Set Up the Remittance Profile

File Maintenance Help for NextGen® Enterprise 8

Set Up the Remittance Profile - Reversals and Corrections Tab

The Reversals and Corrections tab in the Remittance Profile library is used to set options for handling the following types of ERA transactions: Reversals and Corrections Writing Off Balances resulting from Overpayments or Underpayments To set up the Reversals and Corrections tab in a Remittance Profile library, do the following: Open File Maintenance. Select Libraries, and then select Remittance Profiles. The Remittance Profiles List window opens. Open the profile library. The Remittance Profile window opens. Select the Reversals and Corrections tab. Select settings for reversal and correction options. For more information, see Reversals and Corrections Tab - Options and Settings. When you're done setting options, select OK to save changes and close the window. Reversals and Corrections Tab - Options and Settings Parent topic: Remittance Profiles Library

Help Guide for NextGen® Enterprise PM 8

Set Up the Remittance Profile - CSC Options Tab

The CSC Options tab in the Remittance Profile library is used to set options for handling ERA transactions for services that were combined for the same patient on the same day through the Consolidated Services Claim process. Note: The CSC Options tab is available when a Consolidate Services Claim library is attached in Practice Preferences > Libraries. To set up the CSC Options tab in a Remittance Profile library, do the following: Open File Maintenance. Select Libraries, and then select Remittance Profiles. The Remittance Profiles List window opens. Open the profile library. The Remittance Profile window opens. Select the CSC Options tab. Select settings for CSC options. When you're done setting options, select OK to save changes and close the window. CSC Options Tab - Options and Settings Parent topic: Set Up a Remittance Profile Library

File Maintenance Help for NextGen® Enterprise 8

Remittance Profiles Library

You can set the options for ERA import profiles in the Remittance Profiles so that your system properly interprets the ERA information it receives from a payer or clearinghouse. The options are not specific to the reason codes in the Reason Code library. The Default Remittance Profile library is pre-loaded and is configured with the most common ERA settings. You will need to review the default settings and verify if they are in compliance with your primary, secondary, and tertiary payers. In addition to the Default Remittance Profile library, you can create additional libraries as needed. You can then attach the Remittance Profile library to payers. The Remittance Profiles Library has the following tabs: Remittance Profile Library Default Tab The Default tab is for setting payment options and posting rules for claim level and encounter level transactions. CSC Options tab The CSC tab is for setting payment options for consolidated service claims. Set Up the Remittance Profile - Default

Help Guide for NextGen® Enterprise PM 8

Set Up the CSC (Consolidated Service Claim) Parameters in Remittance Profile

Note: The CSC Options tab is available when a Consolidate Services Claim library is attached in Practice Preferences > Libraries. Open File Maintenance. Select Libraries > Remittance Profiles. The Remittance Profiles List window opens. Select and open a profile library. The Remittance Profile window opens. Select the CSC Options tab. Make the desired settings for CSC Options. For more information, see Settings in CSC Options of Remittance Profile. Settings in CSC Options of Remittance Profile Parent topic: Set Up a Remittance Profile Library

File Maintenance Help for NextGen® Enterprise 8

CSC Options Tab - Options and Settings

You can use the following list of options and descriptions to make settings on the CSC Options tab in your Remittance Profile. CSC Tab Options Option Description Consolidated Services Claim payment Posting Enable Posting to CSC Claims Enables matching logic for the following 835 segments during the ERA Posting process: REF*EA Segment REF01 (2100 level)-EA - Medical Record Identification Number identifies the CSC Claim from the superclaim_encounters table. REF*EA - the REF*6R line item control number is used to match to the service line(s) for ERA posting. REF*6R - is used for UB/837I posting of CSC and Non-CSC Claim payments. On the Default tab, in the Charge Matching Options, you must select Use Bundled Payment Processing for UB Claim to this segment. REF*EA - If not returned , the 2100 Service Lines REF6R is used to look for a match. REF6R - identifies a match to a CSC Claim, each payment’s line item is posted to the matching REF*6R. REF*EA and REF*6R - are missing, the normal Remitt

Help Guide for NextGen® Enterprise PM 8

CSC Automation in Remittance Profile

The NextGen® Enterprise PM automatically enables some of the Remittance Profile settings for consolidated claims to post the ERA transactions correctly. In NextGen® Enterprise PM Practice Preferences, when Libraries is selected on the Preference List and CSC Library is selected in the Consolidated Services Claim drop down menu. The system automatically enables the Enable Posting to CSC Claims option on the CSC Options tab in Remittance Profile Library. On the Remittance Profile window, if Enable Posting to CSC Claims is selected manually, then Distribute Claim-Level Payments and Distribute Claim-Level Adjustments become required fields. If the required fields are not filled, a message appears stating that enough information is not collected and that fields in red label required an entry. Parent topic: Consolidated Service Claims

Set Up the Remittance Profile - CSC Options Tab

Recommendations

Set Up the Remittance Profile - Reversals and Corrections Tab

Set Up the Remittance Profile - CSC Options Tab

Remittance Profiles Library

Set Up the CSC (Consolidated Service Claim) Parameters in Remittance Profile

CSC Options Tab - Options and Settings

CSC Automation in Remittance Profile

Set Up the Remittance Profile - CSC Options Tab

Set Up the Remittance Profile - Reversals and Corrections Tab

Set Up the Remittance Profile - CSC Options Tab

Remittance Profiles Library

Set Up the CSC (Consolidated Service Claim) Parameters in Remittance Profile

CSC Options Tab - Options and Settings

CSC Automation in Remittance Profile