Claim Edits Library

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

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

Assign a Default Claim Edits Library

A default Claim Edits Library must be assigned to the practice from the Libraries Practice Preferences so that users can bill encounters and generate claims. Additional information is provided in the Practices Preferences documentation for Libraries. The Claim Edit Library option on the Payer Information window Practice > Libraries tab allows you to override the default Claim Edits library and use an alternate library for a specific payer. Parent topic: Claim Edits Library

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:

Help Guide for NextGen® Enterprise PM 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

Help Guide for NextGen® Enterprise PM 8

Activate Claim Edits

The Claim Edits Library contains a list of the available claim edits you can apply to the claims you generate. In File Maintenance, select Libraries > Claim Edits and select the applicable Claim Edits Library. The Claim Edit Library Maintenance window opens. Select the claim edit you want to activate by selecting in the Active column. A check mark displays to indicate the claim edit is active. To edit the Help Text, select the Help Text field and enter the new description for the Help Text. To change the edit severity level, select in the Severity field, and select one of the following severity levels: Warning Critical Custom Required After you make your selections, select OK. Parent topic: Claim Edits Library

Claim Edits Library