Archived Claims

Help Guide for NextGen® Enterprise PM 8

Setting Up UB Claims for Enhanced UB Users

Setting up UB claims for Enhanced UB users is different from the set up for Regular UB users, especially if you want to use the automated claims process. For Enhanced UB users, the automated UB claims process only applies to payers who are considered the primary payer. The automated UB claims process is not for payers who are considered secondary or tertiary. The automating of the Type of Bill field, the Occurrence codes, and the Value codes only occurs for primary payers who have the required criteria. Set Up Payers for Enhanced UB Users Set Up Encounters for Enhanced UB Claims (Before Billing) Set Up Encounters for Enhanced UB Claims (After Billing) Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

Access an Archived Claim

Select the Claims icon . The Claim Request Lookup window opens. Enter your search criteria on this window. In the Request Status field select Archived. In the Media Type field: To search for printed claims select 1500. To search for electronic claims select EDI. In the Claim Form field, select the desired claim type. To narrow the results of your search, enter any other data specific to the type of archived claim that you are searching for. Select Find. Parent topic: Archived Claims

Help Guide for NextGen® Enterprise PM 8

Access an Archived Claim from the Encounter Claim Request Window

When searching for an archived claim for a particular patient use this procedure. You can search on information in the patient's profile such as: name, address, social security number, medical record number, person number, phone numbers, or location. Select the Chart icon. On the Patient Lookup window, enter the desired search criteria and select Find. The Patient Lookup window opens. Double-click the Name of the patient. The Patient's Chart window opens. In the Encounters section, select an encounter, right-click and select Claims. The Encounter Claims Request window opens. Parent topic: Archived Claims

Help Guide for NextGen® Enterprise PM 8

Claims

You can view claim statistics for the current practice. Statistics shown are As of Last Night and are updated when the nightly Advisor Update Process runs. Claims statistics include: Paper Claims: Total paper claims (1500/UB/ADA) in Pending status and total charges on those claims Electronic Claims: Total electronic claims (1500/UB/ADA) in Pending status and total charges on those claims Claims Processed (YTD): Total paper and electronic claims processed year-to-date and total charges on those claims Note: Each time a claim is created for an encounter, it is added to the (YTD) totals. Parent topic: Sections Displayed on the Advisor

Help Guide for NextGen® Enterprise PM 8

Claim Dates

Create Date: The date captured when a claim is created once the encounter successfully passes all claim edits during the billing process. The date is equal to the current system date and it cannot be modified. Process Date: The date captured when the claim is printed (if paper) or when the claim is added to an 837 claim file (if electronic). The date is equal to the current system date and it cannot be modified. Parent topic: Filter Dates

Help Guide for NextGen® Enterprise PM 8

Process a Claim for a Single Encounter

Open the patient chart and select the Encounters tab. To process a claim, right-click the applicable encounter and then click Claims. The Encounter Claim Requests window opens. You can generate a claim print for a claim request having electronic media type by right selecting the claim request and disabling the Electronic claim option. Note: The alternate payer name appears in the Payer-Insured column for a carve-out claim. Right-click a claim request and then select Print. The Claim Printing window opens. In the Print Format list, do one of the following: Select Actual Claim Form to generate the claim form that you want to submit to the payer. Select Claim Copy - Not for Submission to generate a copy or spare claim form that you do not intend to submit to a payer. Select Preview to preview the claims. Select the Update 'Pending' to 'Archived' status on paper claim check box to automatically archive the claims after claim printing. Select Options to configure the claim print settings. S

Archived Claims

Recommendations

Setting Up UB Claims for Enhanced UB Users

Access an Archived Claim

Access an Archived Claim from the Encounter Claim Request Window

Claims

Claim Dates

Process a Claim for a Single Encounter