Claim Setup Options for Health Centers

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

Help Guide for NextGen® Enterprise PM 8

Create an 837 Electronic File

Use the General tab to search for claims by form type, claim type, CPT4 codes, and by date. To access this window, select the EDI File toolbar button. The 837 Electronic File Creation window opens. On the General tab use the following table to identify your search criteria. Field Description Submitter Profile Library (required) Select the applicable submitter profile library. Pending claims that were created with this submitter profile attached to the payer will be returned in the search. The 837 electronic files are created based on submitter profiles because the settings in the submitter profile are specific to the payer, which maintains HIPAA compliancy. Claim Form (required) Select one of the following claim forms: 1500 ADA (Dental) UB. You can only include one claim form type in an 837 electronic file. This corresponds to the submitter profile option, Number of functional groups per file. Claim Type Select the claim type to narrow the search for pending claims based on the claim t

Help Guide for NextGen® Enterprise PM 8

Payers Master File for Dental Billing

Three areas in the Payers master file must be set up for dental claims. These setup requirements are on the following tabs of the Payers master file: Payer Defaults - 2: Used to set up a payer for dental billing and ADA claims. System: Used to set up provider secondary references. Practice: Used to set up electronic claims. Defaults-2 Tab System Tab Practice Tab Parent topic: Dental Billing

Help Guide for NextGen® Enterprise PM 8

Payer Claim Break Options

The Disable Claim Break options can be used to disable automatic claim breaks by Rendering Provider or by Location for a payer, if needed. This allows multiple charges on an encounter that have different rendering providers or different locations to be combined onto a single claim for the payer. These options affect 1500/837P, UB/837I or ADA/837D claims for the payer in both electronic and paper format. Set Up Claim Break Options for a Payer Parent topic: Behavioral Health Billing

File Maintenance Help for NextGen® Enterprise 8

Claim Printing Library

The Claim Printing library enables you to specify options that define which information prints on claim forms. You must create and attach a Claim Printing library to a practice at the practice preference level before a paper claim can be generated. 1500 Claims, UB Claims, and ADA Claims are available in the Claim Printing library. The Claim Printing library attached at the practice preferences level is the default library. At the payer level, if needed, you can set up an alternate Claim Printing library for a specific payer. You can set the type of information you want to print in each claim field using the selections in the Setting and Option columns in the Claim Printing window. Claim Print Options in Claim Printing Library You can select the claim print options through available paper claims and payer types.

File Maintenance Help for NextGen® Enterprise 8

Set Up Claim Print Options for All Payers

The Common Rules tab lists the Claim Printing options that apply to all payers. In File Maintenance, select Libraries > Claim Printing. The Claim Printing List window opens. Select the applicable library or select open menu and select New. The Claim Printing window opens, displaying the Common Rules tab. Select the claim type in the 1500 Claims, UB Claims, or the ADA Claims fields. Select the settings for the print options in the Option and Setting columns you want to use and then select OK. Universal Options CMS 1500 (2012) Form Print Options for All Payers There are several claim print options applicable to CMS 1500 (2012) claim form for all payers. CMS 1500 (2005) Options UB(04) Form Print Options for All Payers There are several claim print options applicable to UB04 claim form for all payers. UB(92) Options ADA (2019 and 2024) Form Options for All Payers There are several common claim print options applicable to ADA 2019 and ADA 2024 claim forms for all payers. Parent topic: Claim

Claim Setup Options for Health Centers

Recommendations

Dental Billing

Create an 837 Electronic File

Payers Master File for Dental Billing

Payer Claim Break Options

Claim Printing Library

Set Up Claim Print Options for All Payers

Dental Billing

Create an 837 Electronic File

Payers Master File for Dental Billing

Payer Claim Break Options

Claim Printing Library

Set Up Claim Print Options for All Payers