Claim Edits Library for Dental Billing

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

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 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

View Code Tables for Dental Billing

The Tooth, Surface, and Quadrant code tables in File Maintenance are preloaded with standardized codes and descriptions that are used to identify teeth, surfaces, and quadrants for dental services entered on the Charge Posting window in NextGen® Enterprise PM. Access File Maintenance. Select Code Tables. The Code Tables List window opens. In the Code Table field, select a code table. Items within the selected code table are displayed. The following list describes the code tables used for dental billing. Quadrants: Corresponds to the quadrant or area of the mouth for specific dental procedures on the Charge Posting window. The quadrant prints in box 25 on both the ADA 2019 form and the ADA 2024 form. Surface: Corresponds to the surface on the tooth for specific dental procedures on the Charge Posting window. You can select one or more codes if the Allow multiple tooth surfaces check box is selected in Practice Preferences > Charge Entry. The surface prints in box 28 on both the ADA 2019

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

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 checkbox. To allow multiple selections in the Surface field on the Charge Posting window, select the Allow multiple tooth surfaces checkbox. From the Preferences List on the left, select Claims. To enable the three Qualifying Encounter checkboxes on the General tab of the Service Items library, select the Enable Qualifying Encounter Billing check box. To save changes and close the window, select OK. The dental fields display on the Charge Posting window. Parent topic: D

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 Library for Dental Billing

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Claim Edits for Dental Billing

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