NextGen Knowledge Center

Default Settings in Remittance Profile

The following table describes the settings for the Default tab in Remittance Profile.

OptionDescription
Encounter Payer Matching (After GS02 Payer Nbr)
Use the following Encounter Payer Matching optionTo identify the payer during ERA matching, you can select one of the following options:
  • Select Payer using Claim Status (Default):
    After identifying the payer using the GS02 and the ERA payer number, match will further include the CLP02 claim status returned in the 835 file. The following are the most common claim statuses.
    • 1 = Primary Payer
    • 2 = Secondary Payer
    • 3 = Tertiary Payer
    • 19 = Forwarded
    • 22 = Reversal
  • Select Payer using Claim Status with Policy Number
    After identifying the payer using the GS02 and the ERA payer ID, it will also match the claim status and the policy number returned in the 835 file.
    • The ERA matches the Encounter Payer's policy number using the claim status.
    • An ineligible policy number is produced when matching fails on both policy number and claim status.
    • Selecting this option enables you to select the Match On Exact Policy Number and Match on Override Policy Number options.
  • Select Payer using Match on Exact Policy Number without Claim Status
    After identifying the payer using the GS02 and the ERA Payer ID, it also matches the Encounter Payer's exact policy number without using the claim status returned in the 835 file.
    • ERA checks the policy number on the Encounter Payer matches the policy number in the 835 file.
    • An ineligible Policy Number is produced when there is no exact match with the Encounter Payer's Policy Number.
    • If multiple Encounter Payers are found with exactly the same policy number, a message appears stating that multiple encounter payers are matched with the same policy number Multiple encounter payers are matched with the exact policy number <policy number>.
    • Selecting the Select Payer using Match on Exact Policy Number without Claim Status option disables the Match On Exact Policy Number and If no match found with claim status/policy nbr, match on first Payer (Default) options. By default, the Match on Override Policy Number option is disabled, but can be enabled.
Match on Exact Policy NumberMatches the policy number returned in the 835 file with the number in the Policy Nbr field on the Insurance Maintenance window. When a match is not found, you receive a message that the policy number is ineligible.
Match on Override Policy NumberMatches the policy number returned in the 835 file with the override number in the Policy Nbr for [Name] field on the Insurance Maintenance window. This field is used to enter a number for the patient that is different from the number for the subscriber. For example, a child's policy number is different from the parent's policy number. The override policy number field is enabled by selecting the Display override policy number and co-pay check box on the Payer Defaults-2 tab.
If no match found with claim status/policy nbr, match on first Payer (Default)

  • When this option is selected, and the above match options do not return a claim status or policy number match, the first payer on the encounter is used.

  • The Use settled up status with ERA option in Practice Preferences will affect this setting.

