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

Reporting Bundled Payments

The table below outlines how the ERA Import Posting report handles 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 r

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

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

Reporting Bundled Payments

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