Claim Edits for Dental Billing

Help Guide for NextGen® Enterprise PM 8

Service Items Library for Dental Billing

When setting up SIM codes for dental, set the Form field on the Service Item Library Maintenance window to ADA. Service Library Maintenance Set Up Payer-Specific Requirements Parent topic: Dental Billing

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

Help Guide for NextGen® Enterprise PM 8

System Claim Edits for the 5010 Format

You can send diagnosis codes on dental claims using the 5010 837D format. However, this format only allows for four diagnosis codes. To prevent dental encounters from billing when there are more than four diagnosis codes, the following hard-coded system claim edit warning displays: ADA claims only allow for four diagnosis codes. Parent topic: Claim Edits for Dental Billing

Help Guide for NextGen® Enterprise PM 8

Claim Edits Library for Dental Billing

The dental options in the Claim Edits library are described in the following table. ID Claim Edit Description Applicable To Claim Field 87 Quadrant cannot have a value, since Tooth and Surface has a value Do not enter a Quadrant value. Charge Entry CHG01 88 Tooth and Surface cannot have a value, since Quadrant has a value Do not enter Tooth or Surface values. Charge Entry CHG01 89 Invalid Surface Value for the selected Tooth Select a valid Surface associated with the Tooth. Charge Entry CHG01 143 Surface Value cannot exceed maximum length of 0 Revise the Surface Value to be less than or equal to the maximum length specified. Charge Entry CHG01 144 Surface Value can contain only <Unknown> Correct the Surface Value to contain only those code letters specified. Charge Entry CHG01 Parent topic: Claim Edits for Dental Billing

Help Guide for NextGen® Enterprise PM 8

System Claim Edits for the 5010 Format

You can send diagnosis codes on dental claims using the 5010 837D format. However, this format only allows for four diagnosis codes. To prevent dental encounters from billing when there are more than four diagnosis codes, the following hard-coded system claim edit warning displays: ADA claims only allow for four diagnosis codes. Parent topic: Claim Edits for Dental Billing

Help Guide for NextGen® Enterprise PM 8

Claim Edits

This chapter includes information about the Claim Edits library and the various types of edits that can be applied to a claim during claim processing. This section includes: Claim Edits Library PQRI Edits CCI Edits Local Medical Review Policy ICD Diagnosis Edits Claim Edits Library PQRI Edits CCI Edits Local Medical Review Policy Parent topic: Setting Up Claims

Claim Edits for Dental Billing

Recommendations

Service Items Library for Dental Billing

Claim Edits for Dental Billing

System Claim Edits for the 5010 Format

Claim Edits Library for Dental Billing

System Claim Edits for the 5010 Format

Claim Edits

Claim Edits for Dental Billing

Service Items Library for Dental Billing

Claim Edits for Dental Billing

System Claim Edits for the 5010 Format

Claim Edits Library for Dental Billing

System Claim Edits for the 5010 Format

Claim Edits