Claim Edit Columns

File Maintenance Help for NextGen® Enterprise 8

Set Up the Claim Edits Library

Open the Claim Edits Library type. Select open menu button and then select New. The Claim Edit Library Maintenance window opens. Use the following list to complete the required and optional fields. Claim Edit Library(required) - Enter the name of the library. Quick Start - Do not use the Quick Start field on the Claim Edit Library Maintenance window. When a selection is made, it provides incorrect results and should not be used. Default Task Type - Select a Worklog task to associate with the selected claim edits that have check marks next to them in the list. The task you select will be created as the default task when one of these claim edits is encountered during the claims build process or the claim edits process. Note: Each edit can have a specific task or the default task assigned to it. You can override the default task type used for a specific claim edit by selecting a task type in the Task Type column for the active claim edit. Default Severity(required) - Select a severity lev

File Maintenance Help for NextGen® Enterprise 8

Configure Claim Edits

When active, some claim edits display in blue when they require additional parameters to be set up for the description. If the parameters are not set up, then the claim edit displays in red and the library cannot be saved. In addition, several claim edits have variable numeric values that can be changed. Typically, these claim edits display in black and do not require changes because the value in the description is valid. For example, the claim edit "Line Item Charge is equal to $0.00" does not require a change because zero is a valid value. Right-click the claim edit description that displays with blue text, and then select Open. The Claim Edit Options window opens. The parameters that display on this window vary depending on the claim edit description you opened. Enter the applicable parameters. Select OK. After you have set up the additional parameters, the claim edit displays with black text. To save the library, select OK on the Claim Edit Library Maintenance window. Parent topic:

File Maintenance Help for NextGen® Enterprise 8

Change the Claim Edit Help Text

You can change the text in the Help Text fields for a claim edit to display help text that best meets your needs when troubleshooting claim edit errors on the Claims Status report. In the Claim Edit Library Maintenance window, double-click the help text. Change the text to read what you want to display in relation to the claim edit. To save the library, select OK. To change the help text back to the default setting, in the In the Claim Edit Library Maintenance window, right-click on the applicable help text, and then select Reset Help Text. To save the library, select OK. Parent topic: Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Claim Edit Columns

The columns in the Claim Edit Library Maintenance window have the following flexibility: You can sort columns alphabetically or numerically in ascending or descending order. You can adjust most column widths to display more or less information. The following columns appear on the Claim Edit Library Maintenance window: Active – The fields in this column can be checked or unchecked at your discretion. When the field is checked, the claim edit that it corresponds to is considered Activated, which means that the claim edit will run when an encounter is billed and a claim is created using this Claim Edits Library. ID – The fields in this column display a unique ID number that corresponds to each claim edit in the library. These ID numbers cannot be changed. If you sort by the ID number, it makes it easier to reference when new claim edits are added to the library. Claim Edit – The fields in this column display the claim edits that are available in the Claim Edits Library. Help Text – The fi

File Maintenance Help for NextGen® Enterprise 8

Claim Edits Library

Claim edits are a set of conditions that must be (or are suggested to be) met when you generate a claim. For example, is the patient's zip code required in the claim? Must the referring physician's first name appear on the claim? These are the kinds of requirements you can set up to control the information that appears in the claims you generate. The Claim Edits Libraries enable you to select the claim edits to run when billing encounters and generating claims. A default Claim Edits Library must be created and attached at the Practice Preferences level before you can bill encounters and generate claims. After, a default library is created and attached at the Practice Preferences level, you can then create payer-specific Claim Edits Libraries and attach them at the Payer Master level. These payer-specific claim edits libraries override the default Claim Edits Library. The application maintains a list of available claim edits in the Claim Edits Library, which you can access within File M

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

Claim Edit Columns

Recommendations

Set Up the Claim Edits Library

Configure Claim Edits

Change the Claim Edit Help Text

Claim Edit Columns

Claim Edits Library

Claim Edit Descriptions

Set Up the Claim Edits Library

Configure Claim Edits

Change the Claim Edit Help Text

Claim Edit Columns

Claim Edits Library

Claim Edit Descriptions