IB Library with Claim Rules by TOB Report

Column	Description	Data Populates From
Lib Name	Library Name	Institutional Billing Library Name field
Desc	Description	Claim Rules By Type of Bill Range window > Description field
Eff Dt	Effective Date	Claim Rules By Type of Bill Range window > Effective Date field
Exp Dt	Expiration Date	Claim Rules By Type of Bill Range window > Expiration Date field
Tob From	Type of Bill From	Claim Rules By Type of Bill Range window > TOB From field
Tob To	Type of Bill To	Claim Rules By Type of Bill Range window > TOB To field
Adm Diag	Admitting Diagnosis	Claim Rules By Type of Bill Range window > Populate Admitting Diagnosis check box Y or N
Patient Reason Visit	Patient Reason for Visit	Claim Rules By Type of Bill Range window > Populate Reason for Visit Diagnosis check box Y or N
Cover Days	Covered Days	Claim Rules By Type of Bill Range window > Populate Covered Days check box Y or N
Stmt Dates	Statement Dates - Bill Frequency	Claim Rules By Type of Bill Range window > Populate 837I Statement dates based on Bill Frequency check box Y or N
Admit Date	Admission Date	Claim Rules By Type of Bill Range window > Populate Admission Date check box Y or N
Admit Hour	Admission Time/Hour	Claim Rules By Type of Bill Range window > Populate Admission Hour check box Y or N
Dischg Hour	Discharge Hour	Claim Rules By Type of Bill Range window > Populate Discharge Hour check box Y or N
Pat Dischg	Patient Discharge	Claim Rules By Type of Bill Range window > Populate Patient Discharge status from Encounter Maintenance check box Y or N
Chg Date	Charge Line Date of Service	Claim Rules By Type of Bill Range window > Populate charge line date of service check box Y or N
POA	Present on Admission	Claim Rules By Type of Bill Range window > Populate Present on Admission check box Y or N

File Maintenance Help for NextGen® Enterprise 8

IB Library with TOB by Rev Code Report

The Institutional Billing Library with TOB by Rev Code report includes information from the Institutional Billing library in File Maintenance. Information on the report pulls from the Institutional Billing Maintenance window > Define TOB by Rev Code tab. The report includes the following information: Column Description Data Populates From Lib Name Library Name Institutional Billing Library Name field Desc Description Description field Default Default Use as default billing rules for Institutional Claims check box Y or N Type of Bill Rules Type of Bill Rules Define Type of Bill by Revenue Code Category window > Description field Payer Name Payer Name Valid Payers section Eff Dt Effective Date Define Type of Bill by Revenue Code Category window > Effective Date field Exp Dt Expiration Date Define Type of Bill by Revenue Code Category window > Expiration Date field Rev Cd Cat Revenue Code Category Define Type of Bill by Revenue Code Category window > Revenue Code Category field Fac Type F

File Maintenance Help for NextGen® Enterprise 8

IB Library with Payer Exception Claim Rules Report

The Institutional Billing Library with Payer Exception Claim Rules report includes information from the Institutional Billing library in File Maintenance. Information on the report pulls from the Institutional Billing Maintenance window > Payer Exception Claim Rules tab. The report includes the following information: Column Description Data Populates From Lib Name Library Name Institutional Billing Library Name field Desc Description Payer Exception Claim Rules window > Description field Eff Dt Effective Date Payer Exception Claim Rules window > Effective Date field Exp Dt Expiration Date Payer Exception Claim Rules window > Expiration Date field Rev Cd Rev Code Payer Exception Claim Rules window > Revenue Code field Rev Cd Cat Revenue Code Category Payer Exception Claim Rules window > Revenue Code Category(s) field Ovride Rev Cd Qual Override Rev Code Qualifier Payer Exception Claim Rules window > Override Rev Code Qualifier field Sum Claim Create Summary Claim Payer Exception Claim R

