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 defaults the value as FIFO in Distribute Claim-Level Payments and Distribute Claim-Level Adjustments on the CSC Options tab.
A new Remittance Profile Library is created without selecting any value on the Default tab.	The system automatically checks Enable Posting to CSC Claims on the CSC Options tab and the values of Claim level Payments and Adjustments sets to FIFO.
A new Remittance Profile Library is created and value is selected on the CSC Options tab.	The system automatically checks Enable Posting to CSC Claims on the CSC Options tab and it does not override the values of Claim level Payments and Adjustments on the CSC Options tab.
A new Remittance Profile Library is created and Weighted on Current COB Balance or Weighted is selected on the Default tab.	For all Remittance Profile Library if Weighted on Current COB Balance or Weighted is selected on the Default tab, the system selects Weighted on the CSC Options tab.
A new Remittance Profile Library is created and FIFO is selected on the Default tab.	The system automatically checks Enable Posting to CSC Claims on the CSC Options tab and Distribute Claim-Level Payments and Distribute Claim-Level Adjustments sets to FIFO on the CSC Options tab.
In Practice Preference when CSC Library changes from CSC Library A to CSC Library B.	The system retains the existing value on the Default tab.

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

CSC Automation in Remittance Profile

The NextGen® Enterprise PM automatically enables some of the Remittance Profile settings for consolidated claims to post the ERA transactions correctly. In NextGen® Enterprise PM Practice Preferences, when Libraries is selected on the Preference List and CSC Library is selected in the Consolidated Services Claim drop down menu. The system automatically enables the Enable Posting to CSC Claims option on the CSC Options tab in Remittance Profile Library. On the Remittance Profile window, if Enable Posting to CSC Claims is selected manually, then Distribute Claim-Level Payments and Distribute Claim-Level Adjustments become required fields. If the required fields are not filled, a message appears stating that enough information is not collected and that fields in red label required an entry. Parent topic: Consolidated Service Claims

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

CSC Options Tab - Options and Settings

You can use the following list of options and descriptions to make settings on the CSC Options tab in your Remittance Profile. CSC Tab Options Option Description Consolidated Services Claim payment Posting Enable Posting to CSC Claims Enables matching logic for the following 835 segments during the ERA Posting process: REF*EA Segment REF01 (2100 level)-EA - Medical Record Identification Number identifies the CSC Claim from the superclaim_encounters table. REF*EA - the REF*6R line item control number is used to match to the service line(s) for ERA posting. REF*6R - is used for UB/837I posting of CSC and Non-CSC Claim payments. On the Default tab, in the Charge Matching Options, you must select Use Bundled Payment Processing for UB Claim to this segment. REF*EA - If not returned , the 2100 Service Lines REF6R is used to look for a match. REF6R - identifies a match to a CSC Claim, each payment’s line item is posted to the matching REF*6R. REF*EA and REF*6R - are missing, the normal Remitt

File Maintenance Help for NextGen® Enterprise 8

CSC Options Tab - Options and Settings

You can use the following list of options and descriptions to make settings on the CSC Options tab in your Remittance Profile. CSC Tab Options Option Description Consolidated Services Claim payment Posting Enable Posting to CSC Claims Enables matching logic for the following 835 segments during the ERA Posting process: REF*EA Segment REF01 (2100 level)-EA - Medical Record Identification Number identifies the CSC Claim from the superclaim_encounters table. REF*EA - the REF*6R line item control number is used to match to the service line(s) for ERA posting. REF*6R - is used for UB/837I posting of CSC and Non-CSC Claim payments. On the Default tab, in the Charge Matching Options, you must select Use Bundled Payment Processing for UB Claim to this segment. REF*EA - If not returned , the 2100 Service Lines REF6R is used to look for a match. REF6R - identifies a match to a CSC Claim, each payment’s line item is posted to the matching REF*6R. REF*EA and REF*6R - are missing, the normal Remitt

Help Guide for NextGen® Enterprise PM 8

Set Up a Remittance Profile Library

The Remittance Profile Library defines various parameters and rules that are used when importing and processing ERA 835 files downloaded from payers into NextGen® Enterprise PM. The Default Remittance Profile library in File Maintenance is pre-installed in the application and includes a few recommended pre-set options. All remaining options are set based on your organizational preferences or in response to the payer’s ERA 835 file configuration. Practice Level vs. Payer Level Libraries A default Remittance Profile Library must be selected in Practice Preferences > Libraries. The default library is used for all ERA payers in the practice that do not have a specific library linked. A different Remittance Profile Library to be used for a specific payer/financial class can be linked on the Payer > Practice > Libraries sub-tab. This library overrides the default library in Practice Preferences for the payer/financial class. Any payers that do not have a Remittance Profile Library attached u

Default Values for CSC Claim Level Payments and Adjustments

Recommendations

New Value FIFO with Credit Balance in CSC Options

CSC Automation in Remittance Profile

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

CSC Options Tab - Options and Settings

CSC Options Tab - Options and Settings

Set Up a Remittance Profile Library

New Value FIFO with Credit Balance in CSC Options

CSC Automation in Remittance Profile

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

CSC Options Tab - Options and Settings

CSC Options Tab - Options and Settings

Set Up a Remittance Profile Library