Enable Segments for Claim-level Approved Amounts and Adjustments

If the Submitter Profile setting is...	And the payer-level setting is set to...	Then the segment will...
Enabled	<none> (blank)	Create
Enabled	Create
Disabled	Not create
Disabled	<none> (blank)	Not create
Enabled	Create
Disabled	Not create

Help Guide for NextGen® Enterprise PM 8

Setting the Optional Segments for the 837 Format

A secondary electronic file adds several new segments to the standard 837 format for primary claims. These segments are added regardless of how the primary payment is posted: Service line payment information (2430 SVD) Service line adjustment information (2430 CAS) Service line adjudication date (2430 DTP*573) Service line approved amount (2400 AMT*AAE) These segments automatically create based on whether the file type is institutional or professional: Claim-level allowed amount (AMT*B6 – institutional only) Claim-level payer amount paid (AMT*C4 – institutional, AMT*D-prof) Claim-level patient paid amount (AMT*F5 –both) Payer requirements dictate if other optional segments can be added. You can enable these optional segments with the electronic secondary claim options in the Payer master file. Parent topic: Generating Secondary Electronic Claims

Help Guide for NextGen® Enterprise PM 8

Examples of Claims with the Claim Level Adjustment Amount Segment

The following examples show the 2320 loop when the claim-level adjustment amount segment is added to institutional and professional claims. The segment is displayed in bold text. 2320 loop for a professional claim with the claim level adjustment amount added The following example shows how the 2320 loop for a professional claim looks with either the Submitter Profile or Payer option set to add the claim level adjustment amounts. Claim level CAS segments are grouped under the adjustment reason group code (e.g. CO, PR, CR, or PI). When the same group code (PR3, PR1) contain specific multiple reason codes, these codes are combined in the same CAS segment. For example, reason codes PR1 and PR3 would be combined in the same CAS segment like this: CAS*PR*3*20**1*100~, with each reason code paired with the corresponding amount. CLM*000100000970*190***11**1*Y*A*Y*O*B******P~ REF*EA*CP1Z3M36NVOA~ HI*BK*25000~ NM1*82*1*TEAM MD*ROBERT*A***24*404803109~ REF*1D*404803109~ SBR*P*18***C1****BL~ CAS*C

Help Guide for NextGen® Enterprise PM 8

Examples of Claims with the Claim Level Approved Amount Segment

The following examples show the 2320 loop when the claim-level approved amount segment is added to institutional and professional claims. The segment is displayed in bold text. 2320 loop for a professional claim with the claim level approved amount added The following example shows how the 2320 loop for a professional claim looks with either the Submitter Profile or Payer option set to add the claim level approved amount. Since there is no distinction between the approved amount and the allowed amount in the claim file, the option to add the claim level approved amount adds both the approved amount (AMT*AAE) and allowed amount (AMT*B6) segments in a professional file. CLM*000100000970*190***11**1*Y*A*Y*O*B******P~ REF*X4*CLIA123~ REF*EA*CP1Z3M3F8R23~ HI*BK*25000~ NM1*82*1*TEAM MD*ROBERT*A***24*404803109~ PRV*PE*ZZ*207QA0505X~ REF*1D*404803109~ SBR*P*18***C1****BL~ AMT*D*138~ AMT*AAE*157~ AMT*B6*157~ DMG*D8*19661013*F~ OI***Y*B**O~ 2320 loop for an institutional claim with the claim lev

File Maintenance Help for NextGen® Enterprise 8

COB Electronic Claims Sub-Tab

The options on the COB Electronic Claims tab work only for electronic secondary claims and accommodate 837 COB requirements. CAUTION: These options should never be enabled unless the payer requires them. Claim rejections can occur if these segments are present and the payer does not want them. Field Description Populate 2400 CN1 contractual adjustment segment Select this option to add a service line CN1 segment (2400). This amount is also referred to as the OTAF (obligated to accept in full) amount. If this option is enabled and a service line contractual adjustment exists (CAS*CO), then the allowed amount is added as the 2400 CN1 amount. The presence of the CAS*CO segment causes the CN1 segment to create mimicking the allowed/approved amount in the AMT*AAE segment. Enable COB information popup in payment entry Select this option so that during transaction entry the Coordination of Benefits Information window automatically displays when the user tabs out of the Reason field for the las

Help Guide for NextGen® Enterprise PM 8

COB Electronic Claims Sub-Tab

The options on the COB Electronic Claims tab work only for electronic secondary claims and accommodate 837 COB requirements. CAUTION: These options should never be enabled unless the payer requires them. Claim rejections can occur if these segments are present and the payer does not want them. Field Description Populate 2400 CN1 contractual adjustment segment Select this option to add a service line CN1 segment (2400). This amount is also referred to as the OTAF (obligated to accept in full) amount. If this option is enabled and a service line contractual adjustment exists (CAS*CO), then the allowed amount is added as the 2400 CN1 amount. The presence of the CAS*CO segment causes the CN1 segment to create mimicking the allowed/approved amount in the AMT*AAE segment. Enable COB information popup in payment entry Select this option so that during transaction entry the Coordination of Benefits Information window automatically displays when the user tabs out of the Reason field for the las

File Maintenance Help for NextGen® Enterprise 8

ADA Claims Tab on Claims

This window is in the Payer master file. To access the window select Payers and then select the payer. On the Modify Payer Information window select Practice > Claims > ADA Claims sub-tab. Field Description Submitter Profile Select the submitter profile that you want to apply to ADA Claims. Electronic Transmitter ID Enter the payer-assigned electronic transmitter ID to generate a claim with an electronic transmitter ID. Note: This field only displays when you select a submitter profile. Practice Payer Opt Val Enter the practice/payer-specific value. Payer Alias Enter an alternative payer name when a name that differs from the name that appears in the payer's Payer master file is required. Primary, Secondary, and Tertiary Media Types Enter the primary media type as either electronic or paper as accepted by the clearinghouse. If you set it as electronic, then you can also set how the secondary and tertiary claims should be submitted. When Primary, force Secondary claims to paper Enable t

Enable Segments for Claim-level Approved Amounts and Adjustments

Recommendations

Setting the Optional Segments for the 837 Format

Examples of Claims with the Claim Level Adjustment Amount Segment

Examples of Claims with the Claim Level Approved Amount Segment

COB Electronic Claims Sub-Tab

COB Electronic Claims Sub-Tab

ADA Claims Tab on Claims

Setting the Optional Segments for the 837 Format

Examples of Claims with the Claim Level Adjustment Amount Segment

Examples of Claims with the Claim Level Approved Amount Segment

COB Electronic Claims Sub-Tab

COB Electronic Claims Sub-Tab

ADA Claims Tab on Claims