Assign a Default Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Attach a Claim Edits Library to a Practice

A Claim Edits library must be attached to a practice to bill encounters and generate claims for the practice. Once a library is attached to a practice that library becomes the default Claim Edits library for the practice. In NextGen® Enterprise PM, select Admin > Preferences > Practice. The Practice Preferences window appears. Select Libraries. In the Claim Edits Library field, select a Claim Edit library. Select OK. Parent topic: Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Set Up the Claim Edits Library

Open the Claim Edits Library type. Select open menu button and then select New. The Claim Edit Library Maintenance window opens. Use the following list to complete the required and optional fields. Claim Edit Library(required) - Enter the name of the library. Quick Start - Do not use the Quick Start field on the Claim Edit Library Maintenance window. When a selection is made, it provides incorrect results and should not be used. Default Task Type - Select a Worklog task to associate with the selected claim edits that have check marks next to them in the list. The task you select will be created as the default task when one of these claim edits is encountered during the claims build process or the claim edits process. Note: Each edit can have a specific task or the default task assigned to it. You can override the default task type used for a specific claim edit by selecting a task type in the Task Type column for the active claim edit. Default Severity(required) - Select a severity lev

File Maintenance Help for NextGen® Enterprise 8

Assign a Default Claim Edits Library

A default Claim Edits Library must be assigned to the practice from the Libraries Practice Preferences so that users can bill encounters and generate claims. Additional information is provided in the Practices Preferences documentation for Libraries. The Claim Edit Library option on the Payer Information window Practice > Libraries tab allows you to override the default Claim Edits library and use an alternate library for a specific payer. Parent topic: Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Libraries tab on the Practice tab

You can override the default Claim Edits Library selected on the Practice Preferences Libraries window in the Payers file. In File Maintenance, access the Payers master file. On the Payers List window, double-click the applicable payer. Select Practice and then Libraries. In the Claim Edits Library field, select the applicable library. Select OK. Parent topic: Assign a Default Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Claim Edits Library

Claim edits are a set of conditions that must be (or are suggested to be) met when you generate a claim. For example, is the patient's zip code required in the claim? Must the referring physician's first name appear on the claim? These are the kinds of requirements you can set up to control the information that appears in the claims you generate. The Claim Edits Libraries enable you to select the claim edits to run when billing encounters and generating claims. A default Claim Edits Library must be created and attached at the Practice Preferences level before you can bill encounters and generate claims. After, a default library is created and attached at the Practice Preferences level, you can then create payer-specific Claim Edits Libraries and attach them at the Payer Master level. These payer-specific claim edits libraries override the default Claim Edits Library. The application maintains a list of available claim edits in the Claim Edits Library, which you can access within File M

File Maintenance Help for NextGen® Enterprise 8

Select a Default Claim Modifiers Library

A Claim Modifiers library can be selected at the practice-level to be used for all payers, or at the payer-level to be used for specific payers only. A payer-level library overrides the default practice-level library for that payer. To select a default library for a practice, do the following: Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Practice. The Practice Preferences window opens. In the Preferences List, select Libraries. In the Claim Modifiers Library field, select the default library to be used for the practice. To save changes and close the window, select OK. To select a default library for a payer, Access File Maintenance Select System Master Files, then PM, and then Payers. The Payer List window opens. From the list, double-click to open a payer. The Modify Payer Information window opens. Select the Practice tab, and then the Libraries sub-tab. In the Modifiers Library field, select the Claim Modifiers library to be used for the payer. To

Assign a Default Claim Edits Library

Recommendations

Attach a Claim Edits Library to a Practice

Set Up the Claim Edits Library

Assign a Default Claim Edits Library

Libraries tab on the Practice tab

Claim Edits Library

Select a Default Claim Modifiers Library

Attach a Claim Edits Library to a Practice

Set Up the Claim Edits Library

Assign a Default Claim Edits Library

Libraries tab on the Practice tab

Claim Edits Library

Select a Default Claim Modifiers Library