Provider Secondary References

Field	Description
Qualifier	Select the Reference Qualifier, according to the payer, to use in REF01 of the 837 electronic file.
Data Element	Select the provider ID Data Type to use in REF02 of the 837 electronic file. Options for this field include the following: FL51– This option only displays on theUB Claimstab. The default for the Billing Provider references from Field Locator 51 on the UB claims from the Payers master file. Phys Billing ID– If the provider is attached to a billing group, the Physician Billing ID is the group number. If not, then it is the individual provider number. The Physician Billing ID is the default for the Billing Provider references on 1500 claims. Group Nbr– The group number for the rendering physician. If the rendering physician is not attached to a group, the field will be blank. Indiv Phys ID– The individual provider number for Billing Provider and Rendering Provider references. The supervising physician's individual ID for Supervising Provider references. Tax ID– The rendering provider's tax ID for Billing Provider and Rendering Provider references. The supervising physician's tax ID for Supervising Provider references. State Lic Nbr– The state license number for Billing Provider, Referring Provider, and Rendering Provider references. The supervising physician's state license number for Supervising Provider references. Opt Clm Val 1– The optional claim value 1 from the Providers master file. Opt Clm Val 2– The optional claim value 2 from the Providers` master file. Submitter ID– The electronic submitter ID for the payer. Payer Opt Val– The practice/payer-specific value entered in thePractice Payer Opt Valfield on thePracticetab underPayermaster file. Phys Site ID– The default payer from the provider/location setup. Loc Site ID– The location master site ID Facility ID– The facility ID, if available, from the Location master file. It can be any one of the three Claim Type Specific Codes: Medicare Facility ID, BCBS Facility ID, and Medicaid Facility ID. UPIN– The rendering provider's UPIN for Billing Provider and Rendering Provider references. The supervising physician's UPIN for Supervising Provider references. Group Opt Val– The Opt Group Val from the Group master file. Prov Loc Code– The Loc ID number from the Group Information section on the Practice tab of the provider master for Billing Provider and Rendering Provider references. This is a Medicaid clinic rate specific code for Supervising Provider references.

Help Guide for NextGen® Enterprise PM 8

Provider Paper Qualifiers

The following options are on the1500 Claimstab for 1500 paper claims or on theUB Claimstab for UB paper claims. Note: TheBox Numbersfor the 1500 paper claims are 11b, 17a, 19, 24i, 32b, and 33b. TheForm Locatornumbers for the UB paper claims are FL76, FL77, FL78, and FL81. Use the following table to select the qualifier that you want to populate in the box number or form locator number for the claim type selected in theProcess as Claim Typefield. Qualifier Box Number (1500 Claims) Form Locator Number (UB Claims) Blue Cross Provider Number (1A) 19, 32b, 33b, FL76, FL77, FL78 Blue Shield Provider Number (1B) 17a, 19, 24i, 32b, 33b, FL76, FL77, FL78 CHAMPUS Identification Number (1H) 17a, 19, 24i, 32b, 33b, FL76, FL77, FL78 Clinic Number (FH) 19, 33b Clinical Lab Improvement Amendment Nbr (X4) 32b Dental License Number (1E) 19, FL76, FL77, FL78 Employers Id Number (EI) 17a, 19, 24i, 32b, 33b, FL76, FL77, FL78 Facility ID Number (1J) 19, 33b Health Maint Org Code Number (BQ) 19, 33b Locati

Help Guide for NextGen® Enterprise PM 8

UB Claims Tab on Secondary References Tab

Field Description Qualifier Select the Reference Qualifier, according to the payer, to use in REF01 of the 837 electronic file. Data Element Select the provider ID Data Type to use in REF02 of the 837 electronic file. Options for this field include the following: FL51 - (This option only displays on the UB Claims tab.) The default for the 2010A Billing Provider references from Field Locator 51 on the UB claims from the payer master. Physician Billing ID - If the provider is attached to a billing group, the Physician Billing ID is the group number. If not, then it is the individual provider number. The Physician Billing ID is the default for the 2010A Billing Provider references on HCFA claims. Group Nbr - The group number for the rendering physician. If the rendering physician is not attached to a group, the field will be blank. Indiv Phys ID - The individual provider number for 2010A Billing Provider and 2310B Rendering Provider references. The supervising physician's individual ID fo

