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
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Help Guide for NextGen® Enterprise PM 8
837 File Structure
This section provides a detailed description of the 837 file structure. 837 File Structure Parent topic: Claims
Help Guide for NextGen® Enterprise PM 8
Claim Printing Options
Claim Printing options enable you to control what information prints in each box of a paper claim. Claim Print Options in Common Rules Tab This section contains the claim prints options in common rules tab. Claim Print Options When the Payer is Primary This section contains the claim prints options when the payer is primary. Claim Print Options When the Payer is Secondary This section contains the claim print options when the payer is secondary. Claim Print Options When the Payer is Tertiary This section contains the claim prints options when the payer is tertiary. Parent topic: Claims
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
Claim Edit Columns
The columns in the Claim Edit Library Maintenance window have the following flexibility: You can sort columns alphabetically or numerically in ascending or descending order. You can adjust most column widths to display more or less information. The following columns appear on the Claim Edit Library Maintenance window: Active – The fields in this column can be checked or unchecked at your discretion. When the field is checked, the claim edit that it corresponds to is considered Activated, which means that the claim edit will run when an encounter is billed and a claim is created using this Claim Edits Library. ID – The fields in this column display a unique ID number that corresponds to each claim edit in the library. These ID numbers cannot be changed. If you sort by the ID number, it makes it easier to reference when new claim edits are added to the library. Claim Edit – The fields in this column display the claim edits that are available in the Claim Edits Library. Help Text – The fi
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
