CARC and RARC Maintenance Utility

Help Guide for NextGen® Enterprise PM 8

CARC / RARC Combinations - Business Scenarios

The CARC / RARC Combinations Payers report in the 835 must be reported within one of the four Business Scenarios as per the CAQH CORE 360 Rule. CORE defined Claim Adjustment/Denial Business Scenario CORE Business Scenario Description Additonal Information Required - Missing/Invalid/Incomplete Documentation Refers to situations where additional documentation is needed from the billing provider or an ERA from a prior payer. Additonal Information Required - Missing/Invalid/Incomplete Data from Submitted Claim Refers to situations where additional data are needed from the billing provider for missing or invalid data on the submitted claims. Billed Service Not Covered by Health Plan Refers to situations where the billed service is not covered by the health plan. Benefit for Billed Service Not Seperately Payable Refers to situations where the billed service or benefit is not seperately payable by the health plan. Parent topic: CARC and RARC Codes

Help Guide for NextGen® Enterprise PM 8

CARC and RARC Codes

The following table states the various councils and abbreviations used for remittance operating rule. Table 1. Acronyms and Definitions Council/Codes Description Council for Affordable Quality Healthcare (CAQH) An American non-profit organization that collaborates with healthcare providers, trade associations, and insurers. Committee on Operating Rules for Information Exchange (CORE) A multi-stakeholder initiative developing operating rules that streamline electronic healthcare administrative data exchange and support interoperability between payers and providers. Claim Adjustment Reason Codes (CARC) Used to provide an overall explanation for the financial adjustment to the amount submitted on a claim. Remittance Advice Remark Codes (RARC) There are two types of RARC codes: Supplemental: Used to provide additional explanation for an adjustment already described by a CARC. Informational: Used to convey information about remittance processing. These codes are prefaced with "Alert" and ar

NextGen® Enterprise EHR Help

Medication Updates

NextGen Healthcare provides regular medication updates. The medication updates are available for download from the NextGen Healthcare website. You must ensure your medication drug database is up to date. For more information, go to NextGen Healthcare Success Community and download the latest Drug Interaction and Medication Update Utility User Guide for NextGen® Enterprise EHR. Parent topic: Drug and Medication Data

NextGen® Adaptive Content Engine Help Enterprise 8

Configure AUC Scores

Configure AUC Scores Configure AUC Scores You must configure settings in File Maintenance and on the Practice Configuration practice template to use the AUC score wizard. To successfully use the AUC score wizard, you must configure the following settings in File Maintenance. Open NextGen® Enterprise EHR. To activate the AUC rules for the assigned payer, in the File Maintenance, do the following. In the Master Files, click Payers. The Payers List window opens. Double click a payer from the list. The Modify Payer Information window for the payer opens. Click the Orders Module tab, and select the Enable payer for Appropriate Use Criteria rules for Advanced Radiology Imaging orders check box. Apply the AUC for all payers within the same financial class, if necessary. To automate the inclusion of modifier and G-code in the procedure billing, select the Include AUC /HCPCS code modifier automatically option. Select a payer in the encounter level insurance for the current patient. In the Order

File Maintenance Help for NextGen® Enterprise 8

NDC Library in File Maintenance

The NDC (National Drug Code) library enables you to create an NDC drug product list to help you manage billing for drugs that are given in the clinic. In addition, the library enables you to define the relationships between NDC and CPT4 codes. NDC is a universal product identifier for human drugs. Each drug product listed is assigned a unique 11-digit, 3-segment number. This number, known as the NDC identifies the labeler/vendor, product, and trade package size. The NDC Library provides the capability to: Have multiple NDCs for a SIM Populate a claim with an NDC fromNextGen® Enterprise EHR Import NDCs from the published CMS list Display NDC codes from the NDC library on theDrugstab of theService Item Library Maintenancewindow. Display NDC data lines for an imported charge in Charge Entry on theNDC Data for this Chargewindow. CAUTION: To enable the NDC feature for use in your practice, you must first select a default NDC library inLibraries Practice Preferences. NDC Library Security Rig

NextGen® Adaptive Content Engine Help Enterprise 8

Open the Provider CQM Maintenance System Template

You can access the template in multiple ways to capture the provider CQM maintenance details. OpenNextGen® Enterprise EHR. From theFilemenu, selectSystem \ Practice Template. TheSelect Templatewindow opens. From theShowsection, selectAll. To open the Provider CQM Maintenance template, do one of the following: Double-click Provider CQM Maintenance. Select Provider CQM Maintenance, and select OK. Provider CQM Maintenance Parent topic: Configuring Settings for CPT II Claims Based Reporting Parent topic: Provider CQM Maintenance

CARC and RARC Maintenance Utility

Recommendations

CARC / RARC Combinations - Business Scenarios

CARC and RARC Codes

Medication Updates

Configure AUC Scores

NDC Library in File Maintenance

Open the Provider CQM Maintenance System Template

CARC / RARC Combinations - Business Scenarios

CARC and RARC Codes

Medication Updates

Configure AUC Scores

NDC Library in File Maintenance

Open the Provider CQM Maintenance System Template