Set Up Task to Track Discrepancy in ERA Payment Amount and the Contractual Reimbursed Amount

File Maintenance Help for NextGen® Enterprise 8

Setup Auto-Create Tasks for Transactions Posted to a Voided Charge

You can setup a Task Type to automatically generate tasks when a payment or adjustment transaction is posted, either manually or by ERA, to a voided charge. Note: In order for ERA transactions to auto-create tasks, the Post to a voided charge option must be enabled in the Default tab of Remittance Profile Library. Access File Maintenance. Select System Master Files > PM > Tasks Types. The Task Types List window appears. Select the Open Menu button and select New. The Task Types window appears. In the Task Type field, enter a free-text description for the task. This field is required. In the Source Type field, select Encounter. This field is required. Complete the Task Value, Task Subgrouping 1, Task Subgrouping 2, and Note fields as needed for the task. Select the Auto Creation tab. A list of auto-create actions for the Encounter source type display. The list represents the various events in NextGen® Enterprise PM that can be selected to automatically generate tasks. In the Default Ass

File Maintenance Help for NextGen® Enterprise 8

Set Up Auto-Create Tasks for System-Level Claim Edits

You can setup a Task Type to automatically generate tasks when a system-level claim edit fails during the Claim Edits process or during the Billing process in NextGen® Enterprise PM. For system-level claim edit failures to auto-create tasks, one or both of the following options must be enabled in Enterprise Preferences on the General tab: Create tasks during claim edits Create tasks during billing process Access File Maintenance. Select System Master Files > PM > Tasks Types. The Task Types List window opens. Select the open menu button and select New. The Task Types window appears. In the Task Type field, enter a free-text description for the task. This field is required. In the Source Type field, select Encounter. This field is required. Complete the Task Value, Task Subgrouping 1, Task Subgrouping 2, and Note fields as needed for the task. Select the Auto Creation tab. A list of auto-create actions for the Encounter source type display. The list represents the various events in Next

File Maintenance Help for NextGen® Enterprise 8

Set Up Auto-Create Tasks for Remaining Authorizations

Work log can be set up to auto-create tasks when patient authorizations for specific Payers or Financial Classes have less than a specified number of units remaining. Access File Maintenance. Select System Master Files > PM > Task Types. The Task Types List window opens. select Open Menu and select New. The Task Types window opens. In the Task Type field, enter a description for the task. This field is required. In the Source Type field, select Chart. This field is required. Complete additional fields and the Options tab parameters as needed. Select the Auto Creation tab. In the Default Assigned To for all Selected Actions field, select one or more users. In the Activate column, select one of the following auto-create actions. Authorizations with less than 0 encounter(s) remaining for <financial class/payer> <Unknown> Authorizations with less than 0 unit(s) remaining for <financial class/payer> <Unknown> A green check mark displays in the column. Right-click on the selected action and

NextGen® Background Business Processor Help 8

Automated Task for ERA File Posting Using ERA Directory Import

You must create and assign an automated Encounter task in Task Types master file in File Maintenance along with the custom user-defined reason code to track the discrepancy in ERA payment amount and contractual reimbursed amount when you post 835/ERA file in NextGen® Background Business Processor using ERA Directory Import option. Note: If there are more ERA files or each ERA has more than one encounter (claim) and it meets the criteria for payment received but not for the contractual reimbursement amount, then separate tasks must be created for each encounter (claim). When you select the Default for Contract <> ERA Payment Amount check box and configure the patient response (PR) codes in the Reason Code Library Maintenance window in File Maintenance, a task will be generated. This will create the reason code during ERA file import. For more information on creating and assigning the automated task, go to NextGen Healthcare Success Community and download the latest File Maintenance Mast

Help Guide for NextGen® Enterprise PM 8

Start the ERA Posting Process

The Electronic Remittance Advice (ERA) Posting process is not automatic. You must start it from the Import Remittance window. Note: The ERA Import function uses the CLP02 element to determine which COB to use if both primary and secondary payers have the same ERA Payer Number. The Default for Contract <> Payment Allowed Amount and Default for Contract <> ERA Payment Amount options are applicable only for the primary payer (CLP02=1). Note: You must create and assign an automated Encounter task in Task Types master file in File Maintenance along with the custom user-defined reason code to track the discrepancy in ERA payment amount and contractual reimbursed amount when 835/ERA file is posted in NextGen® Enterprise PM. For more information about creating and assigning the automated task, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise From the File menu, select Processes, and then ERA Posting. The Import Remit

Help Guide for NextGen® Enterprise PM 8

Select Transaction Status for Default Option

When you select any of the default options that are available in the Reason Code Library Maintenance window, and you want to ensure that the remaining balance of respective transactions remains in the same payer bucket to follow up with the primary payer, you must select Transaction Status option as applicable. In File Maintenance, select Libraries > Reason Codes. The Reason Codes List window opens. Select the required reason code from the list and right-click to open or select open menu and select New for new reason code. The Reason Code Library Maintenance window opens. Select the required default reason code check box: Default for Contract <> Payment Allowed Amount Default for Contract <> ERA Payment Amount Default for ERA Credit Balance Creation Select any one of the following option in the Transaction Status field. This will ensure that the remaining balance of respective transactions will remain in the same payer bucket. None Deny Appeal Settled moved to primary Note: If you do n

Set Up Task to Track Discrepancy in ERA Payment Amount and the Contractual Reimbursed Amount

Recommendations

Setup Auto-Create Tasks for Transactions Posted to a Voided Charge

Set Up Auto-Create Tasks for System-Level Claim Edits

Set Up Auto-Create Tasks for Remaining Authorizations

Automated Task for ERA File Posting Using ERA Directory Import

Start the ERA Posting Process

Select Transaction Status for Default Option

Setup Auto-Create Tasks for Transactions Posted to a Voided Charge

Set Up Auto-Create Tasks for System-Level Claim Edits

Set Up Auto-Create Tasks for Remaining Authorizations

Automated Task for ERA File Posting Using ERA Directory Import

Start the ERA Posting Process

Select Transaction Status for Default Option