Create a Submitter Group
You can create multiple Submitter Groups for a Submitter Profile.
From the
File Maintenance
window, select
Libraries
>
Submitter Profiles
.
The
Submitter Profile List
window opens.
Right-click a Submitter Profile in the list and then select
Submitter Group
.
The
Submitter Group List
window opens.
Select open menu button and select
New
.
The
Submitter Group
window opens.
Enter a name for the Submitter Group in the
Submitter Group Library
field.
Enter the submitter number in the
Setting
field for the
Submitter Number
option.
Enter the contact information for the Submitter Group.
Select
OK
.
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File Maintenance Help for NextGen® Enterprise 8
Assign a Submitter Group to a Payer at the Provider Level
Before you can use a Submitter Group with a Submitter Profile, you must associate the Submitter Group with a payer at the provider level. In the File Maintenance window, select Master Files - System > Providers. Double-click a provider. On the Modify Provider Information window, select the Practice tab. Select the Rendering provider at this practice check box. Select a location from the Service Location field. Do one of the following: Double-click a payer listed in the Payer Name column. Right-click anywhere in the Group Information list, then select New. The Add/Modify Provider Practice Payer window opens. In the Submitter Group field, select the Submitter Group that you want to associate with the payer displayed in the Payer Name field. Select OK. Parent topic: Using Submitter Groups Parent topic: Providers Practice Tab
File Maintenance Help for NextGen® Enterprise 8
Using Submitter Groups
You can define a Submitter Group for a Submitter Profile. A Submitter Group enables you to use multiple submitter numbers for the same Submitter Profile. To use Submitter Groups, you must: Create one or more Submitter Groups for a Submitter Profile. Assign each Submitter Group to a payer. Set the Break claim file based on submitter ID (GS02) option in the Submitter Profile to use Submitter Groups. Create a Submitter Group Assign a Submitter Group to a Payer at the Provider Level Parent topic: Set Up Submitter Profiles
File Maintenance Help for NextGen® Enterprise 8
Submitter Profiles Library
A Submitter Profile needs to be created for each clearinghouse and direct payer that you use for submitting electronic claims. The information in a submitter profile includes a combination of your submitter information and electronic file options that are specified by the clearinghouse and direct payer, which allow the electronic claim to be accepted and processed without rejection. The Submitter Profile Library Maintenance security right enables users to access the Submitter Profile Library and to create and modify Submitter Profiles. Note: If you want electronic claims to be created for certain payers, payer-specific submitter profiles must be attached at the Payer master level. Set Up Submitter Profiles
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
Set Up Submitter Profiles
Entries can be made in the fields of the Settings column of the Submitter Profile window. There are a few exceptions in the way some of these entries can be made, which include the following: Special characters (such as # and *) can be entered in any alphanumeric field. Carriage returns cannot be entered in a text-only (alpha) field. Note: Anesthesia units only apply to the 4010 format. In File Maintenance, select Libraries and then Submitter Profiles. Select the applicable Submitter Profile or select open menu , and then select New. The Submitter Profile window opens. Enter the name of the submitter profile library in the Submitter Profile Library field. In the ANSI X12 Version field, select the appropriate format for the submitter profile, either Version 4010 (default) or Version 5010. Select the Common Options tab and select your options. Select the Exception Options tab and select your options. Select OK. Common Options for the 4010 Format Exception Options for the 4010 Format Comm
Help Guide for NextGen® Enterprise PM 8
Attach a Submitter Profile to the Payer Master
A submitter profile must be attached to each Payer master file. Note: 837 electronic files cannot be created for payers that do not have a submitter profile set up in their payer master file. In addition, to maintain HIPAA compliance when submitting electronic claims, a provider secondary reference qualifier must be set up at the Payer master file level as well. The provider secondary reference qualifier identifies, based on the claim type, the type of provider in the 837. In File Maintenance, select Master Files > System > Payers. The Add/Modify Payer Information window opens. Select the payer, and then select the Practice tab and then Claims tab and then click either the 1500 Claims, UB Claims, or ADA Claims sub-tab. Select the applicable Submitter Profile from the Submitter Profile drop-down menu (If applicable, attach a Submitter Profile for 1500 Claims, UB Claims, or ADA Claims). Select OK. Parent topic: Payers Master File
