Consolidated Services Claim

Help Guide for NextGen® Enterprise PM 8

Rules for Claims Consolidation in a Hold Status

The CSC process consolidates CSC candidate claims by using the following rules for claims in a HOLD status. The rules for claims consolidation are setup in the Consolidated Services Claim library. CSC candidate encounters are in a HOLD status. The claims are in a HOLD status and are released for processing. When only one of the patient HOLD claims is selected on the Claim Request Lookup window in the Claim Requests list, all patient HOLD claims are combined into a CSC claim for the specified time-frame. Suppressed or exempt claim charges are not included in the claim due amount. Hold Status Changes to Consolidated or Pending Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Create a Consolidated Services Claim

Open the Claim Request Lookup window. In the Request Status field select HOLD - H. Set any additional search criteria on the General tab. Select Find. The filtered claim data displays in the Claim Requests section of the window. Claim Request Lookup To select the claims for consolidation, enable the check box. Right-click and select Consolidate Same Day Claims. Consolidated Services Claim Report The Consolidated Services Claim report opens. Consolidated Services Claim Report The alerts may appear when you try to close the Consolidated Services Claim report. Alert Messages Parent topic: Consolidated Service Claims

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

Rebilling a CSC Claim

After you complete the Create a Consolidated Services Claim procedure, you can rebill a CSC claim. Only CSC candidate encounter charges will be flagged to rebill. The following rules apply for rebilling a CSC claim: Archive Status - the CSC claim must be in an Archive status. Rebill Status - all candidate - encounters that are set to a Rebill Status on the Claim Request Lookup window. Exempt Status - same-day encounters marked as exempt will not be flagged to release to bill. The encounter will remain in its existing status. Use the following table to review claim status and determine if you can rebill, regenerate, delete, or print a claim. Claim Status Flag encounter for Rebill? Regenerate a Claim? Delete?* Print? Archived Yes Yes Hold No No No No Consolidated No No No No Pending No No *Delete a CSC Claim - When a CSC claim is deleted, all of its candidate encounter claims are deleted. Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Consolidated Services Claim

The claims services consolidation process is activated from the Claim Request Lookup window. The user will select the applicable claims to consolidate and then the application automatically consolidates the candidate claims into a Consolidated Services Claim (CSC). This process produces a Consolidated Services Claim report and alerts the user to any further actions that need to be taken before a CSC claim can be created. Note: The Consolidate Same Day Claims option is active when a CSC library is selected on the Practice Preferences Library window. Only claims with a Hold status can be consolidated by the CSC process. Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Create HOLD Claims for CSC Candidate Encounters

During the normal billing process, CSC Candidate Encounters are identified. These encounters must meet the following rules: Multiple encounters for the same patient, on the same day, week, month, or case. Each practice can setup the time-frame for encounter consolidation in the Consolidated Services Claim library. Encounters are attached to the same payer. Meet all claim rules defined in the Consolidated Services Claim library. Hold Status Parent topic: Consolidated Service Claims

Consolidated Services Claim

Recommendations

Rules for Claims Consolidation in a Hold Status

Create a Consolidated Services Claim

Consolidated Services Claim Library

Rebilling a CSC Claim

Consolidated Services Claim

Create HOLD Claims for CSC Candidate Encounters

Consolidated Services Claim

Rules for Claims Consolidation in a Hold Status

Create a Consolidated Services Claim

Consolidated Services Claim Library

Rebilling a CSC Claim

Consolidated Services Claim

Create HOLD Claims for CSC Candidate Encounters