Claim Status Profile Library

File Maintenance Help for NextGen® Enterprise 8

Create a Claim Status Profile Library

In File Maintenance, select Libraries > Claim Status Profile. Select open menu button and select New. The Claim Status Profile window opens. Select the options and setting as described in the following table and then select OK. Parent topic: Claim Status Profile Library

File Maintenance Help for NextGen® Enterprise 8

Eligibility Profiles Library

The Eligibility Profiles library is required for submitting eligibility inquiries in batch mode. This library enables you to set up rules to automatically complete the required fields and additional data for batch mode that you would manually enter when running an eligibility status check in real-time mode. Create an Eligibility Profiles Library

Help Guide for NextGen® Enterprise PM 8

Eligibility Verification Library

Processing inquiries in batch mode requires creating a library. Once created, Eligibility Verification libraries automatically complete required fields and additional data in batch mode that would otherwise require the fields to be entered manually. Two libraries are used to process inquiries in batch mode: Eligibility Profiles Claim Status Profile Your Eligibility Verification Analyst assists in creating the libraries. Attach the Eligibility Profile Library Parent topic: Referral Inquiries and Histories

Help Guide for NextGen® Enterprise PM 8

Submitter Profile Library

Submitter Profile needs to be created for each clearinghouse and direct payer that you use for submitting electronic claims. The Submitter Profile library enables users with the appropriate right to create and modify these submitter profiles, which are payer-specific. Set Up Submitter Profiles Parent topic: Claims

Help Guide for NextGen® Enterprise PM 8

Set Claim Status Request to Run Automatically

You can schedule claim status inquiries to run automatically in batch mode at a set schedule in NextGen® Background Business Processor. In NextGen® Background Business Processor, create a claim status request job. Note: For more information on creating a job in BBP for a claim status check, go to NextGen Healthcare Success Community and download the User Guide for NextGen® Background Business Processor. In File Maintenance, set up a Claim Status Profile library defining the rules for submitting claim status inquiries. For example, specify the type of Service Provider in the Provider Name (2100C Loop NM1 Segments) section. For more information on setting up the Claim Status Profile library, go to NextGen Healthcare Success Community and download the File Maintenance Libraries Guide for NextGen Enterprise. In File Maintenance, select Master Files > System > Payers > Practice > Libraries. The Modify Payer Information window opens. Attach the Claim Status Profile library to the payer and s

Help Guide for NextGen® Enterprise PM 8

Claim Edits Library

This section contains a listing of all of the available claim edits in the application. Claim Edit Columns Claim Edit Descriptions This section describes the various claim edits available. System-Level Claim Edit Descriptions Parent topic: Claims

Claim Status Profile Library

Recommendations

Create a Claim Status Profile Library

Eligibility Profiles Library

Eligibility Verification Library

Submitter Profile Library

Set Claim Status Request to Run Automatically

Claim Edits Library

Create a Claim Status Profile Library

Eligibility Profiles Library

Eligibility Verification Library

Submitter Profile Library

Set Claim Status Request to Run Automatically

Claim Edits Library