Process a Claim for a Single Encounter

Help Guide for NextGen® Enterprise PM 8

Process Claim Requests for Multiple Encounters

To process claim requests for more than one encounter, use the Claim Request Lookup feature to locate claim requests that are in a Pending status. You can set the search criteria for the lookup to narrow your search to specific types of claim requests. Select the Claim Lookup button on the NextGen® Enterprise PM main menu. The Claim Request Lookup window appears. Select Pending in the Request Status field. Enter the additional search criteria that you want to use to locate the claim requests. Select Find. The Claim Request Lookup lists the claim requests that match your criteria in the Claim Requests section of the window. Place an x in the check boxes next to the claim requests that you want to process. To select all the claim requests in the list, place an x in the top check box on the column heading bar. Right-click on one of the claim requests that you selected and choose Print > Claims option from the short-cut menu. The Claim Printing window appears. Select the Print Format that

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Print Options

If your printer is not aligning the text on the claim forms correctly, you can adjust the text alignment by changing the print settings when you process claim requests. You can customize the print offset from the top and left borders of the claim form and experiment with different settings to achieve the ideal text alignment on the forms. You can access the print offset settings by selecting the Properties button on the Claim Printing window that displays when you print claims from the Claim Request Lookup results. You can choose to print the claims you process to a file rather than to a printer by selecting the Print to file option, output format, and file name. When you select this option, you must select the Open Record button and enter a file name and destination folder for the file you want to create. Note: The application does not support electronic paper claim output as a HIPAA-compliant electronic claim solution. Only the paper claim file format required by the payer to process

NextGen® Background Business Processor Help 8

Print Pending Paper Claims Job

To configure the settings for the job, complete the following fields: Field Description Claim Print Action Indicates whether you want to print or export the paper claims. Claim Form Indicates the claim form you want the job to use for the pending claims. This field displays one of the following: ADA 2024 ADA 2019 CMS1500 (2005) UB04 CMS 1500 (2012) UB92 Forms or forms enhanced Note: The forms or forms enhanced are available in Claim Form list only if the forms or forms enhanced are mapped to the payer in File Maintenance. Note: When you change the practice in Run as Practice, the Claim Form list is refreshed. Claim Type Indicates one or more claim types for the job from the list. Rendering Physician Indicates the rendering physician that you want to apply to the job. Financial Class Indicates one or more financial classes that you want to apply to the job. Note: The Self Pay financial class is not available. Primary Indicate whether you want the job to include primary claims or not. Se

Help Guide for NextGen® Enterprise PM 8

Generate Paper Claims

When UB claims are previewed or printed, a claim status header displays at the top of the claim. The claim header indicates the status of the claim, either pending or archived, and for claims that are archived the date they were processed also prints in the header. The claim status header only displays on claims that have already been processed (archived) or when a copy (not for submission) is previewed or printed. The Claim Maintenance window allows you to customize the claim header, insurance information, and additional claim details. Select on the following tabs to populate the fields that you want to display on a claim: View Claim Claim Header Insurance On the tool bar, select the Claims icon . The Claim Request Lookup window opens. To search for the claim request, enter the applicable search criteria. To view the claim, highlight the claim request row and double-click. The Claim Maintenance window opens with a preview of the populated claim form. On the Claim Maintenance tool bar,

Help Guide for NextGen® Enterprise PM 8

Resubmit Claim Status Request from Encounter Claim Request

Before you begin Submit a claim request for an encounter. The Encounter Claim Request window enables you to resubmit a claim status request. In NextGen® Enterprise PM, do one of the following to open the Encounter Lookup window. On the main toolbar, select Encounter. From the Tasks menu, select Lookup > Encounters. The Encounter Lookup window opens. Enter the search criteria to find the desired encounter and select Find. The Encounter List section displays the encounters matching the search criteria. Double-click the desired encounter. The Patient Chart opens displaying the encounter details on the Encounter tab. Do one of the following. In the Encounters list, right-click the desired encounter and select Claims. Select Claims on the taskbar. On the Tasks menu, select Lookup > Claims. The Encounter Claims Request window opens displaying the claim request for the selected encounter. Right-click the claim request and select Claim Status Request. A message appears stating that the applica

Help Guide for NextGen® Enterprise PM 8

Access an Archived Claim from the Encounter Claim Request Window

When searching for an archived claim for a particular patient use this procedure. You can search on information in the patient's profile such as: name, address, social security number, medical record number, person number, phone numbers, or location. Select the Chart icon. On the Patient Lookup window, enter the desired search criteria and select Find. The Patient Lookup window opens. Double-click the Name of the patient. The Patient's Chart window opens. In the Encounters section, select an encounter, right-click and select Claims. The Encounter Claims Request window opens. Parent topic: Archived Claims

Process a Claim for a Single Encounter

Recommendations

Process Claim Requests for Multiple Encounters

Set Up Claim Print Options

Print Pending Paper Claims Job

Generate Paper Claims

Resubmit Claim Status Request from Encounter Claim Request

Access an Archived Claim from the Encounter Claim Request Window

Process Claim Requests for Multiple Encounters

Set Up Claim Print Options

Print Pending Paper Claims Job

Generate Paper Claims

Resubmit Claim Status Request from Encounter Claim Request

Access an Archived Claim from the Encounter Claim Request Window