    • If Use settled up status with ERA check box is selected in Practice PreferencesTransactions tab, the payment will post to the first payer on the encounter (primary).
    • If Use settled up status with ERA check box is not selected, the payment does not post and a message appears stating that the encounter payer is not found Encounter Payer Not Found.
Batch Description These options determine the batch description.
Include payer name(s)Includes payer name in the Batch Description field on the Batch Maintenance window.
Include check amountYou can select this option to include check amount in the Batch Description field on the Batch Maintenance window.
Transaction Description These options determine the transaction description.
Use batch check numberIncludes ERA Check nnnn, where nnnn is the check number, in the batch Default Tracking field on the Batch Maintenance window. Tracking appears on the Payment Entry window and on the ChartEncounters tab, on Transactions sub-tab.
Use payer control numberIncludes payer control number in the batch Default Tracking field on the Batch Maintenance window. Tracking appears on the Payment Entry window and on the ChartEncounters tab, on Transactions sub- tab.
Transaction Date
Use check paid dateUses the check date in the ERA file (the date the check was written) as the Transaction Date for all transactions in the batch, as opposed to the date the file is imported and posted.
Batch Category
Default transaction category valueYou can select a category to default to the Batch Category field on the Batch Maintenance window for all ERA batches.
Batch Import Security
Secure batches to the user importing the ERAAutomatically defaults the name of the user who processes the ERA file into the Secured to User field on the Batch Maintenance window.
Explanation of Benefits
Create EOB data upon importCreates an EOB from data within the ERA file.
On the Fly
Allow creation of reason codes on the flyAutomatically adds codes to Reason Codes Library when an ERA file includes reason codes that do not already exist in the library. New codes added to the library have a generic description of New code entry – no description. Codes with the generic description can later be modified in the library to reflect the actual description.
Posting Rules. These options define business rules for ERA posting transactions. These options apply to line item level payments.
Force line item credit balanceDetermines whether a transaction should be posted and added to the batch, if posting the transaction creates a credit (negative) balance. If this option is not enabled, imported transactions that create a credit balance appear on the ERA Import Posting report as Not Posted.
Post zero line item paymentsDetermines how $0.00 payments are posted. You can select one of the following:
  • Always. $0.00 payments are always posted and added to the batch, whether or not a deductible (PR1) exists.
  • Never. $0.00 transactions are never posted and added to the batch. They appear on the ERA Import Posting report as Not Posted.
  • Only when deductible (PR1) exists. $0.00 payments are posted and added to the batch only when a deductible (PR1) exists.
Process secondary adjustmentsPosts secondary adjustments along with secondary payments in the ERA file. You might select this option for payers where the patient should not be billed for a remaining balance, such as a payer of last resort (for example, Medicaid)
Process tertiary adjustmentsPosts tertiary adjustments along with tertiary payments in the ERA file. You can select this option for payers where the patient should not be billed for a remaining balance, such as a payer of last resort (for example, Medicaid)
Only post transactions to the current practicePrevents batches from being created across multiple practices. When ERA is imported, if the file includes transactions for encounters in practices outside the current practice or is in a Run as practice job in NextGen® Background Business Processor, batches are not created in those other practices. The ERA Import Posting report displays the message that the transaction was not posted due to the remittance profile configuration. To create batches in other practices, you must import the same file into those practices.
Do not post to encounter in bad debtPrevents transactions for encounters in the Bad Debt status from being posted. If not selected, transactions for Bad Debt encounters post using the Default Payment/Adjustment for Bad Debt transaction codes defined for the payer on the PayerPractice tab, Transactions sub-tab.
Post to voided chargeEnables ERA transactions to post to voided charges. The ERA Import Posting report displays the message that the line item successfully posted to voided charge. You must not select this option to prevent ERA transactions from posting to voided charges. The ERA Import Posting report displays the message that the line item was not posted due to remittance profile configuration.
Adjustment Calculation
Use CAS segment total to calculate adjustmentCreates adjustments by totaling the service level non-PR (non-Patient Responsibility) CAS segments and using the total as the adjustment amount. The total is reset each time a new service segment is encountered.
Create write-off adjustments at time of importIf selected, any adjustment amount associated with a reason code that is set up to Write off remaining balance in Reason Codes Library adjusts the balance to zero and is visible in real-time before the batch is posted.
Calculate discrepancy adjustment related to Advance SIMIf using Advanced SIM Library Mode to send one of the two user-defined price fields in SIM library on claims instead of the standard non-facility/facility charge amount, you may select this option to calculate a discrepancy adjustment for the difference between the actual charge amount and the ERA allowed amount which the payer based on the user-defined price received on the claim.
Charge Matching Options. ERA posting within NextGen® Enterprise PM normally matches the service line information received in the ERA 835 file to the charge. It is recommended to not set Charge Matching Options unless specific scenarios exist within the 835 file that prevent standard matching.
Match on remaining balanceMatches transactions to charges by comparing the transaction amount in the ERA file to the charge balance in NextGen® Enterprise PM. This option ignores the CPT® 4 code when importing an ERA returned Revenue/ CPT® 4 code.
Match on unitsMatches transactions with charges by comparing CPT® 4 units in the ERA file to CPT4 units in NextGen® Enterprise PM.
Match on modifiersMatches transactions to charges by comparing CPT4 modifiers in the ERA file to CPT4 modifiers in NextGen® Enterprise PM.
Match on amountMatches transactions to charges by comparing the billed amount in the ERA file to the charge amount in NextGen® Enterprise PM.
Match on only first five CPT4 charactersMatches transactions to charges by comparing the first 5 characters of the CPT4 in the ERA file to the first 5 characters of the CPT4 in NextGen® Enterprise PM.
Ignore Claim ID Nbr matchingIgnores claim level ID matching during import. You might use this setting when payers return identical patient control numbers per service line.
Value Codes
Auto-populate value codesAutomatically populates deductible and co-insurance value codes from the primary payer on the Encounter Maintenance fields, UB tab, Value Codessubtab.
Crossover Indicator (NM1*TT)
Override crossover indicatorMedicare ERA files contain a crossover indicator (NM1*TT) that indicates the claim has been forwarded to the secondary payer on file with Medicare. This indicator directs NextGen® Enterprise PM to suppress the secondary claim and use a transaction detail status of Forwarded to Secondary.

When you select Override crossover indicator, the crossover indicator in the ERA file is ignored and a secondary claim is created in NextGen® Enterprise PM even though Medicare indicates they have already forwarded the claim to the secondary payer.

