Claims Tab

Field	Description
Form Template	If you have used a form template to replace your HCFA or UB paper claims, then select the drop-down arrow and select the appropriate form template for the payer.
Real Time Edits Payer ID	Enter the Payer ID for Real Time Edits at the Payer/Practice level. The Payer ID identifies the client and payer - which in turn represents a set of edits that launch from the NextGen In-line Edits engine. The ID is 13 characters long. The first six characters are interpreted as the client ID and the last seven characters are interpreted as the payer ID. This payer ID overrides the enterprise-level, practice-level, and payer/system-level IDs.

Help Guide for NextGen® Enterprise PM 8

UB Sub-Tab

The following conditions apply to the UB tab that displays on the Practice tab of the Add/Modify Payer Information window: Regular UB users do not use this tab. Set up on this tab for Enhanced UB users is location-specific, not practice-specific. Some of the fields on this tab are labeled Field Locator n, which identifies the corresponding field on the actual UB claim form. The following table contains the UB tab fields and their descriptions: Field Description Location The Location field displays only when the practice has multiple locations. Select a practice location. For multiple location practices, the Location field must be populated before any of the fields on the UB tab are enabled. For single location practices, the Location field does not display and all of the fields on the UB tab are automatically enabled. Field Locator 1 Name The Field Locator 1 Name field is a free-form text entry field. The default for this field is blank. If the field is left blank, the name that defaul

File Maintenance Help for NextGen® Enterprise 8

Claims Tab

The Payer Master file provides information for setting up processing criteria for 1500 Claims, UB Claims, and ADA Claims. Field Description Form Template If you have used a form template to replace your HCFA or UB paper claims, then select the drop-down arrow and select the appropriate form template for the payer. Real Time Edits Payer ID Enter the Payer ID for Real Time Edits at the Payer/Practice level. The Payer ID identifies the client and payer - which in turn represents a set of edits that launch from the NextGen In-line Edits engine. The ID is 13 characters long. The first six characters are interpreted as the client ID and the last seven characters are interpreted as the payer ID. This payer ID overrides the enterprise-level, practice-level, and payer/system-level IDs. Fields in the Claims Tab of Modify Payer Information You can find the descriptions of the fields in the Practice > Claims tab of Modify Payer Information window. UB Claims Tab on Claims ADA Claims Tab on Claims P

Help Guide for NextGen® Enterprise PM 8

ADA Claims Tab on Claims

This window is in the Payer master file. To access the window select Payers and then select the payer. On the Modify Payer Information window select Practice > Claims > ADA Claims sub-tab. Field Description Submitter Profile Select the submitter profile that you want to apply to ADA Claims. Electronic Transmitter ID Enter the payer-assigned electronic transmitter ID to generate a claim with an electronic transmitter ID. Note: This field only displays when you select a submitter profile. Practice Payer Opt Val Enter the practice/payer-specific value. Payer Alias Enter an alternative payer name when a name that differs from the name that appears in the payer's Payer master file is required. Primary, Secondary, and Tertiary Media Types Enter the primary media type as either electronic or paper as accepted by the clearinghouse. If you set it as electronic, then you can also set how the secondary and tertiary claims should be submitted. When Primary, force Secondary claims to paper Enable t

Help Guide for NextGen® Enterprise PM 8

UB Claims Tab on Claims

To access the UB Claims tab, you must select a facility and a bill classification on the Encounters Practice Preferences. Field Description Submitter Profile Select the submitter profile that you want to apply to UB Claims. Electronic Transmitter ID Enter the payer-assigned electronic transmitter ID to generate a claim with an electronic transmitter ID. Note: This field only displays when you select a submitter profile. Field Locator 51 This is a free form text field. If you are a regular UB user, enter the number that was provided to you by the payer in this field. Practice Payer Opt Val Enter the practice/payer-specific value. Payer Alias Enter an alternative payer name when a name that differs from the name that appears in the payer's Payer Master file is required. Primary, Secondary, and Tertiary Media Types Enter the primary media type as either electronic or paper as accepted by the clearinghouse . If you set it as electronic, then you can also set how the secondary and tertiary

Help Guide for NextGen® Enterprise PM 8

Practice tab on UB Tab

The following conditions apply to the UB tab that appears on the Add/Modify Payer Information window and then the Practice tab: Regular UB users do not use this tab. Setup this tab for Enhanced UB users is location-specific, not practice-specific. Some of the fields on this tab are labeled Field Locator n, which identifies the corresponding field on the actual UB claim form. The following table contains the UB tab fields and their descriptions: Field Description Location The Location field displays only when the practice has multiple locations. Select a practice location. For multiple location practices, the Location field must be populated before any of the fields on the UB tab are enabled. For single location practices, the Location field does not display and all fields on the UB tab are automatically enabled. Field Locator 1 Name The Field Locator 1 Name field is a free-form text entry field. The default for this field is blank. If the field is left blank, the name that defaults to

File Maintenance Help for NextGen® Enterprise 8

UB Sub-Tab

The following conditions apply to the UB tab that displays on the Practice tab of the Add/Modify Payer Information window: Regular UB users do not use this tab. Set up on this tab for Enhanced UB users is location-specific, not practice-specific. Some of the fields on this tab are labeled Field Locator n, which identifies the corresponding field on the actual UB claim form. The following table contains the UB tab fields and their descriptions: Field Description Location The Location field displays only when the practice has multiple locations. Select a practice location. For multiple location practices, the Location field must be populated before any of the fields on the UB tab are enabled. For single location practices, the Location field does not display and all of the fields on the UB tab are automatically enabled. Field Locator 1 Name The Field Locator 1 Name field is a free-form text entry field. The default for this field is blank. If the field is left blank, the name that defaul

Claims Tab

Recommendations

UB Sub-Tab

Claims Tab

ADA Claims Tab on Claims

UB Claims Tab on Claims

Practice tab on UB Tab

UB Sub-Tab

Claims Tab

UB Sub-Tab

Claims Tab

ADA Claims Tab on Claims

UB Claims Tab on Claims

Practice tab on UB Tab

UB Sub-Tab