Additional Information on Alternate Payer Billing Options

Field	Description
Submitter Profile Library	You must use the Submitter Profile library while creating electronic claims for the alternate payer. When you do not select the Submitter Profile library for the alternate payer, the alternate payer will use the Submitter Profile library of the payer. When you change the submitter profile in the Payers-Alt Payers master file, a message appears listing the number of pending alternate payer claims (with in the practice) whose submitter profile is flagged for processing. The message also states that if the user proceeds by changing the submitter profile, then the pending claims flagged for processing will be archived and the encounters associated with them will be flagged to rebill.
Claim Edit Library	When you do not select the Claim Edit library for the alternate payer, the alternate payer will use the Claim Edit library of the payer.
Claim Print Library	You must use the Claim Print library while creating paper claims for the alternate payer. When you do not select the Claim Print library for the alternate payer, the alternate payer will use the Claim Print library of the payer.
EDI Claim Profile Library	The EDI Claim Profile library provides support for 2400 loops and segments requested by payers when 2300 loop details are different or same per charge. The settings in this library apply to professional and institutional claims.

Help Guide for NextGen® Enterprise PM 8

Additional Information on Alternate Payer Transaction Options

The following table provides additional information on the alternate payer transaction options. Field Description ERA Payer Numbers The system checks the payer number in the ERA Payer Numbers field and the GS02 segment of the ERA file. If the payer number matches, then the payments are posted against the alternate payer. In the 835 IG, the ERA payer number can be located in the GS02 segment. Require both payments before settling If you select the Require both payments before settling check box, and the billing status shows up as waiting for another payment, then the default status on the line item is set to None to prevent further billing until you receive both the payments. Default Reason Code The default reason code exists at the line item level, and not at the transaction level. Therefore, when posting payments, the default reason code for the alternate payer will be applied to the line item. ERA Reason Code Library You must use the Reason Codes library when the payer number in the

File Maintenance Help for NextGen® Enterprise 8

Additional Information on Alternate Payer Billing Options

The following table provides additional information on the alternate payer billing options. Field Description Submitter Profile Library You must use the Submitter Profile library while creating electronic claims for the alternate payer. When you do not select the Submitter Profile library for the alternate payer, the alternate payer will use the Submitter Profile library of the payer. When you change the submitter profile in the Payers-Alt Payers master file, a message appears listing the number of pending alternate payer claims (with in the practice) whose submitter profile is flagged for processing. The message also states that if the user proceeds by changing the submitter profile, then the pending claims flagged for processing will be archived and the encounters associated with them will be flagged to rebill. Claim Edit Library When you do not select the Claim Edit library for the alternate payer, the alternate payer will use the Claim Edit library of the payer. Claim Print Library

Help Guide for NextGen® Enterprise PM 8

Add an Alternate Payer

In File Maintenance, select Master Files > System > PM, and then select Payers-Alt Payers. The Payers-Alt Payers List window opens. To add an alternate payer, select open menu and then select New. The Add Alt Payer Information window opens. In the Alt Payer Details section, do the following: Enter the alternate payer name. Enter the NEIC/Payer Number, if applicable. You can enter the number for a specific clearing house and/or a specific payer. Enter the alternate payer alias name, if applicable. Enter the in-line edits payer ID, if applicable. Note: You must have a NextGen® In-Line Edits license to use this option. Note: The alternate payer details are system specific. In the Main Address section, enter the address of the alternate payer. To define the billing options for an alternate payer, do the following on the Alt Payer Billing Option tab: Select the applicable values for the fields in the Libraries section. In the Claim Details section, select the applicable media type (electron

Help Guide for NextGen® Enterprise PM 8

Setting Up Claims

Before you can generate claims, you must set up options to define the following: The type of information you want to display in the various claim form fields The way you want the claim forms to print The location, payer, and provider information for a valid claim creation Specialty Billing For more information about the setup and functionality of the types of billing based on speciality, go toNextGen Healthcare Success Communityand download the following user guides: Anesthesia Billing User Guide forNextGen® Enterprise PM Behavioral Health Billing User Guide forNextGen® Enterprise PM Community Health Centers User Guide forNextGen® Enterprise PM Community Health Centers include the following types of billing: Encounter Rate Billing Roll-Up Billing Dental Billing Claim Printing Library The Claim Printing library enables you to specify options that define which information prints on claim forms. Claim Modifiers Library EDI Claim Profile Library The EDI Claim Profile library enables you to

Help Guide for NextGen® Enterprise PM 8

EDI Claim Profile Library

The EDI Claim Profile library enables you to store and configure Electronic Data Interchange (EDI) claim settings in one central library. You can configure EDI claim settings based on payer requirements and control the setup involved when payers require service line level segments to be reported in the 837 claim file. The settings in this library also provide support for the 2400 loops and segments requested by payers when the details are different per charge. After you set up the EDI Claim Profile library, you can: Select a practice specific EDI Claim Profile library on the Libraries tab of the Practice Preferences window. Generate an EDI Claim Profile report to review the library name, dates, default EDI rules, and valid payers. Select the EDI Claim Profile library on the Alt Payer tab of the Add Payer Information or Modify Payer Information window. You can generate EDI Claim Profile Library Listing report from the EDI Claim Profile library. For more information go to NextGen Healthc

File Maintenance Help for NextGen® Enterprise 8

EDI Claim Profile Library

The EDI Claim Profile library enables you to store and configure Electronic Data Interchange (EDI) claim settings in one central library. You can configure EDI claim settings based on payer requirements and control the setup involved when payers require service line level segments to be reported in the 837 claim file. The settings in this library also provide support for the 2400 loops and segments requested by payers when the details are different per charge. After you set up the EDI Claim Profile library, you can: Select a practice specific EDI Claim Profile library on the Libraries tab of the Practice Preferences window. Generate an EDI Claim Profile report to review the library name, dates, default EDI rules, and valid payers. Select the EDI Claim Profile library on the Alt Payer tab of the Add Payer Information or Modify Payer Information window. You can generate EDI Claim Profile Library Listing report from the EDI Claim Profile library. For more information go to NextGen Healthc

Additional Information on Alternate Payer Billing Options

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Additional Information on Alternate Payer Transaction Options

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Additional Information on Alternate Payer Transaction Options

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