Import Posting Report
Use the following memorized Import Posting ReportAllows a custom memorized version of the ERA Import Posting report to be used when importing all ERA files. You can select the custom memorized report here.
Process complete file for reporting purposesDisplays all SVC (charge) line data on the ERA Import Posting report for items that are Not Posted.
2100 Level Claim Reason Codes.

Some payers may return Reason Codes at the 2100 Claim Level in the ERA file. This option determines how the Transaction Detail Status assigned to claim level codes in Reason Codes Library are applied to line items when the file is imported.

Apply Trans Detail Status (per claim)You can select one of the following:
  • <none>. If blank, the transaction detail status for claim level reason codes is applied using previous logic based on Encounter Level distribution settings.
  • To all line items. Applies the transaction detail status for claim level reason codes to all line items.
  • To non-zero balance line items. Applies the transaction detail status for claim level reason codes to all line items except those with $0 balance.
Claim Level Payments and Adjustments.

These options define how a single claim-level payment and adjustment is allocated across multiple line item charges on an encounter during the ERA Posting process.

Use the following method to distribute both payments and adjustments:If an option other than <none> is selected, the distribution method fields in the Encounter Level Payments and Claim Level Adjustments sections are disabled and unavailable for selection.

You can select one of the following:

  • <none>. If blank, a single distribution method for claim level payments and adjustments is not used. Instead, a separate distribution method for each can be selected in the Encounter Level Payments and Claim Level Adjustments sections.
  • Apply to remaining line item with balance. Applies the claim payment and/or adjustment to the first charge with a balance in the corresponding COB bucket. This may potentially create a credit balance on the line item.
  • FIFO. Applies the claim payment and/or adjustment to the first charge with a balance, bringing the balance to $0, then continues to the second charge with a balance, bringing the balance to $0, and continues until the payment/adjustment amount has been exhausted.
  • Weighted: Applies a percentage of the claim payment and/or adjustment amount to all charge line items with a balance. The percentage is calculated by taking the charge balance and dividing by the total balance for all charges. The payment/adjustment is calculated by multiplying the percentage by the total payment or adjustment amount.
  • Weighted on Current COB Balance. Applies a percentage of the claim payment and/or adjustment amount to all charge line items with a balance. The percentage is calculated by taking the charge COB balance and dividing by the total COB balance for all charges. The payment or adjustment is calculated by multiplying the percentage with the total payment or adjustment amount.
  • FIFO with credit balance. Applies to the claim payment and/or adjustment to the first charge with a balance, bringing the balance to 0$, then to the next charge with a balance, and continues until the payment or adjustment amount is exhausted and the credit balance is displayed against last charge of the ERA Import Posting report.
Do not post/distribute ANY adjustmentsPrevents claim level adjustments from being posted and added to the batch when the ERA file is processed.

If selected, claim level payments will still post using the distribution method selected above. The ERA Import Posting report displays payment amounts, but no adjustment amounts due to this setting.

Encounter Level Payments

These options define how a single encounter-level payment is allocated across multiple line item charges on an encounter during the ERA Posting process.

Use the following method to distribute encounter-level payments: Select one of the following:
  • <none>. If blank, a distribution method for encounter level payments will not be used. Instead, a distribution method for both payments and adjustments can be selected in the Claim Level Payments and Adjustments section.
  • Apply to remaining line item with balance. Applies the payment to the first charge with a balance in the corresponding COB bucket. This may potentially create a credit balance on the line item.
  • FIFO. Applies the payment to the first charge with a balance, bringing the balance to $0, then continues to the second charge with a balance, bringing the balance to $0, and continues until the payment amount has been exhausted.
  • Weighted. Applies a percentage of the payment amount to all charge line items with a balance. The percentage is calculated by taking the charge balance and dividing by the total balance for all charges. The payment is calculated by multiplying the percentage by the total payment amount.
  • Weighted on Current COB Balance. Applies a percentage of the claim payment and/or adjustment amount to all charge line items with a balance. The percentage is calculated by taking the charge COB balance and dividing by the total COB balance for all charges. The payment or adjustment is calculated by multiplying the percentage with the total payment or adjustment amount.
  • FIFO with credit balance. Applies to the claim payment and/or adjustment to the first charge with a balance, bringing the balance to $0, then to the next charge with a balance, and continues until the payment or adjustment amount is exhausted and the credit balance is displayed against last charge of the ERA Import Posting report.
Force encounter-level payment distribution on secondary paymentsSelect this option for secondary payers that return claim/encounter level and service line item level payments. If selected, the service line item level payment in the ERA file will be ignored and only the claim/encounter level payment will be imported.
Claim Level Adjustments

These options define how a single claim-level adjustment is allocated across multiple line item charges on an encounter during the ERA Posting process.

