Claim Edits

Help Guide for NextGen® Enterprise PM 8

Claim Modifiers Library

The Claim Modifiers library can be used by practices when the modifier usage differs from payer to payer. During charge posting, add units to a charge when a specific modifier is entered on the charge for specific SIM types. During the billing process, add a modifier to the claim if the modifier was not entered on the charge. During the billing process, remove a modifier from the claim if the modifier was entered on the charge. Note: For a claim modifier to be applied, the charge service date must fall within the effective date and expiration date defined for the modifier, and the charge must meet all Modifier Change for Claims criteria defined for the modifier. The practice-level default Claim Modifiers library selected in Practice Preferences > Libraries is used for all payers. A payer-level library selected in the Libraries sub-tab under the Practice tab in the Payers master file overrides the practice-level library for that payer. You can generate Claim Modifiers report from the Cl

Help Guide for NextGen® Enterprise PM 8

Claim Printing Library

The Claim Printing library enables you to specify options that define which information prints on claim forms. You must create and attach a Claim Printing library to a practice at the practice preference level before a paper claim can be generated. 1500 Claims, UB Claims, and ADA Claims are available in the Claim Printing library. The Claim Printing library attached at the practice preferences level is the default library. At the payer level, if needed, you can set up an alternate Claim Printing library for a specific payer. You can set the type of information you want to print in each claim field using the selections in the Setting and Option columns in the Claim Printing window. Set Up Claim Printing Library Security Right You can modify the access rights of a user group if you are assigned the Claim Printing Library security rights. Claim Print Options in Claim Printing Library You can select the claim print options through available paper claims and payer types. Attach a Claim Prin

Help Guide for NextGen® Enterprise PM 8

Claim Edits Library

This section contains a listing of all of the available claim edits in the application. Claim Edit Columns Claim Edit Descriptions This section describes the various claim edits available. System-Level Claim Edit Descriptions Parent topic: Claims

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

Help Guide for NextGen® Enterprise PM 8

Claim Edits for Dental Billing

Claim edits that are specific to dental can be selected through the Claim Edits library or automatically when sending diagnoses using the 5010 format. Claim Edits Library for Dental Billing System Claim Edits for the 5010 Format Parent topic: Dental Billing

File Maintenance Help for NextGen® Enterprise 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

Claim Edits

Recommendations

Claim Modifiers Library

Claim Printing Library

Claim Edits Library

Claim Edits Library

Claim Edits for Dental Billing

Claim Edits Library

Claim Edits

Claim Modifiers Library

Claim Printing Library

Claim Edits Library

Claim Edits Library

Claim Edits for Dental Billing

Claim Edits Library