Rules for Claims Consolidation in a Hold Status

Help Guide for NextGen® Enterprise PM 8

Rebilling a CSC Claim

After you complete the Create a Consolidated Services Claim procedure, you can rebill a CSC claim. Only CSC candidate encounter charges will be flagged to rebill. The following rules apply for rebilling a CSC claim: Archive Status - the CSC claim must be in an Archive status. Rebill Status - all candidate - encounters that are set to a Rebill Status on the Claim Request Lookup window. Exempt Status - same-day encounters marked as exempt will not be flagged to release to bill. The encounter will remain in its existing status. Use the following table to review claim status and determine if you can rebill, regenerate, delete, or print a claim. Claim Status Flag encounter for Rebill? Regenerate a Claim? Delete?* Print? Archived Yes Yes Hold No No No No Consolidated No No No No Pending No No *Delete a CSC Claim - When a CSC claim is deleted, all of its candidate encounter claims are deleted. Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Consolidated Services Claim

The claims services consolidation process is activated from the Claim Request Lookup window. The user will select the applicable claims to consolidate and then the application automatically consolidates the candidate claims into a Consolidated Services Claim (CSC). This process produces a Consolidated Services Claim report and alerts the user to any further actions that need to be taken before a CSC claim can be created. Note: The Consolidate Same Day Claims option is active when a CSC library is selected on the Practice Preferences Library window. Only claims with a Hold status can be consolidated by the CSC process. Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Automatic Identification of CSC Candidate Encounters

CSC candidate encounters are identified during the billing process and meet the following criteria: All services for a patient in a calendar. All services provided to a patient in a specific time-period that are submitted on a single claim. The time period is defined by the practice and can be daily, weekly, monthly, or on a case basis. The encounters meet the rules applied in the Consolidated Service Claim library for combining form types and encounter rate options. Note: Hold Claim Status: The Hold status is applied to all claims that meet the criteria for CSC candidate encounters. Non-coordinated or Non-covered Service SIMs: Encounters with SIMs for non-coordinated or non-covered services DO NOT qualify as CSC Candidate encounters. Guidelines for Running the CSC Process Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Claim Production Status Report for CSC Candidate Encounters

When a CSC Candidate Encounter is billed, either on demand (individual) or in batch, and the encounter passes all claim edits, a green message displays on the Claim Production Status report for claims in a status of HOLD or PENDING. Hold Claims - Claim Production Status Report Messages Pending Claims - Claim Production Status Report Messages Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Mark a CSC Encounter as Exempt

CSC candidate encounters can be marked exempt either manually or automatically by the system. Automatic exemption of a claim occurs when the claim is suppressed as a result of File Maintenance settings. Exempt encounter charges are not included in a consolidated claim. Access the Consolidated Services Claim tab under the Claims tab on the Encounter Maintenance window. To identify the responsible attending provider for claim header, complete the Primary Responsible Attending, Secondary Responsible Attending, and Tertiary Responsible Attending fields. Select one of the following options for each applicable insurer: None - (default prior to billing) Responsible Attending Ancillary Provider To remove encounter charges from a primary, secondary, or tertiary CSC claim, select the applicable check box: Exempt from Primary Consolidated Services Claim An alert displays if a Primary HOLD claim is attached to the encounter: A HOLD claim exists for this encounter. Would you like to convert the HOL

Help Guide for NextGen® Enterprise PM 8

Consolidated Services Claim Library

The Consolidated Services Claim (CSC) library enables you to establish rules for consolidating multiple encounter charges into a single consolidated services claim (CSC). The purpose of this library is to configure billing and claim form type rules for payers. This section includes the following topics: Security rights for user groups Consolidated Services Claim library CSC configuration rules for the consolidation of daily, weekly, monthly, and case related claims Provider hierarchy for claim headers Bill for eligible patient days You can generate the Consolidated Services Claim Library Listing report and the CSC Library with Timespan Details report from the Consolidated Services Claim library. For more information go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Set Up Security Access Rights for Consolidated Services Claims Consolidated Services Claim Library Setup Create a CSC Library Access a Consolidated Services Cla

Rules for Claims Consolidation in a Hold Status

Recommendations

Rebilling a CSC Claim

Consolidated Services Claim

Automatic Identification of CSC Candidate Encounters

Claim Production Status Report for CSC Candidate Encounters

Mark a CSC Encounter as Exempt

Consolidated Services Claim Library

Rebilling a CSC Claim

Consolidated Services Claim

Automatic Identification of CSC Candidate Encounters

Claim Production Status Report for CSC Candidate Encounters

Mark a CSC Encounter as Exempt

Consolidated Services Claim Library