Create Zero Balance Claims to Subsequent Payers

Help Guide for NextGen® Enterprise PM 8

Select All Lines for Bill to Next Insurance

When an ERA 835 file from a payer is imported, if any line item on the encounter is selected to be rebilled to the next payer, the practice can choose to instead rebill all line items to the next payer. When the below option is selected for a payer and an ERA file is imported, all line items will flag to rebill if one line item is selected to rebill, including those with a $0.00 balance. All line item charges are settled to the next subsequent payer so a claim is created in NextGen® Enterprise PM for that secondary/tertiary payer. Access File Maintenance. Select Master Files, then System, and then Payers. The Payers List window appears. From the list, select and open the desired payer. The Modify Payer Information window appears. Select the Practice tab, and then the Other sub-tab. Select the ERA – If any line is selected for bill, select all lines for bill to next insurance check box. To save changes and close the window, select OK. Parent topic: Setting Up Payers for ERA

Help Guide for NextGen® Enterprise PM 8

Set Up Default Transaction Codes for an Alternate Payer

When you are using the alternate payer functionality, you might find that the main payer on the Payer master file, and the alternate payer on the Payers-Alt Payer master file has different Default Transaction Codes. In File Maintenance, select Master Files > System > PM > Payers-Alt Payers. The Payers-Alt Payers List window opens. From the Payers-Alt Payers List window, select and open the applicable alternate payer. The Modify Alt- Payer Information - Demo Payer window opens. Select the Alt Payer Transaction Option tab. The fields under the Alt Payer Transaction Option tab appear. Select default transaction codes for the alternate payer. For more information, see Settings - default transaction codes for the alternate payer To save the changes and close the window, select OK. Note: For more information on the Payers-Alt Payers master file go to NextGen Healthcare Success Community and download the latest Claims User Guide for NextGen® Enterprise PM. Settings - default transaction codes

Help Guide for NextGen® Enterprise PM 8

Create Zero Balance Claims to Subsequent Payers

A practice may have a need to send a claim to the next payer even though the previous payer paid the claim in full. For example, an FQHC practice reports to a secondary “wrap” payer by sending a claim showing services that were completely paid by the primary payer. Line item charges that have been paid in full by the previous ERA payer, and now have a $0.00 balance, can be settled to the next subsequent payer so a claim is created in NextGen® Enterprise PM for that secondary/tertiary payer. Access File Maintenance. Select Master Files, then System, and then Payers. The Payers List window appears. From the list, select and open the desired payer. The Modify Payer Information window appears. Select the Practice tab, and then the Other sub-tab. Select the ERA – Create Zero Dollar Total Balance Claims to Selected Subsequent Payer(s) check box. In the field to the right, select the subsequent Payer(s). To save changes and close the window, select OK. Additional Information Parent topic: Set

Help Guide for NextGen® Enterprise PM 8

Additional Information

If a patient has a payer with the ERA – Create Zero Dollar Total Balance Claims to Selected Subsequent Payer(s) check box enabled, whether the payer is primary or secondary, and the patient’s next payer is one of the selected subsequent payers, then when an ERA 835 file is processed for that payer and an adjustment is posted from the CAS segment, the following occurs: Transaction Detail Status for charge line items associated with the claim default to Settled move to subsequent payer. Charge line items associated with the claim are flagged for rebill. The encounter status changes from Billed to Rebill. When the ERA – Create Zero Dollar Total Balance Claims to Selected Subsequent Payer(s) check box is not enabled for the payer and an adjustment reason code is defined with a Transaction Detail Status of Settled moved to secondary or Settled moved to tertiary, the following occurs when an ERA 835 file with that adjustment reason code is processed: Transaction Detail Status for charge line

Help Guide for NextGen® Enterprise PM 8

Setting Up Payers for ERA

All payers from whom ERA 835 files will be received must be configured prior to importing the electronic files in NextGen® Enterprise PM. If there are multiple master files for the same payer (e.g. Aetna, Aetna HMO, Aetna PPO, etc.), the setup should be done to all master files for that payer. ERA Payer Number Cross-over Indicator Select All Lines for Bill to Next Insurance Create Zero Balance Claims to Subsequent Payers Set Up Default Transaction Codes for a Payer Set Up Default Transaction Codes for an Alternate Payer You can set up default transaction codes for an alternate payer in File Maintenance. Reason Code Library Remittance Profile Library Parent topic: Setting Up ERA

Help Guide for NextGen® Enterprise PM 8

Select All Lines for Bill to Next Insurance

When an ERA 835 file from a payer is imported, if any line item on the encounter is selected to be rebilled to the next payer, the practice can choose to instead rebill all line items to the next payer. When the below option is selected for a payer and an ERA file is imported, all line items will flag to rebill if one line item is selected to rebill, including those with a $0.00 balance. All line item charges are settled to the next subsequent payer so a claim is created in NextGen® Enterprise PM for that secondary/tertiary payer. Access File Maintenance. Select Master Files, then System, and then Payers. The Payers List window appears. From the list, select and open the desired payer. The Modify Payer Information window appears. Select the Practice tab, and then the Other sub-tab. Select the ERA – If any line is selected for bill, select all lines for bill to next insurance check box. To save changes and close the window, select OK. Parent topic: Setting Up Payers for ERA

Create Zero Balance Claims to Subsequent Payers

Recommendations

Select All Lines for Bill to Next Insurance

Set Up Default Transaction Codes for an Alternate Payer

Create Zero Balance Claims to Subsequent Payers

Additional Information

Setting Up Payers for ERA

Select All Lines for Bill to Next Insurance

Create Zero Balance Claims to Subsequent Payers

Select All Lines for Bill to Next Insurance

Set Up Default Transaction Codes for an Alternate Payer

Create Zero Balance Claims to Subsequent Payers

Additional Information

Setting Up Payers for ERA

Select All Lines for Bill to Next Insurance