Add or Modify EDI Claim Profile Library

File Maintenance Help for NextGen® Enterprise 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 the EDI Claim Profile Maintenance window, select the Institutional tab. 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 2310F Referring Provider Full Middle Name option. For the Send 2420C Rendering Provider Loop Setting option, do one of the following in the Setting column: To generate the 2420C loop with same claim and line-level rendering providers, select Always. To generate the 2420C loop with different claim and line-level rendering providers, select Only if claim and line level renderings are different. Select OK. Parent topic: EDI Claim Profile Library

Help Guide for NextGen® Enterprise PM 8

Add or Modify EDI Claim Profile Library

In File Maintenance, select Libraries > EDI Claim Profile. In the EDI Claim Profile List window, do one of the following: To add a library, select open menu and 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 the EDI Claim Profile Name field, enter a descriptive name for the library. In the Payer Rules for EDI section, do one of the following: To add payer rules, select open menu and select New. To modify payer rules, select the corresponding row from the list, select open menu, and select Open. The EDI Claim Profile Maintenance window opens. Enter an effective date and an expiration date for the payer rules. Note: Dates cannot overlap between payer rules for the same payer. If you enter overlapping dates and select OK, the application displays a message indicating that the effective and expiration dates overlap for an existing payer rule. Enter a descriptive name fo

File Maintenance Help for NextGen® Enterprise 8

EDI Claim Profile Library

The EDI Claim Profile library enables you to store and configure Electronic Data Interchange (EDI) claim settings in one central library. 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: 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. You can generate EDI Claim Profile Library Listing report from the EDI Claim Profile library. For more information go to NextGen Healthc

File Maintenance Help for NextGen® Enterprise 8

Add or Modify an Institutional Billing Library

Open File Maintenance. Select Libraries, and then Institutional Billing. The Institutional Billing List window opens. Do one of the following: To add a new library, select open menu button and select New. To modify an existing library, select the row for the library in the list, select open menu button and select Open. Institutional Billing Library Maintenance window opens. In the Institutional Billing Library Name field, enter a descriptive name for the library. This field is required. In the Payer Rules for Institutional Billing section, existing payer configurations display as separate rows in descending date order. This section is required. Do one of the following: To add new payer rules, select open menu button and select New. To modify existing payer rules, select the row for the rule set in the list, select open menu button and select Open. To copy existing payer rules, select the row for the rule set in the list, select open menu button and select Copy. The Institutional Billin

Help Guide for NextGen® Enterprise PM 8

Set Up Concurrency and Claim Rules for Anesthesia Billing

The Concurrency and Claim Rules section of the Anesthesia Library Maintenance window enables you to define rules for specific payers, for all other payers, and for self-pay. Each set of rules is defined with an effective and expiration date. The date of service and payer on an anesthesia charge determines which set of rules is applied during the Anesthesia Concurrency Audit and billing processes in NextGen Enterprise PM. Access File Maintenance. Select Libraries, and then Anesthesia. The Anesthesia Library List window opens. From the list, double-click to open the desired library. The Anesthesia Library Maintenance window opens. In the Concurrency and Claim Rules section, do one of the following: To create a new rule set, or row, select open menu button and select New. To modify an existing rule set, or row, select the open menu button and select Open. The Anesthesia Library Payer Maintenance window opens. In the Effective Date field, enter the date the rule set becomes effective. This

File Maintenance Help for NextGen® Enterprise 8

Set Up Concurrency and Claim Rules for Anesthesia Billing

The Concurrency and Claim Rules section of the Anesthesia Library Maintenance window enables you to define rules for specific payers, for all other payers, and for self-pay. Each set of rules is defined with an effective and expiration date. The date of service and payer on an anesthesia charge determines which set of rules is applied during the Anesthesia Concurrency Audit and billing processes in NextGen Enterprise PM. Access File Maintenance. Select Libraries, and then Anesthesia. The Anesthesia Library List window opens. From the list, double-click to open the desired library. The Anesthesia Library Maintenance window opens. In the Concurrency and Claim Rules section, do one of the following: To create a new rule set, or row, select open menu button and select New. To modify an existing rule set, or row, select the open menu button and select Open. The Anesthesia Library Payer Maintenance window opens. In the Effective Date field, enter the date the rule set becomes effective. This

Add or Modify EDI Claim Profile Library

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