CSC Automation in Remittance Profile

Help Guide for NextGen® Enterprise PM 8

Default Values for CSC Claim Level Payments and Adjustments

In NextGen® Enterprise PM Practice Preferences, when CSC Library is selected on the Libraries list, the system enables some of the Remittance Profile settings for consolidated claims. The following are the default values for CSC Claim Level Payments and Adjustments. System Settings Description The system takes the value from the Default tab. When Distribute Claim-Level Payments and Distribute Claim-Level Adjustments are blank on the CSC Options tab, the system takes the value FIFO from Claim level Payments and Adjustments on the Default tab. The system takes the value from the Default tab. When CSC Claim Level Payments and Adjustments are blank on the Default tab, then the system takes the value FIFO from Encounter Level Payments and Claim Level Adjustments on the Default tab. Default value FIFO is selected in CSC Claim Level Payments and Adjustments. If CSC Claim Level Payments and Adjustments is blank on the CSC Options tab and the values are blank on the Default tab, then the system

Help Guide for NextGen® Enterprise PM 8

New Value FIFO with Credit Balance in CSC Options

In NextGen® Enterprise PM Practice Preferences, when CSC Library is selected on the Libraries Preference List, the system automatically selects the Enable posting to CSC claims option in the Remittance Profile Library. A new value FIFO with credit balance is added on the CSC Options tab in the Remittance Profile window. For existing and new Remittance Profile Library, if you select FIFO with credit balance on the Default tab and select OK, the system displays FIFO with credit balance on the CSC Options tab. When you reopen the Remittance Profile Library, you can see FIFO with credit balance on the CSC Options tab in the Remittance Profile window. Table 1. Following are the scenarios where application displays the value FIFO with credit balance or FIFO on the CSC Options tab based on the value selected on the Default tab. Default tab Claim level payments and Adjustments Default tab Encounter level payments Default tab Claim Level adjustments CSC Options tab Distributed claim level payme

Help Guide for NextGen® Enterprise PM 8

Apply FIFO with Credit Balance for CSC Claims in the ERA Import Process

When FIFO with credit balance is selected in the Distribute Claim-Level Payments and Distribute Claim-Level Adjustments for CSC Claim Level Payments and Adjustments or Encounter Level Payments and Claim Level Adjustments, you can post the claim or encounter level payment and adjustment with a credit balance. The application displays the following when FIFO with credit balance is applied for the CSC claims in the ERA import process. The credit balance is displayed against the last line item for multiple charges for the encounter. The difference amount is not adjusted from the total adjustment amount received in the ERA file. The adjustment amount received in the claim level CAS segment is displayed in the adjustment column in the ERA import report. When you import the ERA file, the remaining balance displays the credit balance as well as the total claim balance on the transaction window. If payment or payment and adjustment creates an overpayment and FIFO with credit balance is selected

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

File Maintenance Help for NextGen® Enterprise 8

Set Up the Remittance Profile - CSC Options Tab

The CSC Options tab in the Remittance Profile library is used to set options for handling ERA transactions for services that were combined for the same patient on the same day through the Consolidated Services Claim process. Note: The CSC Options tab is available when a Consolidate Services Claim library is attached in Practice Preferences > Libraries. To set up the CSC Options tab in a Remittance Profile library, do the following: Open File Maintenance. Select Libraries, and then select Remittance Profiles. The Remittance Profiles List window opens. Open the profile library. The Remittance Profile window opens. Select the CSC Options tab. Select settings for CSC options. When you're done setting options, select OK to save changes and close the window. CSC Options Tab - Options and Settings Parent topic: Remittance Profiles Library

Help Guide for NextGen® Enterprise PM 8

Set Up the Remittance Profile - CSC Options Tab

The CSC Options tab in the Remittance Profile library is used to set options for handling ERA transactions for services that were combined for the same patient on the same day through the Consolidated Services Claim process. Note: The CSC Options tab is available when a Consolidate Services Claim library is attached in Practice Preferences > Libraries. To set up the CSC Options tab in a Remittance Profile library, do the following: Open File Maintenance. Select Libraries, and then select Remittance Profiles. The Remittance Profiles List window opens. Open the profile library. The Remittance Profile window opens. Select the CSC Options tab. Select settings for CSC options. When you're done setting options, select OK to save changes and close the window. CSC Options Tab - Options and Settings Parent topic: Set Up a Remittance Profile Library

CSC Automation in Remittance Profile

Recommendations

Default Values for CSC Claim Level Payments and Adjustments

New Value FIFO with Credit Balance in CSC Options

Apply FIFO with Credit Balance for CSC Claims in the ERA Import Process

X12 EDI Format of CSC Claims

Set Up the Remittance Profile - CSC Options Tab

Set Up the Remittance Profile - CSC Options Tab

Default Values for CSC Claim Level Payments and Adjustments

New Value FIFO with Credit Balance in CSC Options

Apply FIFO with Credit Balance for CSC Claims in the ERA Import Process

X12 EDI Format of CSC Claims

Set Up the Remittance Profile - CSC Options Tab

Set Up the Remittance Profile - CSC Options Tab