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 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

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

Create an EDI File by Practice

Select the EDI File toolbar button. The 837 Electronic File Creation window opens. Complete the following required fields: Submitter Profile Library Claim Form Send File Name Batch Type Select the Practices tab. You can search for claims by a single practice, multiple practices, or all practices within your enterprise. To search for claims by single or multiple practices go to Step 5. To search for claims for All Practices in your enterprise go to Step 7. To search for pending claims associated with a single or multiple practices, select the open record icon. The Practices window opens. Select the Flashlight icon to search for practices. Move the applicable practices to the Included section. Select OK. To search for pending claims across all practices, enable the All Practices check box. Enable any of the following check boxes to update claims, create a report, or send a test file. Update claim requests as processed Report results - to display the report after it is processed. Use test

Help Guide for NextGen® Enterprise PM 8

Claims

You can view claim statistics for the current practice. Statistics shown are As of Last Night and are updated when the nightly Advisor Update Process runs. Claims statistics include: Paper Claims: Total paper claims (1500/UB/ADA) in Pending status and total charges on those claims Electronic Claims: Total electronic claims (1500/UB/ADA) in Pending status and total charges on those claims Claims Processed (YTD): Total paper and electronic claims processed year-to-date and total charges on those claims Note: Each time a claim is created for an encounter, it is added to the (YTD) totals. Parent topic: Sections Displayed on the Advisor

Help Guide for NextGen® Enterprise PM 8

Create an EDI File by Claim Type, CPT4 Code or Date

To create an EDI file by claim form, claim type, CPT4 code, or begin and end date, use this procedure. Select the EDI File toolbar button. The 837 Electronic File Creation window opens. Complete the following required fields: Submitter Profile Library Claim Form Send File Name Batch Type To further refine your search, enter data in the applicable fields. Enable any of the following check boxes to update claims, create a report, or send a test file: Update claim requests as processed Report results - to display the report after it is processed. Use test code in REF02 trans type segment Select Find. In the Pending Electronic Claims section select the claims to include in the EDI file. Select Process. The Electronic Send report generates and automatically displays when the Report Results check box is enabled. Parent topic: 837 Electronic File Creation Window

Claims Processing

Recommendations

Processing Electronic Claims - 837 Files

Coordination of Benefits Electronic and Manual Processing

837 Electronic File Creation Window

Create an EDI File by Practice

Claims

Create an EDI File by Claim Type, CPT4 Code or Date

Processing Electronic Claims - 837 Files

Coordination of Benefits Electronic and Manual Processing

837 Electronic File Creation Window

Create an EDI File by Practice

Claims

Create an EDI File by Claim Type, CPT4 Code or Date