Use the following method to distribute claim-level adjustments: Select one of the following:
  • <none>. If blank, a distribution method for claim level adjustments will not be used. Instead, a distribution method for both payments and adjustments can be selected in the Claim Level Payments and Adjustments section.
  • Apply to remaining line item with balance. Applies the adjustment to the first charge with a balance in the corresponding COB bucket. This may potentially create a credit balance on the line item.
  • FIFO. Applies the adjustment to the first charge with a balance, bringing the balance to $0, then continues to the second charge with a balance, bringing the balance to $0, and continues until the adjustment amount has been exhausted.
  • Weighted. Applies a percentage of the adjustment amount to all charge line items with a balance. The percentage is calculated by taking the charge balance and dividing by the total balance for all charges. The adjustment is calculated by multiplying the percentage by the total adjustment amount.
  • Weighted on Current COB Balance. Applies a percentage of the claim payment and/or adjustment amount to all charge line items with a balance. The percentage is calculated by taking the charge COB balance and dividing by the total COB balance for all charges. The payment or adjustment is calculated by multiplying the percentage with the total payment or adjustment amount.
  • FIFO with credit balance. Applies to the claim payment and/or adjustment to the first charge with a balance, bringing the balance to 0$, then to the next charge with a balance, and continues until the payment or adjustment amount is exhausted and the credit balance is displayed against last charge of the ERA Import Posting report.
Do not post adjustments that increase the balance (negative adjustments)Prevents negative claim level adjustments that will increase a balance (e.g. corrections, reversals, etc.) from being posted and added to the batch when the ERA file is processed. They display on the ERA Import Posting report as Not Posted. This allows for follow-up to ensure the adjustment amounts are correct.
Group Transaction Codes

Each of the four HIPAA standard reason code groups (CO, CR, OA, PI), can be linked to a specific transaction code below. If the transaction code is also linked to a payer on the Payers > Practice > Transactions tab in one of the “Additional Transaction 1 – 6” fields, an additional transaction corresponding to the group transaction code will be posted when the ERA file is imported

Contractual Obligation (CO)Displays the third-party adjustment code to be used for all CO reasons.
Correction Reversals (CR)Displays the third-party adjustment code to be used for all CR reasons.
Other Adjustment (OA)Displays the third-party adjustment code to be used for all OA reasons.
Payer Initiated (PI)Displays the third-party adjustment code to be used for all PI reasons.
Interest Posting Rules
Do not post interest, report onlyPrevents interest payments from being posted when the ERA file is imported. The payments display on the ERA Import Posting report as Not Posted.
Post interest to the following encounter numberIndicates the encounter number to be used if allowing interest payments to be posted.
and use transaction codeDisplays the third-party transaction code to be used if allowing interest payments to be posted.
Auto Balance Rules
Automatically balance batch when an ERA is imported with no errors Enables the practice to auto-balance ERA batches in NextGen® Enterprise PM. When the rule is set to Auto Balance, the ERA process matches the batch header with the batch ledger. After the matching, the batch is ready to post. Manual balancing and posting are still required for any ERA batch that is imported. You can select one of the following:
  • <none>. If blank, ERA batches are balanced and posted manually. This is the default.
  • Auto Balance and flag for BBP. ERA batches are auto-balanced and posted by NextGen® Background Business Processor.
  • Auto Balance. ERA batches auto-balance and batches need to be manually posted.
Prevent auto balancing when ERA is imported with PLB segmentsAllows practices to prevent automatic balancing of ERA batches in NextGen® Enterprise PM when certain conditions are met.

When the setting Prevent auto balancing when ERA is imported with PLB segments is turned on, any ERA file containing PLB segments is not auto-balanced or flagged for the NextGen® Background Business Processor. Instead, these batches remain out of balance, requiring manual adjustment. The feature supports more precise management of ERA files with PLB adjustments before posting.

Bundled Payment Posting Rules
Use Bundled Payment Processing for UB claimsYou can select this option if a payer has a bundled payment which has returned a revenue code that relates to several CPT4 codes. This option works in conjunction with the Encounter Level Payments options of FIFO (First in First Out) and Weighted.
Post Unbundled Payment to Single ChargeYou can select this option when a single CPT code with quantity >1 is billed and the ERA is returned with individual payments to individual charge lines.
Post Bundled Payment to Multiple ChargesIn the Remittance Profile window.
  • Enable Post Bundled Payment to Multiple Charges
  • For UB Claims, enable Use Bundled Payment Processing for UB Claims
You can select the Post Bundled Payment to Multiple Charges option when multiple charges are billed to a payer and the payer returns a single bundled payment for the multiple charges. The application then posts the transaction against each billed line item by dividing the allowed amount, payment amount and adjustment amount by the quantity on the bundled payment.