Configurations in Claim Practice Preferences

The following table provides descriptions for the fields located in Claims Practice Preferences.

Field	Description
Enable Qualifying Encounter Billing	Activates qualifying encounter billing for all encounters with line items marked as a qualifying SIM Note: To complete the setup for qualifying encounter billing, you must configure one or more SIMs to be a qualifying SIM.
Suppress zero balance claims	Suppresses claims with a $0 (zero) balance during batch billing.
Suppress CLIA ID from mammography claims	Makes mammography certification codes and Clinical Laboratory Improvement Amendments (CLIA) IDs mutually exclusive on electronic claims. When you select this option, NextGen® Enterprise PM identifies a mammography code on a claim and prints the mammography code, and not the CLIA ID for Medicare claims. When you clear this option, both the mammography code and the CLIA codes are printed on the claim. Note: To suppress CLIA ID from mammography claims, you must set a SIM as mammography code and the code must appear on the claim.
Include Self-Pay Encounters In Claim Billing Report	Includes charges and encounters billed to patients when a SIM is flagged as a patient self-pay encounter. The billing report then displays charges and encounters billed to both payers and patients.
Allow multiple Purchased Service lines on one claim	Bills multiple purchased service charges for an encounter on one claim. If you clear the checkbox, the system generates separate claims for each purchased service item.
Do Not Sum Units for CPT4 Code	Indicates that this practice prevents combining multiple identical charge lines on one line and summing them on the paper claim. The identical charges appear on separate lines on the paper healthcare financing administration (HCFA) 1500 claim or entered individually in an electronically sent file. When you clear the checkbox, the NextGen® Enterprise PM application sums identical line items and indicates multiple units for billing on a paper HCFA 1500 or in an electronically sent file. Note: This option can also be set at the SIM or payer levels.
Disable diagnosis claim break	Prevents claim breaks when there are more than four diagnoses on a claim. An excessive number of diagnoses to bill causes an error, preventing the production of the claim. If you clear the checkbox and if there are more than four diagnoses, the system automatically splits the charges into multiple separate claims to handle the number of diagnoses adequately. Note: This option can also be set at the payer level on the Payer Defaults - 2 tab in the Payer master file.
Allow the following # of diagnoses on claims	Enables you to specify the number of diagnosis codes to send electronically. You can select: <none>, 4 diagnosis codes, 8 diagnosis codes, or 12 diagnosis codes (5010 only). Note: The 12 diagnosis codes option is not applicable to dental claims. The first four diagnosis codes are associated with the CPT4 code. Codes 5-8 are applied at the encounter level and are not attached to a charge. Codes 9-12 are for 5010 only. The diagnosis codes appear on the Charge Posting window in NextGen® Enterprise PM and are sent on the 837 electronic claim. Note: This setting works independently from the Allow eight diagnoses checkbox in the NextGen® Enterprise EHR practice preferences. When this field is blank, only four diagnoses codes can be applied to a claim. This can be overridden with the same setting in the Electronic Claims tab on the System tab under the Payers master file.
Anesthesia Units to Follow Primary Claim	Prevents the rounding setting in the Payer master file and the Anesthesia Modifiers library, and instead uses the total anesthesia units calculated on the primary claim for all coordination of benefits (COB). For example, if a charge or modifier combination has different unit calculations depending on the payer, the following occur: The units are calculated with the payer settings, and a primary medicare claim has 10 total anesthesia units while a primary aetna claim has 12 total anesthesia units. For primary medicare and secondary aetna claims, both primary and secondary claims are sent with 10 units. For primary aetna and secondary medicare claims, both primary and secondary claims are sent with 12 units. For more information on anesthesia billing, go to NextGen Healthcare Success Community and download the latest Anesthesia Billing User Guide for NextGen® Enterprise PM.
Enable billing of encounter diagnoses	Displays the Bill encounter diagnoses checkbox in the Other tab on the Practice tab under the Payers master file.
UB Claim Form	Select the information to print on the UB Claim Form. Type of Facility - Prints in the first position of UB Claim Form. The facility type selected also appears in the Add/Modify Payer Information window. Bill Classification - Prints in the second position of UB Claim Form. The selected bill classification also appears on the Add/Modify Payer Information window. Frequency of Bill - If the practice does regular UB claims billing then, this field is optional. You can enter the frequency to print in the third position of the UB Claim Form. If the field is blank, the system automatically determines the correct code based on the other entered information. Source of Admission - Set the default physician recommendation for admission. The selection appears on the UB tab of the Create Encounter window. The code prints in box 20 on the UB92 form and in box 15 in UB04 form. Note: To turn on the UB Claims tab in the Payer master file, you must select a facility and a bill classification.
Real Time Edits Default Payer ID	In Payer ID for real time edits at the practice level, the practice-level ID is used as a default ID for the entire practice when payer-level IDs are blank. The Payer ID identifies the client and payer. The ID is 13 characters long. The first 6 characters are interpreted as the client ID and the last 7 characters are interpreted as the payer ID. This payer ID overrides the enterprise-level ID.
Exclude subsequent payers from EDI file	Excludes subsequent payer information from the electronic data interchange (EDI) file, and displays only the prior payer information. If the primary payer claim is created, the secondary and tertiary payer information are excluded for 837I and 837P claim. If the secondary payer claim is created, the tertiary payer information is excluded, and the primary and secondary payer information appears for 837I and 837P claim. If the tertiary payer claim is created, the primary, secondary, and tertiary payer information appears as there are no subsequent payers. Note: Excluding subsequent payer from EDI file is applicable for institutional and professional claims for Version 5010. The loops affected are 2330B, 2330A, and 2320.