Access an Archived Claim
Select the
Claims
icon
.
The
Claim Request Lookup
window opens.
Enter your search criteria on this window.
In the
Request Status
field select
Archived
.
In the
Media Type
field:
To search for printed claims select
1500
.
To search for electronic claims select
EDI
.
In the
Claim Form
field, select the desired claim type.
To narrow the results of your search, enter any other data specific to the type of archived claim that you are searching for.
Select
Find
.
Recommendations
Explore
Help Guide for NextGen® Enterprise PM 8
Access an Archived Claim from the Encounter Claim Request Window
When searching for an archived claim for a particular patient use this procedure. You can search on information in the patient's profile such as: name, address, social security number, medical record number, person number, phone numbers, or location. Select the Chart icon. On the Patient Lookup window, enter the desired search criteria and select Find. The Patient Lookup window opens. Double-click the Name of the patient. The Patient's Chart window opens. In the Encounters section, select an encounter, right-click and select Claims. The Encounter Claims Request window opens. Parent topic: Archived Claims
Help Guide for NextGen® Enterprise PM 8
Archived Claims
When a claim is created from the billing/claim edits process, it has a status of Pending. Once the pending claim is processed by being printed (paper) or added to an EDI file (electronic), the claim status changes to Archived. Archived claims have a Process Date that indicates the date the claim was put into an archived status. Access an Archived Claim Access an Archived Claim from the Encounter Claim Request Window Parent topic: UB Claims
Help Guide for NextGen® Enterprise PM 8
Search for Claim Requests
The Claim Request Lookup window enables you to search through the system for claims that match the search criteria. In NextGen® Enterprise PM, select Tasks > Lookup > Claims or select the Claims icon. The Claim Request Lookup window opens. To search for claims by request status, media type, claim type, or rendering physician, use the General tab. To search for claims by supervising physician, claim number, or acknowledgment status, select the Advanced tab. Select Find. The search results appear in the Claim Requests list. Double-click the claim in the Claim Requests list to access a claim request. Note: There is a green check mark in the Consolidated Service Claims (CSC) column for all the CSC candidate claims. CSC cannot be deleted. General Search Criteria You can search a claim by its status, media type, claim type, or rendering physician through the General tab of the Claim Request Lookup window. Advanced Search Criteria Parent topic: Generating and Submitting Claims
Help Guide for NextGen® Enterprise PM 8
Advanced Search Criteria
Search Criteria Description Supervising Physician Search by supervising physician. Select the flashlight button to display the Provider Lookup window. Last Name, First Name Search by last name, first name, or both names of the patient associated with the claim. Service Location Search by the service location where the claim was originated. Claim Nbr Search by claim number. Claim Status Category Description Search by the Claim Status Category description. Acknowledgment Status Select the acknowledgment status you want to search by when you perform a claim request lookup. You can search for one of the following statuses: Accepted Accepted w/Errors Awaiting Ack N/A Rejected You can search by acknowledgment status only when the Request Status is set to Archived. Send Filename You can use this field to include an individual EDI file as additional search criteria when you search for archived claims. Select the open record button to locate the EDI file that you want to search on. Fully Capita
Help Guide for NextGen® Enterprise PM 8
Process a Claim for a Single Encounter
Open the patient chart and select the Encounters tab. To process a claim, right-click the applicable encounter and then click Claims. The Encounter Claim Requests window opens. You can generate a claim print for a claim request having electronic media type by right selecting the claim request and disabling the Electronic claim option. Note: The alternate payer name appears in the Payer-Insured column for a carve-out claim. Right-click a claim request and then select Print. The Claim Printing window opens. In the Print Format list, do one of the following: Select Actual Claim Form to generate the claim form that you want to submit to the payer. Select Claim Copy - Not for Submission to generate a copy or spare claim form that you do not intend to submit to a payer. Select Preview to preview the claims. Select the Update 'Pending' to 'Archived' status on paper claim check box to automatically archive the claims after claim printing. Select Options to configure the claim print settings. S
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
.
The Claim Request Lookup window opens.