Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Discharge Date and Time Rules for Consolidated Institutional Fields in CSC Claims

When you consolidate two or more claims, one claim is considered as the king claim. The other claims are referred to as candidate claims. When you consolidate the claim, the following rules are applied. If the values are different in King claim and in Candidate claims, a conflicting error message appears in the CSC report. If the values are the same in the King claim and in Candidate claims, the same value appears in the CSC report. If the value is missing in the King claim, the value is taken from the Candidate claims. An error message appears when there is a conflicting data, and an alert message appears when there is a missing data. The following table describes the messages. Encounter Message Message Type Help Text Occurs When Enc1, Enc2, Enc3, Enc4 System unable to consolidate due to conflicting Discharge Date on encounters <Enc1> and <Enc3>. Error Correct conflicting data on all encounters and rebill. The user has entered different discharge date in <Enc1> and <Enc3>. The Dischar

Help Guide for NextGen® Enterprise PM 8

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

When you consolidate two or more claims, one claim is considered as the King claim. The other claims are referred to as Candidate claims. When you consolidate the claim, the following rules are applied. If the values are different in King claim and in Candidate claims, a conflicting error message appears in the CSC report. If the values are the same in the King claim and in Candidate claims, the same value appears in the CSC report. If the value is missing in the King claim, the value is taken from the Candidate claims. An error message appears when there is a conflicting data, and an alert message appears when there is missing data. The following table describes the messages displayed. Encounter Message Message Type Help Text Occurs When System unable to consolidate due to conflicting Admit Date on encounters <Enc1> and <Enc3> Enc1, Enc2, Enc3, Enc4 Correct conflicting data on all encounters and rebill. The user has entered different admission dates in <Enc1> and <Enc3>. The Admission

Help Guide for NextGen® Enterprise PM 8

Consolidated Services Claim Library

The Consolidated Services Claim (CSC) library enables you to establish rules for consolidating multiple encounter charges into a single consolidated services claim (CSC). The purpose of this library is to configure billing and claim form type rules for payers. This section includes the following topics: Security rights for user groups Consolidated Services Claim library CSC configuration rules for the consolidation of daily, weekly, monthly, and case related claims Provider hierarchy for claim headers Bill for eligible patient days You can generate the Consolidated Services Claim Library Listing report and the CSC Library with Timespan Details report from the Consolidated Services Claim library. For more information go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Set Up Security Access Rights for Consolidated Services Claims Consolidated Services Claim Library Setup Create a CSC Library Access a Consolidated Services Cla

Help Guide for NextGen® Enterprise PM 8

CSC Terms

The following table provides a list of terms associated with the consolidation process of claims. Term Description TS Time Span - claims that occur on the same date, week, month, or case. The time-span is identified in the CSC library. CCCP Case Claim Consolidation Program – The program rules established in the Consolidated Services Claim library to consolidate all claims attached to a Case. CCR Consolidated Claims Rules CSC Consolidated Services Claim CSC Candidate Encounter When a patient has multiple encounters per day. Each encounter can be a CSC candidate encounter. CSC Hold Claims These are the claims created after billing a CSC Candidate Encounter but prior to running the CSC process. Consolidated Claim After the charges from the CSC Hold Claims are consolidated into a CSC, the CSC Hold Claims become Consolidated claims. Claim-Header Encounter The claim header details are derived from this encounter. Primary Attending is selected in the Primary Responsible Attending field from t

Help Guide for NextGen® Enterprise PM 8

Admission Type and Source of Admission Rules for Consolidated Institutional Fields in CSC Claims

When you consolidate two or more claims, one claim is considered as the king claim. The other claims are referred to as Candidate claims. When you consolidate the claim, the following rules are applied. The system uses the data from the King claim for admission type and source of admission. If the king claim is blank, The system uses the data from the Candidate claims. An error message appears when there is a conflicting data, and when the data is missing. The following table describes the messages displayed. Encounter Message Message Type Help Text Occurs When Enc1, Enc2, Enc3, Enc4 System unable to consolidate due to conflicting Admission type on encounter <Enc1> and <Enc3>. Error Correct conflicting data on all the encounters and rebill. The user has entered different admission types in encounter <Enc1> and <Enc3>. The Admission type is missing in all the CSC encounters. Alert Add the Admission type if its applicable. The user has not entered the admission type in any of the CSC enc

Help Guide for NextGen® Enterprise PM 8

Claim Header Rules and Claim Consolidation Rules

Use the Claim Header Rules tab to establish a provider hierarchy and identify the attending provider for consolidated service claims (CSC). The physician with the highest-ranking specialty is automatically listed as the attending provider in the header data of the CSC claim. All CSC claims are sent to the payer as EDI files. These hierarchy rules will apply to all of the payers in the Valid Payers list. Establishing a Provider Hierarchy When a Provider Hierarchy is NOT Established Add Claim Consolidation Rules to a CSC Library Add Claim Header Rules to a CSC Library Eligible Number of Patient Days Billing Parent topic: Consolidated Service Claims

Consolidated Service Claims

Recommendations

Discharge Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Consolidated Services Claim Library

CSC Terms

Admission Type and Source of Admission Rules for Consolidated Institutional Fields in CSC Claims

Claim Header Rules and Claim Consolidation Rules

Discharge Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Consolidated Services Claim Library

CSC Terms

Admission Type and Source of Admission Rules for Consolidated Institutional Fields in CSC Claims

Claim Header Rules and Claim Consolidation Rules

Consolidated Service Claims