Hold Status Changes to Consolidated or Pending

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.

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

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

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

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 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

Consolidated Services Claim

The claims services consolidation process is activated from the Claim Request Lookup window. The user will select the applicable claims to consolidate and then the application automatically consolidates the candidate claims into a Consolidated Services Claim (CSC). This process produces a Consolidated Services Claim report and alerts the user to any further actions that need to be taken before a CSC claim can be created. Note: The Consolidate Same Day Claims option is active when a CSC library is selected on the Practice Preferences Library window. Only claims with a Hold status can be consolidated by the CSC process. Parent topic: Consolidated Service Claims

Hold Status Changes to Consolidated or Pending

Recommendations

Rules for Claims Consolidation in a Hold Status

Hold Status

Claim Production Status Report for CSC Candidate Encounters

Create HOLD Claims for CSC Candidate Encounters

Hold Claims - Claim Production Status Report Messages

Consolidated Services Claim

Rules for Claims Consolidation in a Hold Status

Hold Status

Claim Production Status Report for CSC Candidate Encounters

Create HOLD Claims for CSC Candidate Encounters

Hold Claims - Claim Production Status Report Messages

Consolidated Services Claim

Hold Status Changes to Consolidated or Pending