Add Claim Consolidation Rules to a CSC Library

Help Guide for NextGen® Enterprise PM 8

Add Claim Header Rules to a CSC Library

Access the Consolidated Services Claim Maintenance window for the applicable library. Note: To access a library, refer to the procedure Accessing a Consolidated Services Claim Library. Select the Claim Header Rules tab. In the Select Responsible Attending Provider by Specialty area, select Open Folder. The Attending Specialty Hierarchy window opens. On the Attending Specialty Hierarchy window, do one of the following: To add a specialty to the Included list, select the specialty in the Available list, and then select Include . The specialty moves from the Available list to the Included list. To remove a specialty from the Included list, select the specialty in the Included list, and then select Exclude . The specialty moves from the Included list to the Available list. Note: The list can be sorted numerically by selecting on Specialties column header or alphabetically by selecting the Description column header. Select OK. The Consolidated Services Claim Maintenance window displays with

File Maintenance Help for NextGen® Enterprise 8

Add Claim Consolidation Rules to a CSC Library

To enable claims consolidation, you must select the form types that you want to consolidate. Then you can choose to consolidate only encounter rate claims and/or claims with the same encounter rate SIM. These rules will apply to all of the payers in the Valid Payers list. Access the Consolidated Services Claim Maintenance window for the applicable library. Note: To access a CSC library, refer to the Accessing a Consolidated Services Claim Library procedure. After opening the Consolidated Services Claim Maintenance window, select a valid payer for the claim, then Claim Consolidation Rules. From the Claims Consolidation Rules tab, select a Claim Consolidation Rules row (CCR row) and open by doing one of the following: Right-click the library and select Open. Select the open menu button and select Open. The CSC Timespan Rules window opens for the library you selected. Complete the timespan rules. Note: When creating a new library, the Claim Consolidation Rules row (CCR row) is not require

Help Guide for NextGen® Enterprise PM 8

Claim Consolidation Rules

The following table lists the claim consolidation rules to be set for a selected time span. Field Description Claim Form Type To enable claims consolidation select one of the following options: 837P/1500 837I/UB Both Encounter Rate Claims Select one or both of these options to consolidate encounter rate claims: Consolidate Encounter Rate claims only. Consolidate only claims with the same Encounter Rate SIM. A green check mark appears in these fields. Consolidate Encounter Rate SIM Service Line Rollup Encounter Rate Service Line In this field select either: No - encounter rate SIM claims will not be consolidated. The remaining fields are not available. Yes - to consolidate encounter rate SIM claims. Complete the fields that are active for the selected timespan. Encounter Rate SIM Quarterly Same Day Claims Select either: Sum of ER Service Lines 1 Weekly Claims The default value in this field is 1. The value cannot be changed. Monthly Claims Select either: 1 Sum of ER Service Lines Number

Help Guide for NextGen® Enterprise PM 8

Set Up for Eligible Number of Patient Days Billing

Access File Maintenance. Select Libraries, and then Consolidated Services Claim library. The Consolidated Services Claim List window opens. Double-click to open the desired library. The Consolidated Services Claim Library Maintenance window opens. Select the open menu button . The Consolidated Services Claim Maintenance window opens. Complete the following fields: Effective Date Expiration Date Description Add the Valid Payers Select the Claim Consolidation Rules tab and then select the open menu button and select New. The CSC Timespan Rules window opens. Complete the following fields: In the Length of Timespan field, select Consolidate Monthly Claims. In the Description field, enter a description for this type of billing. In the Rollup Encounter Rate Service Line field, select Yes. In the Encounter Rate SIM Quantity field, select Number of Eligible Days. In the Encounter Rate Service Line Amount field, select Eligible Patient Days times Original Charge Amount. Select OK. Parent topic:

File Maintenance Help for NextGen® Enterprise 8

Set Up for Eligible Number of Patient Days Billing

Access File Maintenance. Select Libraries, and then Consolidated Services Claim library. The Consolidated Services Claim List window opens. Double-click to open the desired library. The Consolidated Services Claim Library Maintenance window opens. Select the open menu button . The Consolidated Services Claim Maintenance window opens. Complete the following fields: Effective Date Expiration Date Description Add the Valid Payers Select the Claim Consolidation Rules tab and then select the open menu button and select New. The CSC Timespan Rules window opens. Complete the following fields: In the Length of Timespan field, select Consolidate Monthly Claims. In the Description field, enter a description for this type of billing. In the Rollup Encounter Rate Service Line field, select Yes. In the Encounter Rate SIM Quantity field, select Number of Eligible Days. In the Encounter Rate Service Line Amount field, select Eligible Patient Days times Original Charge Amount. Select OK. Parent topic:

Help Guide for NextGen® Enterprise PM 8

Consolidate Claims by Time Span

The CSC process is initiated on the Claims Request Lookup window. You can search for claims on a time-span of daily, weekly, monthly, or case. This process provides a clear visual of all of the HOLD claims that can be processed when the CSC process is initiated. You can sort the encounters by selecting on the TS (time-span) column. From the menu, select Tasks > Lookup > Claims or select the Claims icon. The Claim Request Lookup window opens. Claim Request Lookup In the Request Status field, select Hold H. The Consolidated Services Claim Time Span field becomes active. In the Consolidated Services Claim Time Span field select one of the following options: <none> - to display all Hold claims. Consolidate Same Day Claims - to display all encounters that occurred on the same date. Consolidate Weekly Claims - to display all encounters during the same week. The week as defined in the CSC library, either Sunday through Saturday or Monday through Sunday. Consolidate Monthly Claims - to display

Add Claim Consolidation Rules to a CSC Library

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