Claim Production Status Report for CSC Candidate Encounters

Help Guide for NextGen® Enterprise PM 8

Rules for Claims Consolidation in a Hold Status

The CSC process consolidates CSC candidate claims by using the following rules for claims in a HOLD status. The rules for claims consolidation are setup in the Consolidated Services Claim library. CSC candidate encounters are in a HOLD status. The claims are in a HOLD status and are released for processing. When only one of the patient HOLD claims is selected on the Claim Request Lookup window in the Claim Requests list, all patient HOLD claims are combined into a CSC claim for the specified time-frame. Suppressed or exempt claim charges are not included in the claim due amount. Hold Status Changes to Consolidated or Pending Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Claim Production Status Report for CSC Candidate Encounters

When a CSC Candidate Encounter is billed, either on demand (individual) or in batch, and the encounter passes all claim edits, a green message displays on the Claim Production Status report for claims in a status of HOLD or PENDING. Hold Claims - Claim Production Status Report Messages Pending Claims - Claim Production Status Report Messages Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Mark a CSC Encounter as Exempt

CSC candidate encounters can be marked exempt either manually or automatically by the system. Automatic exemption of a claim occurs when the claim is suppressed as a result of File Maintenance settings. Exempt encounter charges are not included in a consolidated claim. Access the Consolidated Services Claim tab under the Claims tab on the Encounter Maintenance window. To identify the responsible attending provider for claim header, complete the Primary Responsible Attending, Secondary Responsible Attending, and Tertiary Responsible Attending fields. Select one of the following options for each applicable insurer: None - (default prior to billing) Responsible Attending Ancillary Provider To remove encounter charges from a primary, secondary, or tertiary CSC claim, select the applicable check box: Exempt from Primary Consolidated Services Claim An alert displays if a Primary HOLD claim is attached to the encounter: A HOLD claim exists for this encounter. Would you like to convert the HOL

Help Guide for NextGen® Enterprise PM 8

Automatic Identification of CSC Candidate Encounters

CSC candidate encounters are identified during the billing process and meet the following criteria: All services for a patient in a calendar. All services provided to a patient in a specific time-period that are submitted on a single claim. The time period is defined by the practice and can be daily, weekly, monthly, or on a case basis. The encounters meet the rules applied in the Consolidated Service Claim library for combining form types and encounter rate options. Note: Hold Claim Status: The Hold status is applied to all claims that meet the criteria for CSC candidate encounters. Non-coordinated or Non-covered Service SIMs: Encounters with SIMs for non-coordinated or non-covered services DO NOT qualify as CSC Candidate encounters. Guidelines for Running the CSC Process Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Pending Claims - Claim Production Status Report Messages

When a CSC Candidate Encounter that is flagged as exempt from CSC claims is billed, either on demand (individual) or in batch, and the encounter passes all claim edits, a green message displays on the Claim Production Status report for the Pending status claim as follows: Demand Billing Severity: Informational Message: No errors found. Claim excluded from CSC by manual selection. Status: Claim Pending Batch Billing Severity: Informational Message: Non-CSC candidate claim successfully created. Claim excluded from CSC by manual selection. Status: Claim Produced Claim Production Status Parent topic: Claim Production Status Report for CSC Candidate Encounters

Help Guide for NextGen® Enterprise PM 8

Hold Claims - Claim Production Status Report Messages

Demand Billing Severity: Informational Message: No errors found for CSC candidate claim. Status: HOLD Claim Pending Batch Billing Severity: Informational Message: HOLD claim successfully created. Status: HOLD Claim Produced Claim Production Status Parent topic: Claim Production Status Report for CSC Candidate Encounters

Claim Production Status Report for CSC Candidate Encounters

Recommendations

Rules for Claims Consolidation in a Hold Status

Claim Production Status Report for CSC Candidate Encounters

Mark a CSC Encounter as Exempt

Automatic Identification of CSC Candidate Encounters

Pending Claims - Claim Production Status Report Messages

Hold Claims - Claim Production Status Report Messages

Claim Production Status Report for CSC Candidate Encounters

Rules for Claims Consolidation in a Hold Status

Claim Production Status Report for CSC Candidate Encounters

Mark a CSC Encounter as Exempt

Automatic Identification of CSC Candidate Encounters

Pending Claims - Claim Production Status Report Messages

Hold Claims - Claim Production Status Report Messages