Additional Information

Help Guide for NextGen® Enterprise PM 8

Create Zero Balance Claims to Subsequent Payers

A practice may have a need to send a claim to the next payer even though the previous payer paid the claim in full. For example, an FQHC practice reports to a secondary “wrap” payer by sending a claim showing services that were completely paid by the primary payer. Line item charges that have been paid in full by the previous ERA payer, and now have a $0.00 balance, can be settled to the next subsequent payer so a claim is created in NextGen® Enterprise PM for that secondary/tertiary payer. Access File Maintenance. Select Master Files, then System, and then Payers. The Payers List window appears. From the list, select and open the desired payer. The Modify Payer Information window appears. Select the Practice tab, and then the Other sub-tab. Select the ERA – Create Zero Dollar Total Balance Claims to Selected Subsequent Payer(s) check box. In the field to the right, select the subsequent Payer(s). To save changes and close the window, select OK. Additional Information Parent topic: Set

Help Guide for NextGen® Enterprise PM 8

Select All Lines for Bill to Next Insurance

When an ERA 835 file from a payer is imported, if any line item on the encounter is selected to be rebilled to the next payer, the practice can choose to instead rebill all line items to the next payer. When the below option is selected for a payer and an ERA file is imported, all line items will flag to rebill if one line item is selected to rebill, including those with a $0.00 balance. All line item charges are settled to the next subsequent payer so a claim is created in NextGen® Enterprise PM for that secondary/tertiary payer. Access File Maintenance. Select Master Files, then System, and then Payers. The Payers List window appears. From the list, select and open the desired payer. The Modify Payer Information window appears. Select the Practice tab, and then the Other sub-tab. Select the ERA – If any line is selected for bill, select all lines for bill to next insurance check box. To save changes and close the window, select OK. Parent topic: Setting Up Payers for ERA

Help Guide for NextGen® Enterprise PM 8

Setting Up Practice Preferences for ERA

You can configure the following ERA settings in Practice Preferences. Go to Practice Preferences, then Libraries and select Remittance Profile Library to set the default library to be used for all ERA payers that do not have a specific library linked in the practice. Go to Practice Preferences, then Transactions and select Default Reason Code Library to set the default library to be used for all payers (ERA and non-ERA) in the practice, that do not have a specific library linked. Note: NextGen Healthcare recommends the use of the HIPAA X12 Standard Reason Codes library as the default for a practice for all payers. Use settled up status with ERA. You can select this check box to default the Settled moved to Primary transaction status onto ERA payment or adjustment transactions received from the secondary payer before the primary payer. When a secondary transaction is received before primary, a credit balance is normally created in the secondary payer (Ins2 Amt) bucket in Balance Control

Help Guide for NextGen® Enterprise PM 8

Posting an Electronic Remittance

This section provides information about the process of posting an electronic remittance. When posting the ERA, the system compares the ERA payment information for each claim in the file against the encounter information in your system that the claim was originally created for. In order for the ERA payments for each claim to post successfully, the ERA payment information for a claim must match the encounter information the ERA is posting against. If there is a discrepancy between the ERA information and the encounter information, the ERA payment for that claim does not post and an error message displays on the ERA Import Posting report. In addition, if an ERA payment is posting against multiple line items in an encounter, all the line items must be error-free for the ERA payment to post successfully. The ERA process only calculates and posts adjustments for encounter primary and secondary payers. If the primary ERA pays a charge off, it is settled to the secondary and is included on the

Help Guide for NextGen® Enterprise PM 8

Resolving Internal System-Related ERA Errors

The ERA messages outlined here are related to internal system errors. These ERA messages are also considered primary and secondary. The primary error ERA message This type of ERA message indicates the exact line item in the encounter that caused the ERA posting process for the encounter to be unsuccessful. The secondary ERA message This type of message displays for any line item following the primary error. Because the ERA posting process was stopped due to the primary error, these line items are not processed. The following table outlines each of the primary error ERA messages and the associated secondary ERA messages, a description of why the primary and secondary ERA message may have occurred, and the possible resolution to the primary error message. Primary Error ERA Message Message Description How to Resolve Insurance not found for this encounter. The ERA file information for the insurance associated with this encounter does not match the insurance associated with the encounter in

File Maintenance Help for NextGen® Enterprise 8

ADA Claims Tab on Claims

This window is in the Payer master file. To access the window select Payers and then select the payer. On the Modify Payer Information window select Practice > Claims > ADA Claims sub-tab. Field Description Submitter Profile Select the submitter profile that you want to apply to ADA Claims. Electronic Transmitter ID Enter the payer-assigned electronic transmitter ID to generate a claim with an electronic transmitter ID. Note: This field only displays when you select a submitter profile. Practice Payer Opt Val Enter the practice/payer-specific value. Payer Alias Enter an alternative payer name when a name that differs from the name that appears in the payer's Payer master file is required. Primary, Secondary, and Tertiary Media Types Enter the primary media type as either electronic or paper as accepted by the clearinghouse. If you set it as electronic, then you can also set how the secondary and tertiary claims should be submitted. When Primary, force Secondary claims to paper Enable t

Additional Information

Recommendations

Create Zero Balance Claims to Subsequent Payers

Select All Lines for Bill to Next Insurance

Setting Up Practice Preferences for ERA

Posting an Electronic Remittance

Resolving Internal System-Related ERA Errors

ADA Claims Tab on Claims

Create Zero Balance Claims to Subsequent Payers

Select All Lines for Bill to Next Insurance

Setting Up Practice Preferences for ERA

Posting an Electronic Remittance

Resolving Internal System-Related ERA Errors

ADA Claims Tab on Claims