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Help Guide for NextGen® Enterprise PM 8

277 File

This section explains the 277 file. The basic steps in working with the 277 file include: Download the file from the payer or clearing house. Select the File menu and select Processes > Claim Status Import. Print the report. Import 277 Claim Status Updates View Claim Status Results on the Patient Chart COB Balancing Using the 5010 Format Set Up a COB Imbalance Warning Parent topic: Claims Processing

Help Guide for NextGen® Enterprise PM 8

Process Claim Requests for Multiple Encounters

To process claim requests for more than one encounter, use the Claim Request Lookup feature to locate claim requests that are in a Pending status. You can set the search criteria for the lookup to narrow your search to specific types of claim requests. Select the Claim Lookup button on the NextGen® Enterprise PM main menu. The Claim Request Lookup window appears. Select Pending in the Request Status field. Enter the additional search criteria that you want to use to locate the claim requests. Select Find. The Claim Request Lookup lists the claim requests that match your criteria in the Claim Requests section of the window. Place an x in the check boxes next to the claim requests that you want to process. To select all the claim requests in the list, place an x in the top check box on the column heading bar. Right-click on one of the claim requests that you selected and choose Print > Claims option from the short-cut menu. The Claim Printing window appears. Select the Print Format that

Help Guide for NextGen® Enterprise PM 8

Processing Paper Claims

This section explains how paper claims are processed. The process for processing a claim include: Select the form, right-click and select Print. Verify claim for accuracy. Set up or modify Claim Printing Library options as necessary. Attach Claim Printing Library to a Practice. Override the default Claim Printing Library. Process a Claim for a Single Encounter You can process a claim for a single encounter. Parent topic: Claims Processing

Help Guide for NextGen® Enterprise PM 8

Processing Electronic Claims - 837 Files

This section explains how electronic claims (837 files) are processed. The basic steps include: Select the EDI file button. The 837 Electronic File Creation window opens. Select a Submitter Profile library. Select options applicable to the types of claims that you want to send electronically. Select the Process button. Electronic Claims File Structure Control Segments Application Setup for the 837 File 837 Electronic File Creation Window Electronic Send Report Set Up Automatic Task Completion for Clean Claims Submitting Electronic Claims Archiving and Retrieving 837 Electronic Files Tracking Records of Reprinted Archived Claims Parent topic: Claims Processing

Help Guide for NextGen® Enterprise PM 8

Claims Processing

Claims can be processed on demand or in batch mode. This section explains: Paper claims Electronic claims - 837 files 997 files 277 files ERA - 835 files COB - manual posting Processing Paper Claims Claim Production Status Report Processing Electronic Claims - 837 Files Process Claim Requests for Multiple Encounters 997/999 File 277 File Coordination of Benefits Electronic and Manual Processing You can view information on all the payers for EDI claims in the Coordination of Benefits Information window. Parent topic: Claims

NextGen® Background Business Processor Help 8

Claim Acknowledgment Import Job

You can create the job to download and export the claim acknowledge report by configuring the fields as described in the following table. Field Description Source Directory Indicates the directory that you want the job to poll for new 997 files. Update Claim Request Acknowledgment Status? Indicate whether you want the claim request acknowledgment status updated when the job processes. Claim Acknowledgment Report: Printer Name If you indicated that you want the Claim Acknowledgment report sent to the printer, identify the printer you want to use. You can also apply the following settings to the printer: Orientation Tray Size Number of copies Claim Acknowledgment Report: Export Format If you indicated that you want the Claim Acknowledgment report exported, identify the file format you want the job to use. Claim Acknowledgment Report: Export File Name If you indicated that you want the Claim Acknowledgment report exported, enter the file name for the exported file that you want the job to

997/999 File

Recommendations

277 File

Process Claim Requests for Multiple Encounters

Processing Paper Claims

Processing Electronic Claims - 837 Files

Claims Processing

Claim Acknowledgment Import Job

277 File

Process Claim Requests for Multiple Encounters

Processing Paper Claims

Processing Electronic Claims - 837 Files

Claims Processing

Claim Acknowledgment Import Job