Help Guide for NextGen® Enterprise PM 8

Secondary References Sub-Tab

The Secondary References tab contains additional tabs for 1500 Claims, UB Claims, and ADA Claims qualifiers and data elements. The sub-tab names, and the qualifier and data element options vary depending on whether you have selected the 1500 Claims, UB Claims, or ADA Claims tab. Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs Note: TheUB Claimstab only displays when you have set up theUB Claim Formoptions in theEncountersPractice Preferences. Field Description Qualifier Select the Reference Qualifier, according to the payer, to use in REF01 of the 837 electronic file. Data Element Select the provider ID Data Type to use in REF02 of the 837 electronic file. Options for this field include the following: FL51– This option only displays on theUB Claimstab. The default for the Billing Provider references from Field Locator 51 on the UB claims from the Payers master file. Phys Billing ID– If the provider is attached to a billing group, the Physician Billing ID is t

File Maintenance Help for NextGen® Enterprise 8

Secondary References Sub-Tab

The Secondary References tab contains additional tabs for 1500 Claims, UB Claims, and ADA Claims qualifiers and data elements. The sub-tab names, and the qualifier and data element options vary depending on whether you have selected the 1500 Claims, UB Claims, or ADA Claims tab. Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs Note: TheUB Claimstab only displays when you have set up theUB Claim Formoptions in theEncountersPractice Preferences. Field Description Qualifier Select the Reference Qualifier, according to the payer, to use in REF01 of the 837 electronic file. Data Element Select the provider ID Data Type to use in REF02 of the 837 electronic file. Options for this field include the following: FL51– This option only displays on theUB Claimstab. The default for the Billing Provider references from Field Locator 51 on the UB claims from the Payers master file. Phys Billing ID– If the provider is attached to a billing group, the Physician Billing ID is t

Help Guide for NextGen® Enterprise PM 8

UB Sub-Tab

The following conditions apply to the UB tab that displays on the Practice tab of the Add/Modify Payer Information window: Regular UB users do not use this tab. Set up on this tab for Enhanced UB users is location-specific, not practice-specific. Some of the fields on this tab are labeled Field Locator n, which identifies the corresponding field on the actual UB claim form. The following table contains the UB tab fields and their descriptions: Field Description Location The Location field displays only when the practice has multiple locations. Select a practice location. For multiple location practices, the Location field must be populated before any of the fields on the UB tab are enabled. For single location practices, the Location field does not display and all of the fields on the UB tab are automatically enabled. Field Locator 1 Name The Field Locator 1 Name field is a free-form text entry field. The default for this field is blank. If the field is left blank, the name that defaul

File Maintenance Help for NextGen® Enterprise 8

UB Sub-Tab

The following conditions apply to the UB tab that displays on the Practice tab of the Add/Modify Payer Information window: Regular UB users do not use this tab. Set up on this tab for Enhanced UB users is location-specific, not practice-specific. Some of the fields on this tab are labeled Field Locator n, which identifies the corresponding field on the actual UB claim form. The following table contains the UB tab fields and their descriptions: Field Description Location The Location field displays only when the practice has multiple locations. Select a practice location. For multiple location practices, the Location field must be populated before any of the fields on the UB tab are enabled. For single location practices, the Location field does not display and all of the fields on the UB tab are automatically enabled. Field Locator 1 Name The Field Locator 1 Name field is a free-form text entry field. The default for this field is blank. If the field is left blank, the name that defaul

Provider Secondary References

Recommendations

Provider Paper Qualifiers

UB Claims Tab on Secondary References Tab

Secondary References Sub-Tab

Secondary References Sub-Tab

UB Sub-Tab

UB Sub-Tab

Provider Paper Qualifiers

UB Claims Tab on Secondary References Tab

Secondary References Sub-Tab

Secondary References Sub-Tab

UB Sub-Tab

UB Sub-Tab