Submitter Profiles Library

Help Guide for NextGen® Enterprise PM 8

Submitter Profile Library

Submitter Profile needs to be created for each clearinghouse and direct payer that you use for submitting electronic claims. The Submitter Profile library enables users with the appropriate right to create and modify these submitter profiles, which are payer-specific. Set Up Submitter Profiles Parent topic: Claims

Help Guide for NextGen® Enterprise PM 8

Attach a Submitter Profile to the Payer Master

A submitter profile must be attached to each Payer master file. Note: 837 electronic files cannot be created for payers that do not have a submitter profile set up in their payer master file. In addition, to maintain HIPAA compliance when submitting electronic claims, a provider secondary reference qualifier must be set up at the Payer master file level as well. The provider secondary reference qualifier identifies, based on the claim type, the type of provider in the 837. In File Maintenance, select Master Files > System > Payers. The Add/Modify Payer Information window opens. Select the payer, and then select the Practice tab and then Claims tab and then click either the 1500 Claims, UB Claims, or ADA Claims sub-tab. Select the applicable Submitter Profile from the Submitter Profile drop-down menu (If applicable, attach a Submitter Profile for 1500 Claims, UB Claims, or ADA Claims). Select OK. Parent topic: Payers Master File

File Maintenance Help for NextGen® Enterprise 8

Create a Submitter Group

You can create multiple Submitter Groups for a Submitter Profile. From the File Maintenance window, select Libraries > Submitter Profiles. The Submitter Profile List window opens. Right-click a Submitter Profile in the list and then select Submitter Group. The Submitter Group List window opens. Select open menu button and select New. The Submitter Group window opens. Enter a name for the Submitter Group in the Submitter Group Library field. Enter the submitter number in the Setting field for the Submitter Number option. Enter the contact information for the Submitter Group. Select OK. Parent topic: Using Submitter Groups

Help Guide for NextGen® Enterprise PM 8

Additional Information on Alternate Payer Billing Options

The following table provides additional information on the alternate payer billing options. Field Description Submitter Profile Library You must use the Submitter Profile library while creating electronic claims for the alternate payer. When you do not select the Submitter Profile library for the alternate payer, the alternate payer will use the Submitter Profile library of the payer. When you change the submitter profile in the Payers-Alt Payers master file, a message appears listing the number of pending alternate payer claims (with in the practice) whose submitter profile is flagged for processing. The message also states that if the user proceeds by changing the submitter profile, then the pending claims flagged for processing will be archived and the encounters associated with them will be flagged to rebill. Claim Edit Library When you do not select the Claim Edit library for the alternate payer, the alternate payer will use the Claim Edit library of the payer. Claim Print Library

File Maintenance Help for NextGen® Enterprise 8

Additional Information on Alternate Payer Billing Options

The following table provides additional information on the alternate payer billing options. Field Description Submitter Profile Library You must use the Submitter Profile library while creating electronic claims for the alternate payer. When you do not select the Submitter Profile library for the alternate payer, the alternate payer will use the Submitter Profile library of the payer. When you change the submitter profile in the Payers-Alt Payers master file, a message appears listing the number of pending alternate payer claims (with in the practice) whose submitter profile is flagged for processing. The message also states that if the user proceeds by changing the submitter profile, then the pending claims flagged for processing will be archived and the encounters associated with them will be flagged to rebill. Claim Edit Library When you do not select the Claim Edit library for the alternate payer, the alternate payer will use the Claim Edit library of the payer. Claim Print Library

Help Guide for NextGen® Enterprise PM 8

Enable Segments for Claim-level Approved Amounts and Adjustments

The Submitter Profile library and the Payer master file both have settings that add the claim-level allowed amount segment and the claim-level adjustment segment to the electronic claim file. Because the settings work independently of each other, you can enable them at either level. However, if the same option is enabled at both levels, the Payer master file setting always overrides the Submitter Profile library setting. The following table shows the various results according to how the submitter profile and payer-level options are set: If the Submitter Profile setting is... And the payer-level setting is set to... Then the segment will... Enabled <none> (blank) Create Enabled Create Disabled Not create Disabled <none> (blank) Not create Enabled Create Disabled Not create Do one of the following: To set the options at the Submitter Profile level: In File Maintenance, select Libraries > Submitter Profiles. Open a submitter profile, and then select the Exception Options tab. Select in th

Submitter Profiles Library

Recommendations

Submitter Profile Library

Attach a Submitter Profile to the Payer Master

Create a Submitter Group

Additional Information on Alternate Payer Billing Options

Additional Information on Alternate Payer Billing Options

Enable Segments for Claim-level Approved Amounts and Adjustments

Submitter Profiles Library

Submitter Profile Library

Attach a Submitter Profile to the Payer Master

Create a Submitter Group

Additional Information on Alternate Payer Billing Options

Additional Information on Alternate Payer Billing Options

Enable Segments for Claim-level Approved Amounts and Adjustments