Access the COB Information Window

Help Guide for NextGen® Enterprise PM 8

Generating Electronic Secondary Claims from Manually Posted Primary Payments

You can generate HIPAA-compliant electronic secondary claims from manually posted primary payments. A Coordination of Benefits Information window is available from the Payment Entry window for the collection of individual reason codes and adjustment amounts for each detail row on the Payment Entry window. Note: To show all line items on the Payment Entry window, enable the Show All Line Items check box. The amounts from the CPT4 code, billed amount (charge amount), payment amount, allowed amount, and reason codes default from the transaction detail of the Payment Entry window to the Coordination of Benefits Information window. The adjudication date defaults from the Adjudication Date field on the payment batch header (Batch Maintenance window), if the field contains a date. When you select the COB button on the Payment Entry window, the Coordination of Benefits Information window opens. Note: The reason code amount defaults to the Coordination of Benefits Information window if only one

Help Guide for NextGen® Enterprise PM 8

Enter the Allowed Amount in the COB Information Window

If the primary payment allowed amount was posted incorrectly or left blank, you cannot edit the amount on the Payment Entry window, but you can correct it using the following procedure: On the Payment Entry window, select the COB button. The Coordination of Benefits Information window appears. Enter the correct amount in the Allowed column. Note: The allowed amount is required in the secondary file to balance, so if your COB does not list an allowed amount, you must enter the charge amount as the allowed amount. Select OK. The amount is pulled into the 837 file for secondary electronic claims processing. Parent topic: Coordination of Benefits Electronic and Manual Processing

Help Guide for NextGen® Enterprise PM 8

Coordination of Benefits Electronic and Manual Processing

You can view information on all the payers for EDI claims in the Coordination of Benefits Information (COB) window. The Coordination of Benefits Information window provides information on all payers for EDI claims. This includes primary, secondary, and tertiary payers for 837I, 837P, and 837D claims. A summary of all COB activity by charge lines on an encounter for all previous transactions will display on the Coordination of Benefits Information window. When viewing COB1, COB2, COB 3, or All Payer data fields are editable by transaction line. ERA File When the ERA file contains a CAS segment with a charge line that has two identical reason codes, one CAS segment is created for the two identical reason codes in the 837 file. The reason codes are combined and display on a single line in the 837 file. Example: The COB window contains CO45 $50 and CO45 $25 and a PR2 on a single service line, the CAS segment will create CAS*CO*45*75 in the 837 file to represent the CO45 amounts and continu

NextGen® Document Management User Guide,

Link Explanation of Benefits Images to NextGen® Enterprise PM Transactions

You can associate Explanation of Benefits (EOB) batches that you scan or import into NextGen® Document Management with the transaction batches you create in NextGen® Enterprise PM. Associating EOB batches enables you to view the EOB information as you enter payment transactions. Note: To link the current NextGen® Document Management image to the active NextGen® Enterprise PM transaction in EOB Payment Entry window, select Alt+L in NextGen® Enterprise PM when the image you want to link is displayed in the viewer. Open NextGen® Document Management. Scan or import an EOB batch of documents to NextGen® Document Management, and then assign an EOB document type to the batch. OpenNextGen® Enterprise PM, and then when you create a transaction batch, in the Batch Maintenance window, select the NextGen® Document Management EOB batch from the Doc Mgmt Image Batch list. The transaction batch is associated with a batch of EOB documents in NextGen® Document Management. The viewer in NextGen® Enterpr

File Maintenance Help for NextGen® Enterprise 8

Reason Code Library Maintenance Field Descriptions

Use the following table to enter reason codes into the library. Field Description Reason Code Library Enter the name for the library. Hide Library Select this check box to hide the library in the Reason Code List. Search Method: Description Select this option to run a search by reason code description. Search Method: Code Select this option to run a search by reason code. Search for keyphrase anywhere in the item Select this check box to search for a string of letters anywhere in the reason code description instead of searching based on the letters at the beginning of the description. This check box is available when you are modifying an existing reason code library. Type the first letter(s) of the Reason Code to locate Enter the first few letters of the reason code description to display the reason code you are searching for. If you selected the Search for keyphrase anywhere in the item check box, enter letters that occur within the description. Reason Codes List Lists the reason code

Help Guide for NextGen® Enterprise PM 8

Viewing Insurance Information in Encounters

You can view a patient's insurance information in the Insurance tab You can view insurance information for an encounter in the Insurance tab under Encounters. The Encounters section displays the list of patient encounters. The Insurance Information section displays information for the selected insurance based on the setup for the payer in the payers master file in File Maintenance. For more information on setting up payers, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise PM. You can do the following on the Insurance tab under Encounters: Open the Encounter Insurance Selection window for the selected encounter. Open the Insurance Maintenance window for the encounter. Remove the selected insurance from the encounter. Open the Balance Control window for the selected encounter. Open the Authorization Listing window for the selected insurance. Open the Referral Listing window for the selected insurance. Open the

Access the COB Information Window

Recommendations

Generating Electronic Secondary Claims from Manually Posted Primary Payments

Enter the Allowed Amount in the COB Information Window

Coordination of Benefits Electronic and Manual Processing

Link Explanation of Benefits Images to NextGen® Enterprise PM Transactions

Reason Code Library Maintenance Field Descriptions

Viewing Insurance Information in Encounters

Generating Electronic Secondary Claims from Manually Posted Primary Payments

Enter the Allowed Amount in the COB Information Window

Coordination of Benefits Electronic and Manual Processing

Link Explanation of Benefits Images to NextGen® Enterprise PM Transactions

Reason Code Library Maintenance Field Descriptions

Viewing Insurance Information in Encounters