Application Setup for the 837 File

In File Maintenance Access...	For more information refer to...
Libraries	Submitter Profiles	File Maintenance Libraries Guide for NextGen® Enterprise PM
Master Files	Locations Payers Providers	File Maintenance Master Files Guide for NextGen® Enterprise PM
Practice Preferences	File Maintenance Preferences Guide for NextGen® Enterprise PM

Help Guide for NextGen® Enterprise PM 8

837 Electronic File Creation Window

Use the 837 Electronic File Creation window to identify search criteria for claims that you want to send in an electronic file. This window has the following tabs: General, Advanced, and Practices. Each tab contains the File Options and Electronic Claims sections. File Options and Pending Electronic Claims Sections These sections display on each of the tabs for the 837 Electronic File Creation window. File Options - you can select the file for data transfer, identify the batch type, create a report, update claim requests, and send a test file. Pending Electronic Claims - displays the claims that match the search criteria on the active tab. General, Advanced, Practices, File Options, and Pending Electronic Claims Refer to the following topics for information about the fields on this window: 837 Electronic File Creation - General Tab 837 Electronic File Creation - Advanced Tab 837 Electronic File Creation Window Practices Tab 837 Electronic File Creation - File Options and Pending Electr

Help Guide for NextGen® Enterprise PM 8

Processing Electronic Claims - 837 Files

This section explains how electronic claims (837 files) are processed. The basic steps include: Select the EDI file button. The 837 Electronic File Creation window opens. Select a Submitter Profile library. Select options applicable to the types of claims that you want to send electronically. Select the Process button. Electronic Claims File Structure Control Segments Application Setup for the 837 File 837 Electronic File Creation Window Electronic Send Report Set Up Automatic Task Completion for Clean Claims Submitting Electronic Claims Archiving and Retrieving 837 Electronic Files Tracking Records of Reprinted Archived Claims Parent topic: Claims Processing

Help Guide for NextGen® Enterprise PM 8

Preparing for the ERA Posting Process

Prior to ERA posting, you need to complete certain pre-requisites in preparation for the ERA posting process. The summarized list of processes to be completed in preparation for ERA are: Enroll for ERA with a trading partner (clearinghouse or payer). Complete the following setup in File Maintenance for ERA posting: Remittance Profile Library Reason Codes Library Payers Master File Payers-Alt Payers Master File Enterprise Preferences Practice Preferences Create a network directory and folder filing structure for ERA 835 files that can be accessed by all users who download/import files. For example: ServerName:\ERA\Medicare ServerName:\ERA\Medicare\Unprocessed_Files ServerName:\ERA\Medicare\Successful_Files ServerName:\ERA\Medicare\Partially_Processed_Files ServerName:\ERA\Medicare\Failed_Files ServerName:\ERA\Medicare\Reports Determine the naming convention to be used for ERA 835 files and reports. Consult with the trading partner for downloading files from their website. Download an ER

Help Guide for NextGen® Enterprise PM 8

Attach a Submitter Profile to the Payer Master

A submitter profile must be attached to each Payer master file. Note: 837 electronic files cannot be created for payers that do not have a submitter profile set up in their payer master file. In addition, to maintain HIPAA compliance when submitting electronic claims, a provider secondary reference qualifier must be set up at the Payer master file level as well. The provider secondary reference qualifier identifies, based on the claim type, the type of provider in the 837. In File Maintenance, select Master Files > System > Payers. The Add/Modify Payer Information window opens. Select the payer, and then select the Practice tab and then Claims tab and then click either the 1500 Claims, UB Claims, or ADA Claims sub-tab. Select the applicable Submitter Profile from the Submitter Profile drop-down menu (If applicable, attach a Submitter Profile for 1500 Claims, UB Claims, or ADA Claims). Select OK. Parent topic: Payers Master File

Help Guide for NextGen® Enterprise PM 8

Setting Up Payers for ERA

All payers from whom ERA 835 files will be received must be configured prior to importing the electronic files in NextGen® Enterprise PM. If there are multiple master files for the same payer (e.g. Aetna, Aetna HMO, Aetna PPO, etc.), the setup should be done to all master files for that payer. ERA Payer Number Cross-over Indicator Select All Lines for Bill to Next Insurance Create Zero Balance Claims to Subsequent Payers Set Up Default Transaction Codes for a Payer Set Up Default Transaction Codes for an Alternate Payer You can set up default transaction codes for an alternate payer in File Maintenance. Reason Code Library Remittance Profile Library Parent topic: Setting Up ERA

Help Guide for NextGen® Enterprise PM 8

Setting up Charge Test Results

The setup required for sending MEA test result segments on electronic 837P (1500) claims involves the following areas in File Maintenance. Service Items Library Claim Edits Library Code Tables Set up SIM Codes for Test Results You can set up SIM Codes to create MEA test results on electronic claims. Set Up Claim Edits for Test Results You can set up claim edits to create MEA test results on electronic claims. View Code Tables for Test Results You can view code tables for test results on the Code Tables List window. Parent topic: Charge Test Results on Electronic Claims

Application Setup for the 837 File

Recommendations

837 Electronic File Creation Window

Processing Electronic Claims - 837 Files

Preparing for the ERA Posting Process

Attach a Submitter Profile to the Payer Master

Setting Up Payers for ERA

Setting up Charge Test Results