Consolidated Services Claim Report

Help Guide for NextGen® Enterprise PM 8

X12 EDI Format of CSC Claims

Consolidated Service Claims are sent in an EDI file in the X12 837 standard format and includes the following criteria: The header data is populated from the header claim. A header claim can be automatically or manually identified to consolidate all claim details by doing the following: Manually identify a header claim - In NextGen® Enterprise PM access the Encounter Maintenance window, and then select Claims > Consolidated Service Claim tab. In the Primary Responsible Attending field select Responsible Attending. Automatically identify a header claim - In File Maintenance access the Consolidated Services Claim library. On the Attending Specialty Hierarchy window, you can identify the Attending Specialty Hierarchy. Claims in the status of Copy of, Hold, and Consolidated are viewable. Charges are in the same order as in the original claim. Non-covered services are not included in the claim data. 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

Consolidate Claims by Time Span

The CSC process is initiated on the Claims Request Lookup window. You can search for claims on a time-span of daily, weekly, monthly, or case. This process provides a clear visual of all of the HOLD claims that can be processed when the CSC process is initiated. You can sort the encounters by selecting on the TS (time-span) column. From the menu, select Tasks > Lookup > Claims or select the Claims icon. The Claim Request Lookup window opens. Claim Request Lookup In the Request Status field, select Hold H. The Consolidated Services Claim Time Span field becomes active. In the Consolidated Services Claim Time Span field select one of the following options: <none> - to display all Hold claims. Consolidate Same Day Claims - to display all encounters that occurred on the same date. Consolidate Weekly Claims - to display all encounters during the same week. The week as defined in the CSC library, either Sunday through Saturday or Monday through Sunday. Consolidate Monthly Claims - to display

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

File Maintenance Help for NextGen® Enterprise 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

Consolidated Services Claim Report

Recommendations

X12 EDI Format of CSC Claims

Consolidated Services Claim

Consolidate Claims by Time Span

Create a Consolidated Services Claim

Consolidated Services Claim Library

Consolidated Services Claim Library