Reporting Bundled Payments

If...	Then the ERA Import Posting Report displays the following message:
No Encounter Level Payment Distribution method is selected in the Remittance Profile	"Bundled payment was not posted because Encounter Level Distribution method was not enabled in the Remittance Profile". Note: To post bundled payments, you must select the Encounter Level Payment Distribution method in the Remittance Profile.
The claim is UB/837I and no claim was found for the encounter of the NU bundled payment	"Bundled payment was not posted because no claim was identified for this encounter".
The claim is UB/837I and no match was found for the NU bundled payment	"Bundled payment was not posted because no charge match was found for this revenue code".
The claim is NU and a match was found for the NU bundled payment, but the balances of the charges are 0 or credit	"Bundled payment was not posted. Charge match(es) found for this revenue code, but charge(es) have no payer balance > 0".
The bundled payment is greater than the billed amount and the remit option Do not post adjustments that increase the balance (negative adjustments) is enabled	"Bundled FIFO payment distribution would have resulted in overpayment".
The payment is a bundled payment	Displays the Product/Svc ID in the Bundle Code column.

Help Guide for NextGen® Enterprise PM 8

Posting Logic for Bundled and Unbundled Payments

You can post bundled and unbundled ERA payments for professional or institutional claims. Bundled payments are single ERA payments remitted for multiple charge lines. Unbundled payments are multiple ERA payments remitted for a single charge line with a quantity greater than one. The following table describes the various settings and their results for an ERA file. Encounter Charge Remittance Profile Library Setting ERA File Result Claim REF*6R Segment SVC Segment Single charge, Quantity >1 Single line, Quantity >1 Enable Post Unbundled Payment to Single Charge Present Unbundled payment (an individual payment per unit) The system posts the allowed amount, payment and adjustment amounts against the single charge using REF*6R and adds the individual transactions as one. Note: The Charge Matching Options configuration in Remittance Profile is not considered when using Post Unbundled Payment to Single Charge option. Single charge, quantity >1 Another single charge where quantity = 1 First li

Help Guide for NextGen® Enterprise PM 8

Posting Logic for Bundled Payment to Multiple Charges

When you bill individual unit charge lines for the same CPT® code and the payer sends a single payment for all of those charges in the Electronic Remittance Advice (ERA) file, you can use the Post Bundled Payment to Multiple Charges option to distribute the transaction amounts. Based on the quantity, the Allowed, Payment, and Adjustment amounts are distributed equally across all charge lines. If the bundled transaction amount does not divide equally across the charge lines, the transaction is not posted and a message appears stating that the bundled payment did not get distributed equally Bundled Payment does not distribute equally in the ERA Import report. The patient-responsible amounts (PR1 Deductible, PR2 Co-Insurance, PR3 Co-pay) are distributed for only reporting purposes and Cordination of Benefits (COB) balancing. The patient-responsible amounts are distributed using weighted distribution logic. When you configure the Remittance Profile library to Only when deductible (PR1) exi

Help Guide for NextGen® Enterprise PM 8

Bundled Payments

For bundled payments, the ERA Import Posting report functions as described below: If an Encounter Level Payment Distribution method is not selected in the Remittance Profile library, the ERA Import Posting report displays the following message: "Bundled payment was not posted because Encounter Level Distribution method was not enabled in the Remittance Profile". Note: The ERA Posting process cannot post bundled payments unless an Encounter Level Payment Distribution method has been selected in the Remittance Profile. If the claim is UB/837I and no claim was found for the encounter of the NU bundled payment, the ERA Import Posting report displays the following message: "Bundled payment was not posted because no claim was identified for this encounter". If the claim is UB/837I and no match was found for the NU bundled payment, the ERA Import Posting report displays the following message: "Bundled payment was not posted because no charge match was found for this revenue code". If the clai

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

File Maintenance Help for NextGen® Enterprise 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

Help Guide for NextGen® Enterprise PM 8

Reading the ERA Import Posting Report

After you have completed the ERA Posting process, the ERA Import Posting report generates. Overall, the report is a complete audit of the ERA 835 file and is grouped by unsuccessful and successful entries. NextGen® Enterprise PM does not, however, report provider level adjustments. The report is sorted by practice with the ERA payments that did not post successfully listed first, followed by all the ERA payments that posted successfully. An ERA message displays in the Description column of the report next to each line item as an indicator for why the ERA claim payment did or did not post against the encounter information. Each of these messages applies to ANSI file formats. The transaction level Reason Codes that are distributed to service lines display on the report, along with their descriptions. Note: The ERA Import Posting report detects and rejects an ERA transaction with a denial reason code and total transaction amount that is not $0.00. Resolving Encounter-Related ERA Errors On

Reporting Bundled Payments

Recommendations

Posting Logic for Bundled and Unbundled Payments

Posting Logic for Bundled Payment to Multiple Charges

Bundled Payments

CSC Options Tab - Options and Settings

CSC Options Tab - Options and Settings

Reading the ERA Import Posting Report

Reporting Bundled Payments

Posting Logic for Bundled and Unbundled Payments

Posting Logic for Bundled Payment to Multiple Charges

Bundled Payments

CSC Options Tab - Options and Settings

CSC Options Tab - Options and Settings

Reading the ERA Import Posting Report