When consolidating two or more claims, one claim is designated as the king claim. The other claims are referred to as child claims. The claim header information is pulled from the consolidated claim. All unique condition codes, value codes, and occurrence codes are included on the king claim. This occurs when the child claim includes value, occurrence, or condition codes that are not a part of the king claim. Depending on your payer's preference, you can have the application automatically sum the value of all value codes on the claim. Or you can contact NextGen Healthcare Support for a script that will not sum the total value of duplicate value codes.
Rules for including condition, occurrence, and value codes are as follows:
- Duplicate codes and values appear one time on the consolidated claim.
- All codes will display in alphanumeric order on the consolidated claim.
- Sum Duplicate Value Codes - When there are two of the same codes that contain different values, the application will automatically sum the values. The value code displays one time with and the values are calculated into one sum. See the example for Value Codes.
- Do Not Sum Duplicate Value Codes - If you do not want to automatically sum the values for duplicate value codes, then contact NextGen Healthcare Support for the script.
Value Code Example
When a consolidated claim has three encounters and the value codes are the same with different sum amounts, when the king claim is created the value codes will be summed together.
- Encounter 1 has an A7 value code for 50.00.
- Encounter 2 has an A7 value code for 100.00.
- Encounter 3 has an A7 value code for 50.00
Result: The value codes on the consolidated claim will include the A7 code for $200.00.
Occurrence Code Example
- Encounter 1 has a 03 occurrence code.
- Encounter 2 has a 01 occurrence code.
Result: The encounter codes on the consolidated claim will include both the 01 and the 03 occurrence codes.
