Claim Edits for Dental Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Practice Preferences for Dental Billing

Dental billing in NextGen® Enterprise PM requires specific settings in Practice Preferences. Two Charge Entry options must be enabled to display dental fields on the Charge Posting window, and one Claims option must be enabled to enable the three Qualifying Encounter check boxes on the General tab of the Service Items library. Access Practice Preferences. From the Preferences List, select Charge Entry. To display Tooth, Surface and Quadrant fields on the Charge Posting window, select the Display tooth, surface, quadrant check box. To allow multiple selections in the Surface field on the Charge Posting window, select the Allow multiple tooth surfaces check box. Practice Preferences From the Preferences List on the left, select Claims. To enable the three Qualifying Encounter check boxes on the General tab of the Service Items library, select the Enable Qualifying Encounter Billing check box. Practice Preferences To save changes and close the window, select OK. The dental fields display

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

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

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

Help Guide for NextGen® Enterprise PM 8

Dental Billing

This section provides information on dental billing for Health Centers that perform dental services. Specific setup in File Maintenance is required so that dental charges can be entered on encounters and then billed to dental payers on either 1500, ADA or UB claim forms. The type of claim form generated is determined by the setup for each dental payer. The following claim formats are supported in NextGen® Enterprise PM: 1500: Electronic 837PPaper CMS 1500 Form (2012) ADA: Electronic 837D Paper ADA Form (2024) UB: Electronic 837IPaper UB04 Form (2004) Dental billing in NextGen® Enterprise PM involves the following setup in File Maintenance: Practice Preferences Code Tables CPT4 Codes SIM library Claim Edits library Claim Printing library Transaction Codes Payers Set Up Practice Preferences for Dental Billing View Code Tables for Dental Billing Service Items Library for Dental Billing Claim Edits for Dental Billing Claim Printing Library for ADA Claims Payers Master File for Dental Billi

Claim Edits for Dental Billing

Recommendations

Set Up Practice Preferences for Dental Billing

Service Items Library for Dental Billing

System Claim Edits for the 5010 Format

Claim Edits Library for Dental Billing

Claim Edits

Dental Billing

Set Up Practice Preferences for Dental Billing

Service Items Library for Dental Billing

System Claim Edits for the 5010 Format

Claim Edits Library for Dental Billing

Claim Edits

Dental Billing