Attach Formats to a Payer

File Maintenance Help for NextGen® Enterprise 8

Add or Modify Format Sets

A format set contains one or more formats. From the Master Files - System list, select Formats. The Formats List window opens. Do one of the following: To add a new item, select open menu , and then select New. To modify an existing item, select the item in the list, select open menu , and then select Open. You can also double-click to open the item. The Formats window opens. In the Format Name field, enter a name for the format set. Do one of the following: To add a new format, select Open Menu , then select New. To modify a format, double-click a format in the Acceptable Number Formats list. The Format Detail window opens. Enter the format value in the Format Value field. Use the following information to help define the appropriate format value. Valid entries include: A – represents any character or space B – represents a letter (A to Z) C – represents a digit (0-9) D – represents a letter (A-Z) or a digit (0-9) The code's position in the format means that only those character types

File Maintenance Help for NextGen® Enterprise 8

Formats

You define specific formats used for payers with the Formats master file. This master file defines specific formats of character types that can be entered for group and policy numbers on patient records. Only entries that correspond to the specified format are acceptable or valid for the Group and Policy Numbers fields. You can attach a format to a payer and also require policy and group numbers on the Insurance Maintenance window in NextGen® Enterprise PM. When a group or policy number format is selected on the Payer Defaults - 2 tab, only character types defined in that format from the Formats List can be entered in the Health Insurance Claim (HIC)/Policy Number and Group Number fields for that payer on the Insurance Maintenance window. Access the Formats Master File Add or Modify Format Sets Delete Formats Attach Formats to a Payer Parent topic: Master Files - System

Help Guide for NextGen® Enterprise PM 8

Set Up a Default Location for Group Provider Numbers

To set up a group that has the same Group Provider number for payers at all or several practice locations, do the following: In File Maintenance, under Master Files, select Practice > Groups. The Groups List window opens. Double-click a group. The Group Information window opens. From the Service Location list, select the <Default> option. Select one of the following options based on the following information: To set up the group on the default payer, double-click the Default row listed under the Payer Name column. The Group Information window opens additional fields. This set up is for the default payer and the Payer Name field is disabled. To set up a specific payer for the group, right-click in the Group Information section, then select New. The Group Information window opens additional fields. Because this setup is for a specific payer, the Payer Name field is available. From the Payer Name list, select a payer. In the Group Number field, enter the group number. In the Opt Group Val

Help Guide for NextGen® Enterprise PM 8

Set Up Practice Default Information

In File Maintenance, select Master Files > System, and select Practices. The Practice List access window opens. The practices that displays in this window are determined by your security rights. Do one of the following: To add a new item, select the open menu button and then select New. To modify an existing item, select the item in the list, select the open menu button and then select Open. The Practice Defaults tab on the Add/Modify Practice Information window opens. Note: You can set the access right for the Practices master file to read-only for the groups that users belong to. This setting prevents that group of users from making any modifications to the master file. For detailed information about rights and permissions, go to the NextGen Healthcare Success Community and download the latest System Administrator Guide for NextGen® Enterprise. Field Description Practice ID Displays the ID of the practice. The system generates a sequential number for each new practice. Practice Name

File Maintenance Help for NextGen® Enterprise 8

Claim Edit Descriptions

The following table lists each claim edit and its corresponding ID, help text, the area in the application where the claim edit applies, and the claim field on the 837 electronic claim file that the claim edit affects. The table does not contain the following fields: The Active fields because activating a claim edit is optional. The Severity fields because the default for all of these fields is Warning, which you can change by making a selection from the drop-down list. ID Claim Edit Description Applicable To Claim Field 1 Submitter Profile is required Add the Submitter Profile. Submitter Master NM103 2 Provider’s Specialty is required Add the Provider’s Specialty. Billing Provider PRV03 3 Provider’s Phone number must contain an area code Add the area code to the Provider’s phone number. Billing Provider PER04 4 Payer requires the Insurance Type code, when it is not primary Add a valid Insurance Type code. Valid codes are 12, 13, 14, 15, 16, 41, 42, 43, and 47. Payer Master SBR05 5 Cla

Help Guide for NextGen® Enterprise PM 8

Claim Edit Descriptions

The following table lists each claim edit and its corresponding ID, help text, the area in the application where the claim edit applies, and the claim field on the 837 electronic claim file that the claim edit affects. The table does not contain the following fields: The Active fields because activating a claim edit is optional. The Severity fields because the default for all of these fields is Warning, which you can change by making a selection from the drop-down list. ID Claim Edit Description Applicable To Claim Field 1 Submitter Profile is required Add the Submitter Profile. Submitter Master NM103 2 Provider’s Specialty is required Add the Provider’s Specialty. Billing Provider PRV03 3 Provider’s Phone number must contain an area code Add the area code to the Provider’s phone number. Billing Provider PER04 4 Payer requires the Insurance Type code, when it is not primary Add a valid Insurance Type code. Valid codes are 12, 13, 14, 15, 16, 41, 42, 43, and 47. Payer Master SBR05 5 Cla

Attach Formats to a Payer

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Add or Modify Format Sets

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