Claim Requests Report

Help Guide for NextGen® Enterprise PM 8

Claim Status Report

Claim status enables you to know the status of a claim and where it is placed in the adjudication process. Claim status inquiries can be submitted in batch mode or real-time for electronic claims with a status of archived. You can schedule claim status checks to run automatically in batch mode at set intervals throughNextGen® Background Business Processor. The results of the inquiry show you the status of the claim and the reason for rejection, if any. The Claim Status Profile library in File Maintenance supports services rendered by professional, dental, or institutional service providers. The institutional claim status request file (276) sends the rendering provider or billing provider in 2100C loop to the real-time server (RTS). Before you submit claim status inquiries, you need to open File Maintenance,Claim Status Profilelibrary and specify the type of provider in theProvider Name (2100C Loop NM1 Segments)section. The following types of service providers are available. Billing: Th

Help Guide for NextGen® Enterprise PM 8

Open Claim Status Report from Reports Menu

Before you begin Submit a claim request for a encounter. In NextGen® Enterprise PM, select Reports > General > Claim Status. The Claim Status report opens. The Columns filter in the Configuration Options list opens by default. Select the columns that need to appear on the report and select Refresh Report. The Claim Status report opens displaying the following: Claim status response date and time. Statistical overview of the claims (accepted and rejected), billed amount, and paid amount. Collapsed view of the list of the claims whose status is requested for. Note: To view the details of the claim status, select and expand the desired claim. Parent topic: Claim Status

Help Guide for NextGen® Enterprise PM 8

Open Claim Status Report from Clinical History/Notes

Before you begin Submit a claim status request for the encounter. In theClinical History/Notes tab, Chart Notes > Claim Status Result under Topics list displays the list of claim requests submitted for the encounter. You can open and view the claim status report. In NextGen® Enterprise PM, open the Patient Chart and select the Clinical History/Notes tab. From Topics, select Claims Status Result located under Chart Notes. The Details pane displays the claim status results attached to the patient. Right-click the desired encounter or claim number and select Open. The Claim Status report opens displaying the following: Claim status response date and time. Statistical view of the claim status (accepted or rejected), bill amount, and paid amount. Collapsed view of the claim status requested for the encounter. Note: To view the detailed report of the claim status, select and expand the claim. Parent topic: Claim Status

Help Guide for NextGen® Enterprise PM 8

Open Claim Status Report from Encounter

Before you begin Submit a claim status request for an encounter. In NextGen® Enterprise PM, do one of the following to open the Encounter Lookup window. On the toolbar, select Encounter. From the Tasks menu, select Lookup > Encounters. The Encounter Lookup window opens. Enter the search criteria to find the desired encounters and select Find. The Encounter List section displays the encounters matching the search criteria. Double-click the desired encounter. The Encounters tab on the Patient Chart opens displaying the details of the encounter. The Claim Status section displays the eligibility verification claim status details such as the claim status date and claim status result. The claim status result is a link. Select the claim status result link in Status. The Claim Status report opens displaying the following: Claim status response date and time. Statistical view of the claim status (accepted or rejected), bill amount, and paid amount. Collapsed view of the claim status requested f

Help Guide for NextGen® Enterprise PM 8

Resubmit Claim Request from Clinical History/Notes

Before you begin Submit a claim status request for the encounter. After you submit a claim request, you can resubmit the same request from the Clinical History/Notes tab in the patient's chart. In NextGen® Enterprise PM, open the Patient Chart and select the Clinical History/Notes tab. From Topics, select Claims Status Result located under Chart Notes. The Details pane displays the claim status results attached to the patient. Right-click the desired encounter or claim number and select Claim Status Request. A message appears indicating that the application will process the claims and submit them in real time. It also indicates that you will experience pauses while it communicates with the server and the process can be lengthy depending on the number of claims selected. Select OK The system submits the claim status request. The request is added to the list in the Details pane. The Claim Status report opens displaying the following: Claim status response date and time. Statistical view

Help Guide for NextGen® Enterprise PM 8

Filters in Claim Requests Report

The following table lists the filters available on the Filter 1 section. Filter Description Create Date Select a Create Date range for claims Processed Date Select a Process Date range for claims Request Status Select one or more of the following to be included on the report: Pending Archived HOLD Consolidated Payer Seq Select one or more of the following to be included on the report: Primary Secondary Tertiary Media Type Select one or both of the following to be included on the report: Paper Electronic Name Used to narrow the focus of the report to Patient Names that fall within the beginning and ending name range you enter. You can enter: whole names partial names first initials only Status Cat Code Select a 997 acknowledgement transaction Status Category Code to be included on the report Status Code Select a 277/277u claim Status Code to be included on the report You can use the following operators on columns in theFilter 2section to filter the data in the report: Between Equals Not

Claim Requests Report

Recommendations

Claim Status Report

Open Claim Status Report from Reports Menu

Open Claim Status Report from Clinical History/Notes

Open Claim Status Report from Encounter

Resubmit Claim Request from Clinical History/Notes

Filters in Claim Requests Report

Claim Status Report

Open Claim Status Report from Reports Menu

Open Claim Status Report from Clinical History/Notes

Open Claim Status Report from Encounter

Resubmit Claim Request from Clinical History/Notes

Filters in Claim Requests Report