Processing Paper Claims

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

Processing Electronic Claims - 837 Files

This section explains how electronic claims (837 files) are processed. The basic steps include: Select the EDI file button. The 837 Electronic File Creation window opens. Select a Submitter Profile library. Select options applicable to the types of claims that you want to send electronically. Select the Process button. Electronic Claims File Structure Control Segments Application Setup for the 837 File 837 Electronic File Creation Window Electronic Send Report Set Up Automatic Task Completion for Clean Claims Submitting Electronic Claims Archiving and Retrieving 837 Electronic Files Tracking Records of Reprinted Archived Claims Parent topic: Claims Processing

Help Guide for NextGen® Enterprise PM 8

Process a Claim for a Single Encounter

Open the patient chart and select the Encounters tab. To process a claim, right-click the applicable encounter and then click Claims. The Encounter Claim Requests window opens. You can generate a claim print for a claim request having electronic media type by right selecting the claim request and disabling the Electronic claim option. Note: The alternate payer name appears in the Payer-Insured column for a carve-out claim. Right-click a claim request and then select Print. The Claim Printing window opens. In the Print Format list, do one of the following: Select Actual Claim Form to generate the claim form that you want to submit to the payer. Select Claim Copy - Not for Submission to generate a copy or spare claim form that you do not intend to submit to a payer. Select Preview to preview the claims. Select the Update 'Pending' to 'Archived' status on paper claim check box to automatically archive the claims after claim printing. Select Options to configure the claim print settings. S

Help Guide for NextGen® Enterprise PM 8

Claims Processing

Claims can be processed on demand or in batch mode. This section explains: Paper claims Electronic claims - 837 files 997 files 277 files ERA - 835 files COB - manual posting Processing Paper Claims Claim Production Status Report Processing Electronic Claims - 837 Files Process Claim Requests for Multiple Encounters 997/999 File 277 File Coordination of Benefits Electronic and Manual Processing You can view information on all the payers for EDI claims in the Coordination of Benefits Information window. Parent topic: Claims

Help Guide for NextGen® Enterprise PM 8

Preview and Print Paper Claims

The Claim Printing window enables you to bulk preview and print the paper claim forms. In NextGen® Enterprise PM, select File > Print Forms > Claims. The Claim Printing window opens. Select the preferred Print Format. Select the type of Form. Do one of the following: Select Preview to view the claim forms. Select OK to print the claim forms. Parent topic: Generating and Submitting Claims

Help Guide for NextGen® Enterprise PM 8

Claim Printing Library

The Claim Printing library enables you to specify options that define which information prints on claim forms. You must create and attach a Claim Printing library to a practice at the practice preference level before a paper claim can be generated. 1500 Claims, UB Claims, and ADA Claims are available in the Claim Printing library. The Claim Printing library attached at the practice preferences level is the default library. At the payer level, if needed, you can set up an alternate Claim Printing library for a specific payer. You can set the type of information you want to print in each claim field using the selections in the Setting and Option columns in the Claim Printing window. Set Up Claim Printing Library Security Right You can modify the access rights of a user group if you are assigned the Claim Printing Library security rights. Claim Print Options in Claim Printing Library You can select the claim print options through available paper claims and payer types. Attach a Claim Prin

Processing Paper Claims

Recommendations

Process Claim Requests for Multiple Encounters

Processing Electronic Claims - 837 Files

Process a Claim for a Single Encounter

Claims Processing

Preview and Print Paper Claims

Claim Printing Library

Process Claim Requests for Multiple Encounters

Processing Electronic Claims - 837 Files

Process a Claim for a Single Encounter

Claims Processing

Preview and Print Paper Claims

Claim Printing Library