Using Submitter Groups

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

File Maintenance Help for NextGen® Enterprise 8

Assign a Submitter Group to a Payer at the Provider Level

Before you can use a Submitter Group with a Submitter Profile, you must associate the Submitter Group with a payer at the provider level. In the File Maintenance window, select Master Files - System > Providers. Double-click a provider. On the Modify Provider Information window, select the Practice tab. Select the Rendering provider at this practice check box. Select a location from the Service Location field. Do one of the following: Double-click a payer listed in the Payer Name column. Right-click anywhere in the Group Information list, then select New. The Add/Modify Provider Practice Payer window opens. In the Submitter Group field, select the Submitter Group that you want to associate with the payer displayed in the Payer Name field. Select OK. Parent topic: Using Submitter Groups Parent topic: Providers Practice Tab

File Maintenance Help for NextGen® Enterprise 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 8

Submitter Profiles Library

A Submitter Profile needs to be created for each clearinghouse and direct payer that you use for submitting electronic claims. 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. Set Up Submitter Profiles

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

Groups Master File

You can add group numbers to claims for insurance carriers by properly setting up the groups. The groups are managed in File Maintenance using both the Groups and Providers master file. Set Up the Groups Master File Parent topic: Setting Up Claims

Using Submitter Groups

Recommendations

Create a Submitter Group

Assign a Submitter Group to a Payer at the Provider Level

Set Up Submitter Profiles

Submitter Profiles Library

Submitter Profile Library

Groups Master File

Using Submitter Groups

Create a Submitter Group

Assign a Submitter Group to a Payer at the Provider Level

Set Up Submitter Profiles

Submitter Profiles Library

Submitter Profile Library

Groups Master File