New Value FIFO with Credit Balance in CSC Options

Table 1. Following are the scenarios where application displays the value FIFO with credit balance or FIFO on the CSC Options tab based on the value selected on the Default tab.
Default tab Claim level payments and Adjustments	Default tab Encounter level payments	Default tab Claim Level adjustments	CSC Options tab Distributed claim level payments	CSC Options tab Distributed claim level adjustments
FIFO with credit balance	-	-	FIFO with credit balance	FIFO with credit balance
-	FIFO with credit balance	-	FIFO with credit balance	FIFO
-	-	FIFO with credit balance	FIFO	FIFO with credit balance
-	-	-	FIFO	FIFO
-	FIFO with credit balance	FIFO with credit balance	FIFO with credit balance	FIFO with credit balance

Help Guide for NextGen® Enterprise PM 8

Default Values for CSC Claim Level Payments and Adjustments

In NextGen® Enterprise PM Practice Preferences, when CSC Library is selected on the Libraries list, the system enables some of the Remittance Profile settings for consolidated claims. The following are the default values for CSC Claim Level Payments and Adjustments. System Settings Description The system takes the value from the Default tab. When Distribute Claim-Level Payments and Distribute Claim-Level Adjustments are blank on the CSC Options tab, the system takes the value FIFO from Claim level Payments and Adjustments on the Default tab. The system takes the value from the Default tab. When CSC Claim Level Payments and Adjustments are blank on the Default tab, then the system takes the value FIFO from Encounter Level Payments and Claim Level Adjustments on the Default tab. Default value FIFO is selected in CSC Claim Level Payments and Adjustments. If CSC Claim Level Payments and Adjustments is blank on the CSC Options tab and the values are blank on the Default tab, then the system

Help Guide for NextGen® Enterprise PM 8

Apply FIFO with Credit Balance for CSC Claims in the ERA Import Process

When FIFO with credit balance is selected in the Distribute Claim-Level Payments and Distribute Claim-Level Adjustments for CSC Claim Level Payments and Adjustments or Encounter Level Payments and Claim Level Adjustments, you can post the claim or encounter level payment and adjustment with a credit balance. The application displays the following when FIFO with credit balance is applied for the CSC claims in the ERA import process. The credit balance is displayed against the last line item for multiple charges for the encounter. The difference amount is not adjusted from the total adjustment amount received in the ERA file. The adjustment amount received in the claim level CAS segment is displayed in the adjustment column in the ERA import report. When you import the ERA file, the remaining balance displays the credit balance as well as the total claim balance on the transaction window. If payment or payment and adjustment creates an overpayment and FIFO with credit balance is selected

Help Guide for NextGen® Enterprise PM 8

CSC Automation in Remittance Profile

The NextGen® Enterprise PM automatically enables some of the Remittance Profile settings for consolidated claims to post the ERA transactions correctly. In NextGen® Enterprise PM Practice Preferences, when Libraries is selected on the Preference List and CSC Library is selected in the Consolidated Services Claim drop down menu. The system automatically enables the Enable Posting to CSC Claims option on the CSC Options tab in Remittance Profile Library. On the Remittance Profile window, if Enable Posting to CSC Claims is selected manually, then Distribute Claim-Level Payments and Distribute Claim-Level Adjustments become required fields. If the required fields are not filled, a message appears stating that enough information is not collected and that fields in red label required an entry. Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Consolidated Services Claim Library

The Consolidated Services Claim (CSC) library enables you to establish rules for consolidating multiple encounter charges into a single consolidated services claim (CSC). The purpose of this library is to configure billing and claim form type rules for payers. This section includes the following topics: Security rights for user groups Consolidated Services Claim library CSC configuration rules for the consolidation of daily, weekly, monthly, and case related claims Provider hierarchy for claim headers Bill for eligible patient days You can generate the Consolidated Services Claim Library Listing report and the CSC Library with Timespan Details report from the Consolidated Services Claim library. For more information go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Set Up Security Access Rights for Consolidated Services Claims Consolidated Services Claim Library Setup Create a CSC Library Access a Consolidated Services Cla

Help Guide for NextGen® Enterprise PM 8

Consolidated Service Claims

This section explains the process of creating a Consolidated Services Claim (CSC). This process enables you to consolidate claims when a patient has more than two encounters and the same payers are attached for billing. Claims can be consolidated by a single date, week, calendar month, or case. This section covers the following topics: CSC Terms Rules for Claims Consolidation Automatic Identification of CSC Candidate Encounters Consolidate Claims by Time Span Create HOLD Claims for CSC Candidate Encounters Set Up CSC Options for an Encounter Create a Consolidated Services Claim Rebill a Consolidated Services Claim Significant Events for Consolidated Claims Create a CSC Event Audit Trail Claim Production Status report for CSC Candidate Encounters Create Tasks from the Consolidated Services Claim report EDI Format of CSC Claims CSC Terms Rules for Claims Consolidation in a Hold Status Rules for CSC Claims - Condition, Value and Occurrence Codes Admission Date and Time Rules for Consolida

Help Guide for NextGen® Enterprise PM 8

CSC Options Tab - Options and Settings

You can use the following list of options and descriptions to make settings on the CSC Options tab in your Remittance Profile. CSC Tab Options Option Description Consolidated Services Claim payment Posting Enable Posting to CSC Claims Enables matching logic for the following 835 segments during the ERA Posting process: REF*EA Segment REF01 (2100 level)-EA - Medical Record Identification Number identifies the CSC Claim from the superclaim_encounters table. REF*EA - the REF*6R line item control number is used to match to the service line(s) for ERA posting. REF*6R - is used for UB/837I posting of CSC and Non-CSC Claim payments. On the Default tab, in the Charge Matching Options, you must select Use Bundled Payment Processing for UB Claim to this segment. REF*EA - If not returned , the 2100 Service Lines REF6R is used to look for a match. REF6R - identifies a match to a CSC Claim, each payment’s line item is posted to the matching REF*6R. REF*EA and REF*6R - are missing, the normal Remitt

New Value FIFO with Credit Balance in CSC Options

Recommendations

Default Values for CSC Claim Level Payments and Adjustments

Apply FIFO with Credit Balance for CSC Claims in the ERA Import Process

CSC Automation in Remittance Profile

Consolidated Services Claim Library

Consolidated Service Claims

CSC Options Tab - Options and Settings

Default Values for CSC Claim Level Payments and Adjustments

Apply FIFO with Credit Balance for CSC Claims in the ERA Import Process

CSC Automation in Remittance Profile

Consolidated Services Claim Library

Consolidated Service Claims

CSC Options Tab - Options and Settings