Set Up Submitter Profiles

File Maintenance Help for NextGen® Enterprise 8

Exception Options for the 4010 Format

File Options Option Setting Force Rendering information Activate this option to force the creation of the rendering provider segments on non-billing group claims. Force Subscriber information Activate this option to populate the subscriber demographics segments when the patient is not the insured. This option populates the DMG and address segments in the subscriber loop of the 837 file for both 837I and 837P. Globally enable National Provider Identifier (NPI) Activate this option to enable sending NPIs. This submitter profile option applies to any fields (provider, group, or location) that have a saved NPI in the master file. If an NPI is not in the master files, then the Tax ID becomes the default used for the rendering and group. The field for Tax ID does not populate for locations. Create Transaction Set(s) (ST/SE) per Payer Alias instead of Payer Activate this option to group the claims by Payer Alias. When this option is activated and the eTrans ID changes, but not the payer Alias

File Maintenance Help for NextGen® Enterprise 8

Common Options for the 4010 Format

Separators/Delimiters Option Setting Component element separator* Enter the component element separator character in the Setting column to the right of this option. The component element separator is a character used to separate multiple components that are associated to make up an element within a segment. Typically, the component element separator is a colon (:). This option is required. Element separator* Enter the element separator character in the Setting column to the right of this option. The element separator is a character used to separate the elements that make up a segment. Typically, the element separator is an asterisk (*). This option is required. Segment terminator* Enter the segment terminator character in the Setting column to the right of this option. The segment terminator is a character used to separate each segment in a control segment. Typically, the segment terminator is a tilde (~). This option is required. *Consult the Trading Partner Agreement/Companion Guide

Help Guide for NextGen® Enterprise PM 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

File Maintenance Help for NextGen® Enterprise

Set Up Submitter Profiles

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. Open File Maintenance and select Libraries > Submitter Profiles. The Submitter Profiles List window opens. Select the open menu button and then select New The Submitter Profile window opens. Note: You can double-click an existing submitter profile to modify the values. Enter a library name in the Submitter Profile Library field. Select the appropriate version from the ANSI X12 Version list. Configure the following tab options: Common

Help Guide for NextGen® Enterprise PM 8

Set Up Submitter Profiles

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. Open File Maintenance and select Libraries > Submitter Profiles. The Submitter Profiles List window opens. Select the open menu button and then select New The Submitter Profile window opens. Note: You can double-click an existing submitter profile to modify the values. Enter a library name in the Submitter Profile Library field. Select the appropriate version from the ANSI X12 Version list. Configure the following tab options: Common

File Maintenance Help for NextGen® Enterprise 8

Disable Admitting Diagnosis on UB Claims

If you do not normally send Admitting Diagnosis information on electronic 837I claims, and you find that Admitting Diagnosis is populating your ANSI X12 5010 claims, then you may need to disable a legacy ANSI X12 4010 option in the Submitter Profile Library. Open File Maintenance. Select Libraries, and then Submitter Profiles. The Submitter Profiles List window opens. From the list, double-click to open the library used for 837I claims. The Submitter Profile window opens. In the ANSI X12 Version field, select Version 4010 (default). The following prompt appears: There are currently [n] pending electronic claims for this submitter profile flagged for processing as well as [n] electronic claims which are not flagged for processing. If you change this submitter profile's ANSI X12 version then the pending claims flagged for processing will be archived and the encounters associated with them flagged for re-bill. Would you like to save this change to the submitter profile? Select No. Select

Set Up Submitter Profiles

Recommendations

Exception Options for the 4010 Format

Common Options for the 4010 Format

Set Up Submitter Profiles

Set Up Submitter Profiles

Set Up Submitter Profiles

Disable Admitting Diagnosis on UB Claims

Set Up Submitter Profiles

Exception Options for the 4010 Format

Common Options for the 4010 Format

Set Up Submitter Profiles

Set Up Submitter Profiles

Set Up Submitter Profiles

Disable Admitting Diagnosis on UB Claims