Create an Eligibility Profiles Library

Help Guide for NextGen® Enterprise PM 8

Attach the Eligibility Profile Library

In NextGen® Background Business Processor, create an eligibility responses job to receive a response. In File Maintenance, set up an eligibility profiles library defining the rules for submitting eligibility inquiries in batch mode. In file maintenance, select Master Files > System > Payers > Practice tab, and then select the Libraries sub-tab. The Modify Payer Information opens. Attach the Eligibility Profile Library to the payer and select OK. Parent topic: Eligibility Verification Library

Help Guide for NextGen® Enterprise PM 8

Set Up a Remittance Profile Library

The Remittance Profile Library defines various parameters and rules that are used when importing and processing ERA 835 files downloaded from payers into NextGen® Enterprise PM. The Default Remittance Profile library in File Maintenance is pre-installed in the application and includes a few recommended pre-set options. All remaining options are set based on your organizational preferences or in response to the payer’s ERA 835 file configuration. Practice Level vs. Payer Level Libraries A default Remittance Profile Library must be selected in Practice Preferences > Libraries. The default library is used for all ERA payers in the practice that do not have a specific library linked. A different Remittance Profile Library to be used for a specific payer/financial class can be linked on the Payer > Practice > Libraries sub-tab. This library overrides the default library in Practice Preferences for the payer/financial class. Any payers that do not have a Remittance Profile Library attached u

File Maintenance Help for NextGen® Enterprise 8

Libraries Practice Preferences Descriptions

Default Libraries Select the following libraries for the practice as needed. Diagnosis Code Library: Select the Diagnosis Codes library to be used in the practice. Service Item Library: Select the Service Items library to be used in the practice. Claim Modifiers Library: Select the default Claim Modifiers library to be used for all payers in the practice, if applicable. Payer-specific libraries are linked to the payer in the Payers master file Practice tab > Libraries sub-tab. NDC Library: Select the NDC library to be used in the practice. Claim Edits Library: Select the default Claim Edits library to be used for all payers in the practice. Payer-specific libraries are linked to the payer in the Payers master file > Practice tab > Libraries sub-tab. Self Pay SIM Exception: Select the SIM Exception to be used for all self-pay patients in the practice, if applicable. Eligibility Profile Library: Select the default Eligibility Profiles library to be used for all RTS payers in the practice

File Maintenance Help for NextGen® Enterprise 8

Attach a Remittance Profile Library to Payers

You can attach a remittance profile library to individual payers or to multiple payers based on financial class. To attach a remittance profile library to one payer: In the Payer master file > Practice tab > Libraries tab, select the library in the Remittance Profile Library field. To attach a remittance profile library to multiple payers: Open a Remittance Profile library, and then select Default to Payers. The Remittance Library Default window opens. Select a Financial Class to attach the library to payers within the selected financial class. Do one of the following: Select Default to All to attach the library to all payers within the selected financial class. All existing remittance profile libraries attached to the payers are overwritten. Select Default if Blank to attach the library to only those payers in the selected financial class that do not already have a library attached. Select Close. Parent topic: Remittance Profiles 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

Add or Modify EDI Claim Profile Library

In File Maintenance, select Libraries > EDI Claim Profile. In the EDI Claim Profile List window, do one of the following: To add a library, select open menu and select New. To modify a library, select the corresponding row from the list, select open menu , and then select Open. The EDI Claim Profile Maintenance window opens. In the EDI Claim Profile Name field, enter a descriptive name for the library. In the Payer Rules for EDI section, do one of the following: To add payer rules, select open menu and select New. To modify payer rules, select the corresponding row from the list, select open menu, and select Open. The EDI Claim Profile Maintenance window opens. Enter an effective date and an expiration date for the payer rules. Note: Dates cannot overlap between payer rules for the same payer. If you enter overlapping dates and select OK, the application displays a message indicating that the effective and expiration dates overlap for an existing payer rule. Enter a descriptive name fo

Create an Eligibility Profiles Library

Recommendations

Attach the Eligibility Profile Library

Set Up a Remittance Profile Library

Libraries Practice Preferences Descriptions

Attach a Remittance Profile Library to Payers

Create a Claim Status Profile Library

Add or Modify EDI Claim Profile Library

Attach the Eligibility Profile Library

Set Up a Remittance Profile Library

Libraries Practice Preferences Descriptions

Attach a Remittance Profile Library to Payers

Create a Claim Status Profile Library

Add or Modify EDI Claim Profile Library