Discharge Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Encounter	Message	Message Type	Help Text	Occurs When
Enc1, Enc2, Enc3, Enc4	System unable to consolidate due to conflicting Discharge Date on encounters <Enc1> and <Enc3>.	Error	Correct conflicting data on all encounters and rebill.	The user has entered different discharge date in <Enc1> and <Enc3>.
The Discharge date is missing in all the CSC encounters.	Alert	Add Discharge date if its applicable.	The user has not entered the discharge date in any of the CSC encounters.
System unable to consolidate due to conflicting Discharge time on encounters <Enc1> and <Enc3>.	Error	Correct conflicting data on all encounters and rebill.	The user has entered different discharge time in <Enc1> and <Enc3>.
The Discharge time is missing in all the CSC encounters. If Discharge date is captured then the Default time 0800 gets added by default in the EDI file.	Alert	Add Discharge time if its applicable.	User has not entered Discharge time in any of the CSC encounters.

Help Guide for NextGen® Enterprise PM 8

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

When you consolidate two or more claims, one claim is considered as the King claim. The other claims are referred to as Candidate claims. When you consolidate the claim, the following rules are applied. If the values are different in King claim and in Candidate claims, a conflicting error message appears in the CSC report. If the values are the same in the King claim and in Candidate claims, the same value appears in the CSC report. If the value is missing in the King claim, the value is taken from the Candidate claims. An error message appears when there is a conflicting data, and an alert message appears when there is missing data. The following table describes the messages displayed. Encounter Message Message Type Help Text Occurs When System unable to consolidate due to conflicting Admit Date on encounters <Enc1> and <Enc3> Enc1, Enc2, Enc3, Enc4 Correct conflicting data on all encounters and rebill. The user has entered different admission dates in <Enc1> and <Enc3>. The Admission

Help Guide for NextGen® Enterprise PM 8

Admission Type and Source of Admission Rules for Consolidated Institutional Fields in CSC Claims

When you consolidate two or more claims, one claim is considered as the king claim. The other claims are referred to as Candidate claims. When you consolidate the claim, the following rules are applied. The system uses the data from the King claim for admission type and source of admission. If the king claim is blank, The system uses the data from the Candidate claims. An error message appears when there is a conflicting data, and when the data is missing. The following table describes the messages displayed. Encounter Message Message Type Help Text Occurs When Enc1, Enc2, Enc3, Enc4 System unable to consolidate due to conflicting Admission type on encounter <Enc1> and <Enc3>. Error Correct conflicting data on all the encounters and rebill. The user has entered different admission types in encounter <Enc1> and <Enc3>. The Admission type is missing in all the CSC encounters. Alert Add the Admission type if its applicable. The user has not entered the admission type in any of the CSC enc

Help Guide for NextGen® Enterprise PM 8

Mark a CSC Encounter as Exempt

CSC candidate encounters can be marked exempt either manually or automatically by the system. Automatic exemption of a claim occurs when the claim is suppressed as a result of File Maintenance settings. Exempt encounter charges are not included in a consolidated claim. Access the Consolidated Services Claim tab under the Claims tab on the Encounter Maintenance window. To identify the responsible attending provider for claim header, complete the Primary Responsible Attending, Secondary Responsible Attending, and Tertiary Responsible Attending fields. Select one of the following options for each applicable insurer: None - (default prior to billing) Responsible Attending Ancillary Provider To remove encounter charges from a primary, secondary, or tertiary CSC claim, select the applicable check box: Exempt from Primary Consolidated Services Claim An alert displays if a Primary HOLD claim is attached to the encounter: A HOLD claim exists for this encounter. Would you like to convert the HOL

Help Guide for NextGen® Enterprise PM 8

Rules for CSC Claims - Condition, Value and Occurrence Codes

When consolidating two or more claims, one claim is designated as the king claim. The other claims are referred to as child claims. The claim header information is pulled from the consolidated claim. All unique condition codes, value codes, and occurrence codes are included on the king claim. This occurs when the child claim includes value, occurrence, or condition codes that are not a part of the king claim. Depending on your payer's preference, you can have the application automatically sum the value of all value codes on the claim. Or you can contact NextGen Healthcare Support for a script that will not sum the total value of duplicate value codes. Rules for including condition, occurrence, and value codes are as follows: Duplicate codes and values appear one time on the consolidated claim. All codes will display in alphanumeric order on the consolidated claim. Sum Duplicate Value Codes - When there are two of the same codes that contain different values, the application will automa

Help Guide for NextGen® Enterprise PM 8

CSC Terms

The following table provides a list of terms associated with the consolidation process of claims. Term Description TS Time Span - claims that occur on the same date, week, month, or case. The time-span is identified in the CSC library. CCCP Case Claim Consolidation Program – The program rules established in the Consolidated Services Claim library to consolidate all claims attached to a Case. CCR Consolidated Claims Rules CSC Consolidated Services Claim CSC Candidate Encounter When a patient has multiple encounters per day. Each encounter can be a CSC candidate encounter. CSC Hold Claims These are the claims created after billing a CSC Candidate Encounter but prior to running the CSC process. Consolidated Claim After the charges from the CSC Hold Claims are consolidated into a CSC, the CSC Hold Claims become Consolidated claims. Claim-Header Encounter The claim header details are derived from this encounter. Primary Attending is selected in the Primary Responsible Attending field from t

Help Guide for NextGen® Enterprise PM 8

Exempting CSC Encounters

CSC options can be set manually on the Consolidated Services Claim tab under the Claims tab on the Encounter Maintenance window. The options set on this tab override the rules in the Consolidated Services Claims library. On the Consolidated Services Claim sub-tab, you can you can do the following: Identify the responsible attending physician to display in the claim header for primary, secondary, and tertiary payers. Identify specific encounters to be exempt from a consolidated services claim. If there is an eligibility overlap during billing, the application displays the following error in the Claim Production Status report: CSC Eligibility Dates overlap with HOLD claims for encounter(s). Correct Eligibility. Parent topic: Claims Consolidated Services Claim Sub-Tab Parent topic: Consolidated Service Claims

Discharge Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Recommendations

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Admission Type and Source of Admission Rules for Consolidated Institutional Fields in CSC Claims

Mark a CSC Encounter as Exempt

Rules for CSC Claims - Condition, Value and Occurrence Codes

CSC Terms

Exempting CSC Encounters

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Admission Type and Source of Admission Rules for Consolidated Institutional Fields in CSC Claims

Mark a CSC Encounter as Exempt

Rules for CSC Claims - Condition, Value and Occurrence Codes

CSC Terms

Exempting CSC Encounters