Attach a Submitter Profile to the Payer Master

Help Guide for NextGen® Enterprise PM 8

Select Media Types

You can select the media type for secondary and tertiary COB levels in the Payer master file. You can set the default media type for primary, secondary, and tertiary claims to be different for a particular payer. To access this window, open File Maintenance, select Master Files > PM > Payers, and then select the applicable payer. On the Modify Payer Information window, select the Practice tab and then the Claims sub-tab. In addition, you can set the Payer master file to force secondary and tertiary claims to paper for another payer. In other words, regardless of the media type setting in the Payer master file for the next payer, you can override those settings and force the claim to paper for the payers getting the secondary and tertiary claim. To force secondary and tertiary claims to paper for the next payer, activate the following options on the Practice Parameters tab of the Payer master file: When Primary, force Secondary claims to paper When Secondary, force Tertiary claims to pa

Help Guide for NextGen® Enterprise PM 8

System Tab

To set up provider secondary references, use the ADA Claims tab on the Claims sub-tab on the System tab of the Modify Payer Information window. Modify Payer Information Use the following table to set up your Provider Secondary References for dental payers. Provider Secondary Reference Qualifier / Data Element Billing Tab Employer ID Number (EI) / Tax ID Referring Tab <none> / <none> Rendering Tab <none> / <none> Service Facility Tab <none> / <none> Payer Billing Tab <none> / <none> Note: For more information on provider secondary references, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise, and then refer to the Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs section. Parent topic: Payers Master File for Dental Billing

Help Guide for NextGen® Enterprise PM 8

Create an 837 Electronic File

Use the General tab to search for claims by form type, claim type, CPT4 codes, and by date. To access this window, select the EDI File toolbar button. The 837 Electronic File Creation window opens. On the General tab use the following table to identify your search criteria. Field Description Submitter Profile Library (required) Select the applicable submitter profile library. Pending claims that were created with this submitter profile attached to the payer will be returned in the search. The 837 electronic files are created based on submitter profiles because the settings in the submitter profile are specific to the payer, which maintains HIPAA compliancy. Claim Form (required) Select one of the following claim forms: 1500 ADA (Dental) UB. You can only include one claim form type in an 837 electronic file. This corresponds to the submitter profile option, Number of functional groups per file. Claim Type Select the claim type to narrow the search for pending claims based on the claim t

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

Help Guide for NextGen® Enterprise PM 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

File Maintenance Help for NextGen® Enterprise 8

Submitter Profiles Library

A Submitter Profile needs to be created for each clearinghouse and direct payer that you use for submitting electronic claims. The information in a submitter profile includes a combination of your submitter information and electronic file options that are specified by the clearinghouse and direct payer, which allow the electronic claim to be accepted and processed without rejection. The Submitter Profile Library Maintenance security right enables users to access the Submitter Profile Library and to create and modify Submitter Profiles. Note: If you want electronic claims to be created for certain payers, payer-specific submitter profiles must be attached at the Payer master level. Set Up Submitter Profiles

Attach a Submitter Profile to the Payer Master

Recommendations

Select Media Types

System Tab

Create an 837 Electronic File

ADA Claims Tab on Claims

ADA Claims Tab on Claims

Submitter Profiles Library

Select Media Types

System Tab

Create an 837 Electronic File

ADA Claims Tab on Claims

ADA Claims Tab on Claims

Submitter Profiles Library