277 File

Help Guide for NextGen® Enterprise PM 8

997/999 File

This section explains the 997/999 file. The basic steps in working with the 997 and 999 file include: Download the file from the payer or clearing house. Select the File menu and select Processes > Claim Acknowledgement Import. Print the report. Functional Acknowledgements Parent topic: Claims Processing

Help Guide for NextGen® Enterprise PM 8

Claim Production Status Report

The Claim Production Status report is generated when charges are put through the edit process. Edit happens automatically when the charge is being billed as described in Billing Encounters. The edits include checking if the charges adhere to National Standard Format (NSF) criteria, and any other contractual criteria that might be required. The report lists out charges sorted by encounter, then 1500 or UB form type, rendering physician, payer name, insured's name, patient's name, and severity of the warning. There are no totals or additional filters for this report. The columns are encounter number, 1500 or UB form type, patient name, severity of the warning, error message, edit source, rendering physician, payer name, insured's name, error number, claim status, NSF ID, encounter referring provider, supervisor provider, SIM total charge amount, provider NPI, and SIM (Service Item Codes). Error, Warning, and Informational labels appear underneath the Severity column. Errors result in dir

Help Guide for NextGen® Enterprise PM 8

Import 277 Claim Status Updates

You can receive and view solicited and unsolicited 277 claim status updates. Payers, with whom you have arranged to send you claim status updates, periodically send you status files that you can locate and import using the Import Claim Status window. Select the File menu and select Processes > Claim Status Import. The Import Claim Status window appears. Do one of the following: To save the import to a folder, enter the path of the folder in the Claim Status Filename field. To view the claim status information, without importing the results, select Display Only. When you import the status result, the application checks to see if the status is associated with a current claim request. If it is, the application updates that claim request status with the newly imported status. The application displays the contents of the imported claim status in the Claim Status Import report. This report displays automatically immediately after you import the status file. Parent topic: 277 File

Help Guide for NextGen® Enterprise PM 8

View Claim Status Results on the Patient Chart

Quicknotes are automatically added to the patient chart when the claim status is run. You can track and view solicited and unsolicited claim status results from the claim status import in a quicknote, which is attached to an encounter. Quicknotes are only created if the referenced 277 finds the encounter ID and the patient ID. Open the patient chart and select the Clinical History/Notes tab. The Clinical History/Notes window appears the Topics section on the left and the Description section on the right. In the Topics section, expand the Notes folder under the Chart Notes folder. Double-click on the note you want to access or right-click and select Open from the shortcut menu. The Quicknote window appears. Parent topic: 277 File

Help Guide for NextGen® Enterprise PM 8

Set Up a COB Imbalance Warning

You can setup a practice preference to issue a warning when the COB allowed or billed amount is out of balance. On the Admin menu and select Preferences and then Practice. The Practice Preferences window opens. Select Transactions from the Preference List. In the COB Windows Options section of the window, enable one or more of the following check boxes: Warn on COB imbalance with allowed amount Warn on COB imbalance with billed amount After you enable one of the check boxes, and close the Coordination of Benefits Information window, a balance check is performed on the COB information. If the information does not balance, then one or both of the following warning messages appear if the allowed amount or billed amount is out of balance: Paid amount and patient responsible amounts do not equal allowed amount. Do you want to continue? All payments and adjustments do not equal billed amount. Do you want to continue? Parent topic: 277 File

Help Guide for NextGen® Enterprise PM 8

Open Claim Status Report from Clinical History/Notes

Before you begin Submit a claim status request for the encounter. In theClinical History/Notes tab, Chart Notes > Claim Status Result under Topics list displays the list of claim requests submitted for the encounter. You can open and view the claim status report. In NextGen® Enterprise PM, open the Patient Chart and select the Clinical History/Notes tab. From Topics, select Claims Status Result located under Chart Notes. The Details pane displays the claim status results attached to the patient. Right-click the desired encounter or claim number and select Open. The Claim Status report opens displaying the following: Claim status response date and time. Statistical view of the claim status (accepted or rejected), bill amount, and paid amount. Collapsed view of the claim status requested for the encounter. Note: To view the detailed report of the claim status, select and expand the claim. Parent topic: Claim Status

277 File

Recommendations

997/999 File

Claim Production Status Report

Import 277 Claim Status Updates

View Claim Status Results on the Patient Chart

Set Up a COB Imbalance Warning

Open Claim Status Report from Clinical History/Notes

997/999 File

Claim Production Status Report

Import 277 Claim Status Updates

View Claim Status Results on the Patient Chart

Set Up a COB Imbalance Warning

Open Claim Status Report from Clinical History/Notes