Set Up Professional EDI Claim Profile Rules

File Maintenance Help for NextGen® Enterprise

Set Up Institutional EDI Claim Profile Rules

On the Institutional tab of the EDI Claim Profile Maintenance window, you can determine how the details appear in rendering provider loop and the referring provider full middle name for the 837I Electronic Data Interchange (EDI) claim files of specific payers. In File Maintenance, select Libraries > EDI Claim Profile. In EDI Claim Profile List, do one of the following: To add a library, select Open Menu, and then select New. To modify a library, select the corresponding row from the list, select Open Menu, and then select Open. The EDI Claim Profile Maintenance window opens. In EDI Claim Profile Name, enter a descriptive name for the library. In Payer Rules for EDI, do one of the following: To add payer rules, select Open Menu, and then select New. To modify payer rules, select the corresponding row from the list, select Open Menu, and then select Open. The EDI Claim Profile Maintenance window opens. Select Institutional. To generate the full middle name instead of the middle initial o

Help Guide for NextGen® Enterprise PM 8

Set Up Professional EDI Claim Profile Rules

On the Professional tab of the EDI Claim Profile Maintenance window, you can determine how the details appear in the rendering provider loop, the service facility location loops, and the referring provider full middle name for the 837P Electronic Data Interchange (EDI) claim files of specific payers. In File Maintenance, select Libraries > EDI Claim Profile. In EDI Claim Profile List, do one of the following: To add a library, select Open Menu, and then select New. To modify a library, select the corresponding row from the list, select Open Menu, and then select Open. The EDI Claim Profile Maintenance window opens. In EDI Claim Profile Name, enter a descriptive name for the library. In Payer Rules for EDI, do one of the following: To add payer rules, select Open Menu, and then select New. To modify payer rules, select the corresponding row from the list, select Open Menu, and then select Open. The EDI Claim Profile Maintenance window opens. Select Professional. To generate the location

File Maintenance Help for NextGen® Enterprise 8

Set Up Professional EDI Claim Profile Rules

On the Professional tab of the EDI Claim Profile Maintenance window, you can determine how the details appear in the rendering provider loop, the service facility location loops, and the referring provider full middle name for the 837P Electronic Data Interchange (EDI) claim files of specific payers. In the EDI Claim Profile Maintenance window, select the Professional tab. To generate the location loop with Place of Service (POS) 99 details in the EDI claim file, select the corresponding row in the Setting column for the Send Service Facility Location Loop with POS 99 Details option. To generate the full middle name instead of the middle initial of the referring provider in the EDI claim file, select the corresponding row in the Setting column for the Send 2310A Referring Provider Full Middle Name option. For the Send 2420A Rendering Provider Loop option, do one of the following in the Setting column: To generate the 2420A loop with rendering provider details, select Always. To generat

Help Guide for NextGen® Enterprise PM 8

Set Up Professional EDI Claim Profile Rules

On the Professional tab of the EDI Claim Profile Maintenance window, you can determine how the details appear in the rendering provider loop, the service facility location loops, and the referring provider full middle name for the 837P Electronic Data Interchange (EDI) claim files of specific payers. In the EDI Claim Profile Maintenance window, select the Professional tab. To generate the location loop with Place of Service (POS) 99 details in the EDI claim file, select the corresponding row in the Setting column for the Send Service Facility Location Loop with POS 99 Details option. To generate the full middle name instead of the middle initial of the referring provider in the EDI claim file, select the corresponding row in the Setting column for the Send 2310A Referring Provider Full Middle Name option. For the Send 2420A Rendering Provider Loop option, do one of the following in the Setting column: To generate the 2420A loop with rendering provider details, select Always. To generat

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

Help Guide for NextGen® Enterprise PM 8

Set Up Institutional EDI Claim Profile Rules

On the Institutional tab of the EDI Claim Profile Maintenance window, you can determine how the details appear in rendering provider loop and the referring provider full middle name for the 837I Electronic Data Interchange (EDI) claim files of specific payers. In File Maintenance, select Libraries > EDI Claim Profile. In EDI Claim Profile List, do one of the following: To add a library, select Open Menu, and then select New. To modify a library, select the corresponding row from the list, select Open Menu, and then select Open. The EDI Claim Profile Maintenance window opens. In EDI Claim Profile Name, enter a descriptive name for the library. In Payer Rules for EDI, do one of the following: To add payer rules, select Open Menu, and then select New. To modify payer rules, select the corresponding row from the list, select Open Menu, and then select Open. The EDI Claim Profile Maintenance window opens. Select Institutional. To generate the full middle name instead of the middle initial o

Set Up Professional EDI Claim Profile Rules

Recommendations

Set Up Institutional EDI Claim Profile Rules

Set Up Professional EDI Claim Profile Rules

Set Up Professional EDI Claim Profile Rules

Set Up Professional EDI Claim Profile Rules

Set Up Submitter Profiles

Set Up Institutional EDI Claim Profile Rules

Set Up Professional EDI Claim Profile Rules

Set Up Institutional EDI Claim Profile Rules

Set Up Professional EDI Claim Profile Rules

Set Up Professional EDI Claim Profile Rules

Set Up Professional EDI Claim Profile Rules

Set Up Submitter Profiles

Set Up Institutional EDI Claim Profile Rules