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Set Up Professional EDI Claim Profile Rules

On the Professional tab of the EDI Claim Profile Maintenance window, you can determine how the details appear in the rendering provider loop, the service facility location loops, and the referring provider full middle name for the 837P Electronic Data Interchange (EDI) claim files of specific payers.

  1. In the EDI Claim Profile Maintenance window, select the Professional tab.

  2. To generate the location loop with Place of Service (POS) 99 details in the EDI claim file, select the corresponding row in the Setting column for the Send Service Facility Location Loop with POS 99 Details option.
  3. To generate the full middle name instead of the middle initial of the referring provider in the EDI claim file, select the corresponding row in the Setting column for the Send 2310A Referring Provider Full Middle Name option.
  4. For the Send 2420A Rendering Provider Loop option, do one of the following in the Setting column:
    • To generate the 2420A loop with rendering provider details, select Always.
    • To generate the 2420A loop when the claim and line-level rendering providers are different, select Only if claim and line level renderings are different.
  5. For the Send 2420C Service Facility Location Loop option, in the Setting column, do one of the following:
    • To generate the 2420C loop with service location details, select Always.
    • To generate the 2420C loop when the claim and line-level service locations are different, select Only if claim and line level locations are different.

  6. Select OK.