File Maintenance Help for NextGen® Enterprise 8

Institutional Billing Library Listing Report

The Institutional Billing Library Listing report includes information from the Institutional Billing library in File Maintenance. Information on the report pulls from the Institutional Billing Maintenance window. The report includes the following information: Column Description Data Populates From Lib Name Library Name Institutional Billing Library Name field Eff Dt Effective Date Effective Date field Exp Dt Expiration Date Expiration Date field Desc Description Description field Use as Default Billing Rules Use as default billing rules for Institutional claims Use as default billing rules for Institutional Claims check box Y or N Valid Payers Valid Payers Valid Payers section Multiple entries are separated by semi-colons Crt Dt Created Date Modification Information > Creation Date & Time field Created By Created By Modification Information > Creator field Mod Dt Last Modified Date Modification Information > Modified Date & Time field Modified By Last Modified By Modification Informati

File Maintenance Help for NextGen® Enterprise 8

Set Up the Claim Rules by TOB Tab

The Claim Rules by TOB tab on the Institutional Billing Maintenance window allows the Type of Bill (TOB) to control whether specific fields are populated on claims for the selected payers. From the Institutional Billing Maintenance window, select the Claim Rules by TOB tab. In the Claim Rules by Type of Bill section, do one of the following: To add a new claim rule by TOB, select open menu button and select New. To modify an existing claim rule by TOB, select the row for the rule in the list, select the open menu button and select Open. The Claim Rules by Type of Bill Range window opens. In the Effective Date and Expiration Date fields, enter an effective date and an expiration date for the rule. These fields are required. Dates cannot overlap between rules for the same TOB range. If dates overlap, the following prompt displays when the OK button is selected: Effective/Expiration dates overlap with [Claim Rules by TOB Name]. In the Description field, enter a descriptive name for the ru

File Maintenance Help for NextGen® Enterprise 8

Setup the Define TOB by Rev Code

The TOB by Rev Code tab on the Institutional Billing Maintenance window allows the Type of Bill (TOB) for claims to be defined by revenue code for the selected payers. The system creates a claim break based on TOB. Therefore, all SIM codes that have a revenue code with the same TOB are grouped together on one claim. Note: TOB populates the 2300 CLM05 segment on electronic 837I claims, and FL 4 on paper UB04 claims. From the Institutional Billing Maintenance window, select the Define TOB by Rev Code tab. In the Type of Bill by Revenue Code section, do one of the following: To add a new TOB by revenue code rule, select open menu button and select New. To modify an existing TOB by revenue code rule, select the row for the rule in the list, select open menu button and select Open. The Define Type of Bill by Revenue Code Category window opens. In the Effective Date and Expiration Date fields, enter an effective date and an expiration date for the rule. These fields are required. Dates canno

Help Guide for NextGen® Enterprise PM 8

Billed Encounters Report Columns

This report contains fields that can be identified as Protected Content in the Enterprise Preferences window. These fields identify a patient's sexual orientation and gender identity (SOGI). If any of these fields have been identified as protected content fields, then you must have the appropriate security access rights to view the data in these fields. The following table describes the columns that are available on the Billed Encounters report: Column Name Description Data Populates From Enc UD 1 - 4 Encounter User Defined 1 - 4 Note: User defined names are from Practice Preferences > Encounters. Encounter Maintenance > Generaltab Enc Spec UD 1 - 50 Encounter Specific 1 - 50 Note: User defined names are from Practice Preferences > Encounters. Encounter Maintenance > Encounter Specifics tab Enc Bill & Collect UD 1 - 4 Encounter Billing/Collections 1 - 4 Note: User defined names are from Practice Preferences > Encounters. The Billing & Collections tab on the Encounter Maintenance window

IB Library with Claim Rules by TOB Report

Recommendations

IB Library with TOB by Rev Code Report

IB Library with Payer Exception Claim Rules Report

Institutional Billing Library Listing Report

Set Up the Claim Rules by TOB Tab

Setup the Define TOB by Rev Code

Billed Encounters Report Columns

IB Library with TOB by Rev Code Report

IB Library with Payer Exception Claim Rules Report

Institutional Billing Library Listing Report

Set Up the Claim Rules by TOB Tab

Setup the Define TOB by Rev Code

Billed Encounters Report Columns