Hold Claims - Claim Production Status Report Messages

Help Guide for NextGen® Enterprise PM 8

Pending Claims - Claim Production Status Report Messages

When a CSC Candidate Encounter that is flagged as exempt from CSC claims is billed, either on demand (individual) or in batch, and the encounter passes all claim edits, a green message displays on the Claim Production Status report for the Pending status claim as follows: Demand Billing Severity: Informational Message: No errors found. Claim excluded from CSC by manual selection. Status: Claim Pending Batch Billing Severity: Informational Message: Non-CSC candidate claim successfully created. Claim excluded from CSC by manual selection. Status: Claim Produced Claim Production Status Parent topic: Claim Production Status Report for CSC Candidate Encounters

Help Guide for NextGen® Enterprise PM 8

Claim Production Status Report for CSC Candidate Encounters

When a CSC Candidate Encounter is billed, either on demand (individual) or in batch, and the encounter passes all claim edits, a green message displays on the Claim Production Status report for claims in a status of HOLD or PENDING. Hold Claims - Claim Production Status Report Messages Pending Claims - Claim Production Status Report Messages Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Hold Status

During the billing process, CSC candidate encounters must pass all claim edits, just like any other encounter, for a claim to be created. When a claim is created for a CSC Candidate Encounter, it has a status of HOLD instead of the standard claim status of Pending. Claims with a status of HOLD are consolidated into a single CSC claim, using the Consolidate Same Day Claims process. Parent topic: Create HOLD Claims for CSC Candidate Encounters

Help Guide for NextGen® Enterprise PM 8

Alert Messages

The following table provides information on the alert messages and the action to take after reviewing the message. Alert Message Occurs when... Status Click... To... All claims are ready for consolidation. Would you like to create Consolidated Services Claims? All lines in the report are green CSC Claim Pending Yes Create consolidated claims and close the report No Close the report and do not create CSC claim Cancel Return to the report No claims are ready for consolidation. No Consolidated Services Claims will be created. All lines in the report are red Error OK Close the report; no CSC claims created Cancel Return to the report No matching candidate encounter claims found. Convert single HOLD claims to Pending status? All lines in the report are blue Claim Pending Yes Convert single HOLD claims to Pending status and close the report No Close the report and no HOLD claims are converted to Pending Cancel Return focus to the report Not all claims are ready for consolidation. Would you l

Help Guide for NextGen® Enterprise PM 8

Hold Status Changes to Consolidated or Pending

CSC candidate claims status can change from a status of Hold to Consolidated or Pending. The following table provides an explanation of when the claim status can change: Status Changes to... When a ... Hold Consolidated HOLD claim is to be consolidated. Hold Pending Single HOLD claim exists and no other CSC Candidate encounters exist. Parent topic: Rules for Claims Consolidation in a Hold Status

Help Guide for NextGen® Enterprise PM 8

Rules for Claims Consolidation in a Hold Status

The CSC process consolidates CSC candidate claims by using the following rules for claims in a HOLD status. The rules for claims consolidation are setup in the Consolidated Services Claim library. CSC candidate encounters are in a HOLD status. The claims are in a HOLD status and are released for processing. When only one of the patient HOLD claims is selected on the Claim Request Lookup window in the Claim Requests list, all patient HOLD claims are combined into a CSC claim for the specified time-frame. Suppressed or exempt claim charges are not included in the claim due amount. Hold Status Changes to Consolidated or Pending Parent topic: Consolidated Service Claims

Hold Claims - Claim Production Status Report Messages

Recommendations

Pending Claims - Claim Production Status Report Messages

Claim Production Status Report for CSC Candidate Encounters

Hold Status

Alert Messages

Hold Status Changes to Consolidated or Pending

Rules for Claims Consolidation in a Hold Status

Pending Claims - Claim Production Status Report Messages

Claim Production Status Report for CSC Candidate Encounters

Hold Status

Alert Messages

Hold Status Changes to Consolidated or Pending

Rules for Claims Consolidation in a Hold Status