837 Electronic File Creation - File Options and Pending Electronic Claims

Menu Item	Description
Send Filename (required)	To name the EDI file and the path to save the file, select the open folder icon . Browse to the desired location and then name the file.
Batch Type (required	Select the batch type. Prod Test
Update claim requests as processed	Enable this check box to update claim requests as processed.
Report results	Enable this check box to audit changes made on the General, Advanced, or Practice tabs. The changes will display on the Significant Events report.
Use test code in REF02 trans type segment	Enable this check box if you want the Reference Indication (REF02) element in the REF segment, which follows the BHT segment, to indicate that the transaction being transmitted is a test. (Refer to the 837 File Structure section, which explains each of the segments). Note: This option is unavailable when a submitter profile for 5010 is selected for any claim type.

Column	Select to include the...
Encounter Nbr	encounter number on the claim.
Name	patient's name.
Location	location where services were provided.
CT	claim type.
COB	coordination of benefits form number.
Payer/Insured	name of the payer or insurer.
Create	date the claim was created.
Form	claim form type.
Rendering	rendering provider or physician.
Fin Class	financial class.
RTC	data transfer method for sending the claim data.

Help Guide for NextGen® Enterprise PM 8

Create an EDI File by Claim Type, CPT4 Code or Date

To create an EDI file by claim form, claim type, CPT4 code, or begin and end date, use this procedure. Select the EDI File toolbar button. The 837 Electronic File Creation window opens. Complete the following required fields: Submitter Profile Library Claim Form Send File Name Batch Type To further refine your search, enter data in the applicable fields. Enable any of the following check boxes to update claims, create a report, or send a test file: Update claim requests as processed Report results - to display the report after it is processed. Use test code in REF02 trans type segment Select Find. In the Pending Electronic Claims section select the claims to include in the EDI file. Select Process. The Electronic Send report generates and automatically displays when the Report Results check box is enabled. Parent topic: 837 Electronic File Creation Window

Help Guide for NextGen® Enterprise PM 8

Create an EDI File by Practice

Select the EDI File toolbar button. The 837 Electronic File Creation window opens. Complete the following required fields: Submitter Profile Library Claim Form Send File Name Batch Type Select the Practices tab. You can search for claims by a single practice, multiple practices, or all practices within your enterprise. To search for claims by single or multiple practices go to Step 5. To search for claims for All Practices in your enterprise go to Step 7. To search for pending claims associated with a single or multiple practices, select the open record icon. The Practices window opens. Select the Flashlight icon to search for practices. Move the applicable practices to the Included section. Select OK. To search for pending claims across all practices, enable the All Practices check box. Enable any of the following check boxes to update claims, create a report, or send a test file. Update claim requests as processed Report results - to display the report after it is processed. Use test

Help Guide for NextGen® Enterprise PM 8

Create an EDI File by Payer, Patient Name, Rendering Physician, Financial Class, or Location

Click the EDI File toolbar button. The 837 Electronic File Creation window opens. Complete the following required fields: Submitter Profile Library Claim Form Send File Name Batch Type Click the Advanced tab. To refine your search by payer, patient name, provider, financial class, or location, complete any of the following fields: Payer Last/First Name of the patient Rendering- select or search for the rendering provider Report Transmission Code Financial Class Location To search for claims by the primary, secondary, tertiary payer, or for ERA Posted Charges, enable the following check boxes: Primary Secondary Tertiary ERA Posted Charges Only Enable any of the following check boxes to update claims, automatically create a report, or send a test file: Update claim requests as processed Report results - to display the report after it is processed. Use test code in REF02 trans type segment Click Find. In the Pending Electronic Claims section select the claims to include in the EDI file. C

Help Guide for NextGen® Enterprise PM 8

Create an 837 Electronic File

Use the General tab to search for claims by form type, claim type, CPT4 codes, and by date. To access this window, select the EDI File toolbar button. The 837 Electronic File Creation window opens. On the General tab use the following table to identify your search criteria. Field Description Submitter Profile Library (required) Select the applicable submitter profile library. Pending claims that were created with this submitter profile attached to the payer will be returned in the search. The 837 electronic files are created based on submitter profiles because the settings in the submitter profile are specific to the payer, which maintains HIPAA compliancy. Claim Form (required) Select one of the following claim forms: 1500 ADA (Dental) UB. You can only include one claim form type in an 837 electronic file. This corresponds to the submitter profile option, Number of functional groups per file. Claim Type Select the claim type to narrow the search for pending claims based on the claim t

Help Guide for NextGen® Enterprise PM 8

Search for 837 Electronic Claims

Use the Advanced tab to create a search query for encounters by payer, patient name, rendering provider, financial class, report transmission code, ERA posted charges only, or location. The query you create, will return a list of pending electronic claims that match the search criteria. Select the EDI File button on the tool bar. Use the following table to enter search criteria on the Advanced tab: Field Description Payer Select a payer to narrow the search for pending claims. When a specific payer is selected, the search returns pending claims based on the submitter profile and claim form criteria, as well as the specific payer that was selected. This search field is beneficial if you want to create an 837 file for a single payer, but the submitter profile has been attached to more than one payer. Last Enter the first few characters or the last name of the patient to narrow the search for pending claims. First Enter the first few characters or the first name of the patient to narrow t

Help Guide for NextGen® Enterprise PM 8

837 Electronic File Creation Window Practices Tab

Practices Tab Field Description Practices List window Select the Open Record icon to display the Practices window, which allows you to include and exclude practices from the search criteria for pending claims. The ability to include or exclude practices is not limited by the Association feature for the Secure People Lookup function. Search functionality for creating 837 electronic files is available across all practices. All Practices Enable this check box to include all practices in the search criteria for pending claims. Note: If the system-level 837 Elect File Creation Search Filter Changed significant event is enabled, selections or changes made in the following fields on the Practices tab are included in the significant event message that is recorded when a user creates the electronic claim file: Practices added, All Practices. Parent topic: 837 Electronic File Creation Window

837 Electronic File Creation - File Options and Pending Electronic Claims

File Options Section

Pending Electronic Claims Section

Recommendations

Create an EDI File by Claim Type, CPT4 Code or Date

Create an EDI File by Practice

Create an EDI File by Payer, Patient Name, Rendering Physician, Financial Class, or Location

Create an 837 Electronic File

Search for 837 Electronic Claims

837 Electronic File Creation Window Practices Tab