Pending Claims - Claim Production Status Report Messages

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

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

Claim Production Status Report

The Claim Production Status report is automatically generated when one or more encounters are billed in NextGen® Enterprise PM. After the claim edits process completes for all encounters, the report generates and appears on screen. The report identifies whether the encounters passed or failed claim edits by displaying each encounter in one of the following text colors: Green: Indicates the encounter passed all claim edits and a pending claim is created for the payer. Self-pay encounters also display in green if the Include Self-Pay Encounters In Claim Billing Report option is enabled in Practice Preferences > Claims. Blue: Indicates the encounter failed one or more claim edits that are set up in the Claim Edits Library with Severity = Warning, and a pending claim is created for the payer. Red: Indicates the encounter failed one or more claim edits that are set up in the Claim Edits Library with Severity = Build, Critical or Required, and a pending claim is not created for the payer. To

Help Guide for NextGen® Enterprise PM 8

Case Consolidation Claim Edits

Build level claim edits and a warning message can appear on the Claim Production report when the following scenarios occur: Build Level Claim Edits Case is not complete. Encounter date is after the CSC program expiration date. Warning Message Program payers do not match on the encounters and the case. The following table describes the claim edits, warning message, help text, error applicable to, and the claim field. Claim Edit or Warning Message Description Applicable To Claim Field Case is not complete Case with Case Consolidated Claim Program incomplete for Candidate Encounter (list candidate encounters). Claim Data 2400 DTP Encounter date is after CSC program expiry date Remove encounter from CSC Program Case or change dates so that Encounter date falls within CSC Program effective dates. Claim Dates 2300/2400 DTP Case Consolidated Claim Program payers do not match on Encounter and Case. (Warning Message) All claims for a Case CSC Program must have the same payers on all encounters

Help Guide for NextGen® Enterprise PM 8

Working with the Report

This Claim Production Status report displays claim errors and the status of the encounters you have billed. The text displays in colors. These colors indicate the following: Green text indicates that the claim is clean and a pending claim request has been successfully created. Note: Self-pay encounters may display here as well depending on your practice preferences. Blue text indicates items that you flagged as warnings in the Claim Edits library. A pending claim request has been successfully created. Red text indicates an error that is required to be corrected. Items with red error messages will not create claim requests. Black text typically indicates that no charges have been selected for billing. This could occur under the following circumstances: If you try to bill records without charges If an encounter is in a rebill or unbilled status, but no line items were errors, review the error to determine the field to be corrected. The following are examples of errors and where the error

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

Pending Claims - Claim Production Status Report Messages

Recommendations

Hold Claims - Claim Production Status Report Messages

Claim Production Status Report for CSC Candidate Encounters

Claim Production Status Report

Case Consolidation Claim Edits

Working with the Report

Alert Messages

Hold Claims - Claim Production Status Report Messages

Claim Production Status Report for CSC Candidate Encounters

Claim Production Status Report

Case Consolidation Claim Edits

Working with the Report

Alert Messages