Case Consolidation Claim Edits

Claim Edit or Warning Message	Description	Applicable To	Claim Field
`Case is not complete`	Case with Case Consolidated Claim Program incomplete for Candidate Encounter (list candidate encounters).	Claim Data	2400 DTP
`Encounter date is after CSC program expiry date`	Remove encounter from CSC Program Case or change dates so that Encounter date falls within CSC Program effective dates.	Claim Dates	2300/2400 DTP
`Case Consolidated Claim Program payers do not match on Encounter and Case. (Warning Message)`	All claims for a Case CSC Program must have the same payers on all encounters and the attached Case, or mark the encounter exempt from consolidation.	Claim Payer	1000B

Help Guide for NextGen® Enterprise PM 8

Alerts for Case Consolidation

The following alerts appear when the user selects OK on the Financial tab of the Case Management window. Encounter Dates - The expiration date in the CSC Program window is not required. The application verifies that the encounter dates are prior to the CSC Program date. Alerts are activated when: A case with a Case Consolidated Claim Program is attached and the status is set to close. The case status is closed with no expiration date. When you try to attach a billed encounter to a case with a Case Consolidated Claim Program attached. Attach encounters to a case that is outside the Effective and Expiration date range in the Select Claim Services Consolidation window. Parent topic: Alerts for Case Management

Help Guide for NextGen® Enterprise PM 8

Mark a CSC Encounter as Exempt

CSC candidate encounters can be marked exempt either manually or automatically by the system. Automatic exemption of a claim occurs when the claim is suppressed as a result of File Maintenance settings. Exempt encounter charges are not included in a consolidated claim. Access the Consolidated Services Claim tab under the Claims tab on the Encounter Maintenance window. To identify the responsible attending provider for claim header, complete the Primary Responsible Attending, Secondary Responsible Attending, and Tertiary Responsible Attending fields. Select one of the following options for each applicable insurer: None - (default prior to billing) Responsible Attending Ancillary Provider To remove encounter charges from a primary, secondary, or tertiary CSC claim, select the applicable check box: Exempt from Primary Consolidated Services Claim An alert displays if a Primary HOLD claim is attached to the encounter: A HOLD claim exists for this encounter. Would you like to convert the HOL

Help Guide for NextGen® Enterprise PM 8

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

When you consolidate two or more claims, one claim is considered as the King claim. The other claims are referred to as Candidate claims. When you consolidate the claim, the following rules are applied. If the values are different in King claim and in Candidate claims, a conflicting error message appears in the CSC report. If the values are the same in the King claim and in Candidate claims, the same value appears in the CSC report. If the value is missing in the King claim, the value is taken from the Candidate claims. An error message appears when there is a conflicting data, and an alert message appears when there is missing data. The following table describes the messages displayed. Encounter Message Message Type Help Text Occurs When System unable to consolidate due to conflicting Admit Date on encounters <Enc1> and <Enc3> Enc1, Enc2, Enc3, Enc4 Correct conflicting data on all encounters and rebill. The user has entered different admission dates in <Enc1> and <Enc3>. The Admission

Help Guide for NextGen® Enterprise PM 8

Discharge Date and Time Rules for Consolidated Institutional Fields in CSC Claims

When you consolidate two or more claims, one claim is considered as the king claim. The other claims are referred to as candidate claims. When you consolidate the claim, the following rules are applied. If the values are different in King claim and in Candidate claims, a conflicting error message appears in the CSC report. If the values are the same in the King claim and in Candidate claims, the same value appears in the CSC report. If the value is missing in the King claim, the value is taken from the Candidate claims. An error message appears when there is a conflicting data, and an alert message appears when there is a missing data. The following table describes the messages. Encounter Message Message Type Help Text Occurs When Enc1, Enc2, Enc3, Enc4 System unable to consolidate due to conflicting Discharge Date on encounters <Enc1> and <Enc3>. Error Correct conflicting data on all encounters and rebill. The user has entered different discharge date in <Enc1> and <Enc3>. The Dischar

Help Guide for NextGen® Enterprise PM 8

Alert Messages

The following table provides information on the alert messages and the action to take after reviewing the message. Alert Message Occurs when... Status Click... To... All claims are ready for consolidation. Would you like to create Consolidated Services Claims? All lines in the report are green CSC Claim Pending Yes Create consolidated claims and close the report No Close the report and do not create CSC claim Cancel Return to the report No claims are ready for consolidation. No Consolidated Services Claims will be created. All lines in the report are red Error OK Close the report; no CSC claims created Cancel Return to the report No matching candidate encounter claims found. Convert single HOLD claims to Pending status? All lines in the report are blue Claim Pending Yes Convert single HOLD claims to Pending status and close the report No Close the report and no HOLD claims are converted to Pending Cancel Return focus to the report Not all claims are ready for consolidation. Would you l

Help Guide for NextGen® Enterprise PM 8

Exempting CSC Encounters

CSC options can be set manually on the Consolidated Services Claim tab under the Claims tab on the Encounter Maintenance window. The options set on this tab override the rules in the Consolidated Services Claims library. On the Consolidated Services Claim sub-tab, you can you can do the following: Identify the responsible attending physician to display in the claim header for primary, secondary, and tertiary payers. Identify specific encounters to be exempt from a consolidated services claim. If there is an eligibility overlap during billing, the application displays the following error in the Claim Production Status report: CSC Eligibility Dates overlap with HOLD claims for encounter(s). Correct Eligibility. Parent topic: Claims Consolidated Services Claim Sub-Tab Parent topic: Consolidated Service Claims

Case Consolidation Claim Edits

Recommendations

Alerts for Case Consolidation

Mark a CSC Encounter as Exempt

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Discharge Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Alert Messages

Exempting CSC Encounters

Alerts for Case Consolidation

Mark a CSC Encounter as Exempt

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Discharge Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Alert Messages

Exempting CSC Encounters