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Activate a Claim Edit to Require Case Management
You can create claim edits that indicate that a case must be attached to an encounter.
In File Maintenance, select
Libraries
>
Claim Edits
.
The
Claim Edits List
window opens.
Select a claim edit library.
In the
ID
column, locate the row that contains ID number 217
Claim payer requires case management
.
Select the
Active
column.
A green check mark
appears in the cell to indicate that the claim edit is active.
Activate a Claim Edit to Require Case Management
Help Guide for NextGen® Enterprise PM 8
Require Case Management for a Payer
You can indicate that a payer requires case management in NextGen® Enterprise PM. The payer can then only be used on encounters that are part of a case. When case management is required, the following occurs: The Case Management Required field displays on the Patient Chart > Encounters tab > Case Management tab. If a user selects insurance for an encounter and a case is not attached to the encounter, then a warning alert displays when a user saves the encounter insurance. To generate a claim edit when the payer is attached and the encounter is not linked to a case, activate claim edit 217. In File Maintenance, select Master Files > System > Payers. Double-click a payer. The Modify Payer Information window opens. Select Practice tab > Other tab. Select Require Case Management, and then select OK. Select Require Case Management, and then select OK. If you want to generate a claim edit when the payer is attached but the encounter is not linked to a case, activate claim edit 217. Parent to
Help Guide for NextGen® Enterprise PM 8
Activate Claim Edits
The Claim Edits Library contains a list of the available claim edits you can apply to the claims you generate. In File Maintenance, select Libraries > Claim Edits and select the applicable Claim Edits Library. The Claim Edit Library Maintenance window opens. Select the claim edit you want to activate by selecting in the Active column. A check mark displays to indicate the claim edit is active. To edit the Help Text, select the Help Text field and enter the new description for the Help Text. To change the edit severity level, select in the Severity field, and select one of the following severity levels: Warning Critical Custom Required After you make your selections, select OK. Parent topic: Claim Edits Library
Help Guide for NextGen® Enterprise PM 8
Activate Claim Edits
The Claim Edits Library contains a list of the available claim edits you can apply to the claims you generate. In File Maintenance, select Libraries > Claim Edits and select the applicable Claim Edits Library. The Claim Edit Library Maintenance window opens. Select the claim edit you want to activate by selecting in the Active column. A check mark displays to indicate the claim edit is active. To edit the Help Text, select the Help Text field and enter the new description for the Help Text. To change the edit severity level, select in the Severity field, and select one of the following severity levels: Warning Critical Custom Required After you make your selections, select OK. Parent topic: Claim Edits Library
File Maintenance Help for NextGen® Enterprise
Configure Claim Edits
Some claim edits display in blue when they are active and require additional parameters to set up the description. If the parameters are not set up, then the claim edit displays in red and the library cannot be saved. In addition, several claim edits have variable numeric values that can be changed. Typically, these claim edits display in black and do not require changes because the value in the description is valid. If the claim edit line item charge is equal to $0.00, it does not require a change because zero is a valid value. In File Maintenance, select Libraries, and then select Claim Edits. The Claim Edits List window opens. Double-click the claim edit or select the Open Menu, and then select New. The Claim Edit Library Maintenance window opens. Right-click the claim edit description that displays with blue text, and then select Open. Claim Edit Library Maintenance Window The Claim Edit Options window opens. The parameters that display on this window depends on the claim edit desc
Help Guide for NextGen® Enterprise PM 8
Configure Claim Edits
Some claim edits display in blue when they are active and require additional parameters to set up the description. If the parameters are not set up, then the claim edit displays in red and the library cannot be saved. In addition, several claim edits have variable numeric values that can be changed. Typically, these claim edits display in black and do not require changes because the value in the description is valid. If the claim edit line item charge is equal to $0.00, it does not require a change because zero is a valid value. In File Maintenance, select Libraries, and then select Claim Edits. The Claim Edits List window opens. Double-click the claim edit or select the Open Menu, and then select New. The Claim Edit Library Maintenance window opens. Right-click the claim edit description that displays with blue text, and then select Open. Claim Edit Library Maintenance Window The Claim Edit Options window opens. The parameters that display on this window depends on the claim edit desc
Help Guide for NextGen® Enterprise PM 8
Case Management Setup
Setting up Case Management involves the following: Grant the necessary user rights and permissions in System Administrator. Enable Case Management in File Maintenance. Set alerts. Add case information to: Fee tickets Form and label templates from the data repository Requires a case on an encounter. Activate claim edits. Set up the Case Type Master. File in the File Maintenance. Set up and populate the Case Category, Case Contact Role, and Case Market in Master Lists in File Maintenance. Restrict user access to case management in System Administrator. If you use template editor, create the appropriate Case Management Templates in Template Editor. This involves setting the following General Options universal preferences in the System Administrator application that enable you to map template field names to case level templates: Case Mgt Case Type Category Field Case Mgt Case Type Category Item Field Case Mgt Market Field Enable consolidation of claims related to a Clinical Episode of care
