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Claims Processing
Claims can be processed on demand or in batch mode. This section explains:
Paper claims
Electronic claims - 837 files
997 files
277 files
ERA - 835 files
COB - manual posting
Processing Paper Claims
Claim Production Status Report
Processing Electronic Claims - 837 Files
Process Claim Requests for Multiple Encounters
997/999 File
277 File
Coordination of Benefits Electronic and Manual Processing
You can view information on all the payers for EDI claims in the
Coordination of Benefits Information
window.
Claims Processing
Help Guide for NextGen® Enterprise PM 8
Claims Processing
Claims can be processed on demand or in batch mode. This section explains: Paper claims Electronic claims - 837 files 997 files 277 files ERA - 835 files COB - manual posting Processing Paper Claims Claim Production Status Report Processing Electronic Claims - 837 Files Process Claim Requests for Multiple Encounters 997/999 File 277 File Coordination of Benefits Electronic and Manual Processing You can view information on all the payers for EDI claims in the Coordination of Benefits Information window.
Help Guide for NextGen® Enterprise PM 8
Processing Electronic Claims - 837 Files
This section explains how electronic claims (837 files) are processed. The basic steps include: Select the EDI file button. The 837 Electronic File Creation window opens. Select a Submitter Profile library. Select options applicable to the types of claims that you want to send electronically. Select the Process button. Electronic Claims File Structure Control Segments Application Setup for the 837 File 837 Electronic File Creation Window Electronic Send Report Set Up Automatic Task Completion for Clean Claims Submitting Electronic Claims Archiving and Retrieving 837 Electronic Files Tracking Records of Reprinted Archived Claims Parent topic: Claims Processing
Help Guide for NextGen® Enterprise PM 8
Processing Electronic Claims - 837 Files
This section explains how electronic claims (837 files) are processed. The basic steps include: Select the EDI file icon. The 837 Electronic File Creation window opens. Select a Submitter Profile library. Select options applicable to the types of claims that you want to send electronically. Select the Process button. Electronic Claims File Structure Control Segments Application Setup for the 837 File 837 Electronic File Creation Window Electronic Send Report Set Up Automatic Task Completion for Clean Claims Submitting Electronic Claims Archiving and Retrieving 837 Electronic Files Tracking Records of Reprinted Archived Claims Parent topic: Claims Processing
Help Guide for NextGen® Enterprise PM 8
Coordination of Benefits Electronic and Manual Processing
You can view information on all the payers for EDI claims in the Coordination of Benefits Information (COB) window. The Coordination of Benefits Information window provides information on all payers for EDI claims. This includes primary, secondary, and tertiary payers for 837I, 837P, and 837D claims. A summary of all COB activity by charge lines on an encounter for all previous transactions will display on the Coordination of Benefits Information window. When viewing COB1, COB2, COB 3, or All Payer data fields are editable by transaction line. ERA File When the ERA file contains a CAS segment with a charge line that has two identical reason codes, one CAS segment is created for the two identical reason codes in the 837 file. The reason codes are combined and display on a single line in the 837 file. Example: The COB window contains CO45 $50 and CO45 $25 and a PR2 on a single service line, the CAS segment will create CAS*CO*45*75 in the 837 file to represent the CO45 amounts and continu
Help Guide for NextGen® Enterprise PM 8
837 Electronic File Creation Window
Use the 837 Electronic File Creation window to identify search criteria for claims that you want to send in an electronic file. This window has the following tabs: General, Advanced, and Practices. Each tab contains the File Options and Electronic Claims sections. File Options and Pending Electronic Claims Sections These sections display on each of the tabs for the 837 Electronic File Creation window. File Options - you can select the file for data transfer, identify the batch type, create a report, update claim requests, and send a test file. Pending Electronic Claims - displays the claims that match the search criteria on the active tab. General, Advanced, Practices, File Options, and Pending Electronic Claims Refer to the following topics for information about the fields on this window: 837 Electronic File Creation - General Tab 837 Electronic File Creation - Advanced Tab 837 Electronic File Creation Window Practices Tab 837 Electronic File Creation - File Options and Pending Electr
Help Guide for NextGen® Enterprise PM 8
837 Electronic File Creation Window
Use the 837 Electronic File Creation window to identify search criteria for claims that you want to send in an electronic file. This window has the following tabs: General, Advanced, and Practices. Each tab contains the File Options and Electronic Claims sections. File Options and Pending Electronic Claims Sections These sections display on each of the tabs for the 837 Electronic File Creation window. File Options - you can select the file for data transfer, identify the batch type, create a report, update claim requests, and send a test file. Pending Electronic Claims - displays the claims that match the search criteria on the active tab. General, Advanced, Practices, File Options, and Pending Electronic Claims Refer to the following topics for information about the fields on this window: 837 Electronic File Creation - General Tab 837 Electronic File Creation - Advanced Tab 837 Electronic File Creation Window Practices Tab 837 Electronic File Creation - File Options and Pending Electr
