Set Up Submitter Profiles

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 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

Add or Modify EDI Claim Profile Library

The EDI Claim Profile library enables you to store and configure Electronic Data Interchange (EDI) claim settings. You can configure EDI claim settings based on payer requirements and control the setup involved when payers require service line level segments to be reported in the 837 claim file. The settings in this library also provide support for the 2400 loops and segments requested by payers when the details are different per charge. After you set up the EDI Claim Profile library, you can do the following: Select a practice specific EDI Claim Profile library on the Libraries tab of the Practice Preferences window. Generate an EDI Claim Profile report to review the library name, dates, default EDI rules, and valid payers. Select the EDI Claim Profile library on the Alt Payer tab of the Add Payer Information or Modify Payer Information window. In File Maintenance, select Libraries > EDI Claim Profile. In EDI Claim Profile List, do one of the following: To add a library, select Open M

File Maintenance Help for NextGen® Enterprise 8

Set Up Submitter Profiles

Entries can be made in the fields of the Settings column of the Submitter Profile window. There are a few exceptions in the way some of these entries can be made, which include the following: Special characters (such as # and *) can be entered in any alphanumeric field. Carriage returns cannot be entered in a text-only (alpha) field. Note: Anesthesia units only apply to the 4010 format. In File Maintenance, select Libraries and then Submitter Profiles. Select the applicable Submitter Profile or select open menu , and then select New. The Submitter Profile window opens. Enter the name of the submitter profile library in the Submitter Profile Library field. In the ANSI X12 Version field, select the appropriate format for the submitter profile, either Version 4010 (default) or Version 5010. Select the Common Options tab and select your options. Select the Exception Options tab and select your options. Select OK. Common Options for the 4010 Format Exception Options for the 4010 Format Comm

Help Guide for NextGen® Enterprise PM 8

Set Up Submitter Profiles

Entries can be made in the fields of the Settings column of the Submitter Profile window. There are a few exceptions in the way some of these entries can be made, which include the following: Special characters (such as # and *) can be entered in any alphanumeric field. Carriage returns cannot be entered in a text-only (alpha) field. Note: Anesthesia units only apply to the 4010 format. In File Maintenance, select Libraries and then Submitter Profiles. Select the applicable Submitter Profile or select open menu , and then select New. The Submitter Profile window opens. Enter the name of the submitter profile library in the Submitter Profile Library field. In the ANSI X12 Version field, select the appropriate format for the submitter profile, either Version 4010 (default) or Version 5010. Select the Common Options tab and select your options. Select the Exception Options tab and select your options. Select OK. Common Options for the 4010 Format Exception Options for the 4010 Format Comm

File Maintenance Help for NextGen® Enterprise 8

Disable Admitting Diagnosis on UB Claims

If you do not normally send Admitting Diagnosis information on electronic 837I claims, and you find that Admitting Diagnosis is populating your ANSI X12 5010 claims, then you may need to disable a legacy ANSI X12 4010 option in the Submitter Profile Library. Open File Maintenance. Select Libraries, and then Submitter Profiles. The Submitter Profiles List window opens. From the list, double-click to open the library used for 837I claims. The Submitter Profile window opens. In the ANSI X12 Version field, select Version 4010 (default). The following prompt appears: There are currently [n] pending electronic claims for this submitter profile flagged for processing as well as [n] electronic claims which are not flagged for processing. If you change this submitter profile's ANSI X12 version then the pending claims flagged for processing will be archived and the encounters associated with them flagged for re-bill. Would you like to save this change to the submitter profile? Select No. Select

Set Up Submitter Profiles

Recommendations

Set Up Institutional EDI Claim Profile Rules

Set Up Submitter Profiles

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Disable Admitting Diagnosis on UB Claims

Set Up Institutional EDI Claim Profile Rules

Set Up Submitter Profiles

Add or Modify EDI Claim Profile Library

Set Up Submitter Profiles

Set Up Submitter Profiles

Disable Admitting Diagnosis on UB Claims