition, to maintain HIPAA compliance when submitting electronic claims, a provider secondary reference qualifier must be set up at the Payer master file level as well. The provider secondary reference qualifier identifies, based on the claim type, the type of provider in the 837. In File Maintenance, select Master Files > System > Payers. The Add/Modify Payer Information window opens. Select the payer, and then select the Practice tab and then Claims tab and then click either the 1500 Claims, UB Claims, or ADA Claims sub-tab. Select the applicable Submitter Profile from the Submitter Profile drop-down menu (If applicable, attach a Submitter Profile for 1500 Claims, UB Claims, or ADA Claims). Select OK. Parent topic: Payers Master File

Create a Submitter Group

Recommendations

Assign a Submitter Group to a Payer at the Provider Level

Using Submitter Groups

Create a Submitter Group

Set Up Submitter Profiles

Assign a Submitter Group to a Payer at the Provider Level

Attach a Submitter Profile to the Payer Master

Assign a Submitter Group to a Payer at the Provider Level

Using Submitter Groups

Create a Submitter Group

Set Up Submitter Profiles

Assign a Submitter Group to a Payer at the Provider Level

Attach a Submitter Profile to the Payer Master