Hold Status

Help Guide for NextGen® Enterprise PM 8

Create HOLD Claims for CSC Candidate Encounters

During the normal billing process, CSC Candidate Encounters are identified. These encounters must meet the following rules: Multiple encounters for the same patient, on the same day, week, month, or case. Each practice can setup the time-frame for encounter consolidation in the Consolidated Services Claim library. Encounters are attached to the same payer. Meet all claim rules defined in the Consolidated Services Claim library. Hold Status Parent topic: Consolidated Service Claims

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

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 Claims - Claim Production Status Report Messages

Demand Billing Severity: Informational Message: No errors found for CSC candidate claim. Status: HOLD Claim Pending Batch Billing Severity: Informational Message: HOLD claim successfully created. Status: HOLD Claim Produced Claim Production Status Parent topic: Claim Production Status Report for CSC Candidate Encounters

Help Guide for NextGen® Enterprise PM 8

Automatic Identification of CSC Candidate Encounters

CSC candidate encounters are identified during the billing process and meet the following criteria: All services for a patient in a calendar. All services provided to a patient in a specific time-period that are submitted on a single claim. The time period is defined by the practice and can be daily, weekly, monthly, or on a case basis. The encounters meet the rules applied in the Consolidated Service Claim library for combining form types and encounter rate options. Note: Hold Claim Status: The Hold status is applied to all claims that meet the criteria for CSC candidate encounters. Non-coordinated or Non-covered Service SIMs: Encounters with SIMs for non-coordinated or non-covered services DO NOT qualify as CSC Candidate encounters. Guidelines for Running the CSC Process Parent topic: Consolidated Service Claims

Hold Status

Recommendations

Create HOLD Claims for CSC Candidate Encounters

Hold Status Changes to Consolidated or Pending

Rules for Claims Consolidation in a Hold Status

Claim Production Status Report for CSC Candidate Encounters

Hold Claims - Claim Production Status Report Messages

Automatic Identification of CSC Candidate Encounters

Create HOLD Claims for CSC Candidate Encounters

Hold Status Changes to Consolidated or Pending

Rules for Claims Consolidation in a Hold Status

Claim Production Status Report for CSC Candidate Encounters

Hold Claims - Claim Production Status Report Messages

Automatic Identification of CSC Candidate Encounters