Run Claim Edits on Appointments or Encounters

Help Guide for NextGen® Enterprise PM 8

Open Claim Status Report from Encounter Lookup

Before you begin Submit a claim request for the encounter. In NextGen® Enterprise PM, do one of the following to open the Encounter Lookup window: On the main toolbar, select Encounter. From the Tasks menu, select Lookup > Encounters. The Encounter Lookup window opens. Enter the search criteria to find the desired encounter and select Find. The Encounter List section displays the encounters matching the search criteria. Right-click the desired encounter and select Claims. Note: Alternatively, you can open the Encounter Claims Request window using one of the following methods. From the Patient Chart, on the Encounters tab, in the Encounters list, right-select the desired encounter and select Claims. Select Claims on the taskbar. From the Tasks menu, select Lookup > Claims The Encounter Claims Request window opens displaying the claim requests for the selected encounter. Right-click the desired claim request and select View Claim Status. The Claim Status report opens displaying the follo

Help Guide for NextGen® Enterprise PM 8

Run Claim Edits after Entering Charges

You must run claim edits on charges immediately after you enter charges. The edits identify errors that may need to be corrected before the encounter goes through the billing process to create a claim for the payer. Open the Patient Chart for the desired patient. On the Encounters tab, select the encounter to run the claim edits. From the main toolbar, select Edits and do one of the following: You can run edits from the Appointment Book using Edits on the appointment toolbar. You can run edits from an open claim. You can add edits to the autoflow process. When the claim edits run successfully, the Claim Production Status window opens displaying the following: Build, Critical, Custom, Required, Error, Warning, and Informational labels under the Severity column. Errors for encounters appearing in red that result in bad claims and prevent reimbursement. Warnings for encounters appearing in blue do not prevent a clean claim, but might be contractual, and should be addressed. Informational

Help Guide for NextGen® Enterprise PM 8

Billing Process Work Flow

After charges are applied to an encounter, you can: Bill the encounter to the guarantor (for encounters with no attached insurance) - or - Bill the encounter to a payer (for encounters with attached insurance). You can bill only those encounters with an Unbilled (U) or a Rebill (R) encounter status. To bill a single encounter, access the Chart > Encounters tab, right-click on the encounter you want to bill, and select Bill from the menu. To bill multiple encounters at once (Batch billing), access the Encounter Lookup window, enter search criteria to locate Unbilled encounters, select the encounters you want to bill from the list of matching records, right-click and select Bill from the short-cut menu. You can review the charges applied to the encounter in the Encounter Bill window. For encounters with insurance, the application generates a claim by checking the encounter against the Claim Edits that are configured in the Claim Edits library. The results of this Claim Edit check display

Help Guide for NextGen® Enterprise PM 8

Bill Multiple Encounters (Batch Billing)

All encounters in Unbilled or Rebill status with charges can be billed at the same time in a batch. Open NextGen® Enterprise PM. Select Encounter. The Encounter Lookup window opens. Select Bill Status, and then select Rebill and Unbilled. Note: Encounters with a status of Bad Debt, Billed or History have already been billed. Clear the Include records without charges check box to exclude encounters that do not have charges. Enter additional Search Criteria to locate the desired encounters. Select Find. Encounters matching the search criteria appear in the Encounter List section of the window. Select Encounter List, and then select all encounters to be billed in the Enc Nbr column. Right-click the encounter and select Bill. A message appears stating that confirm bill processing for the [n] selected encounters. To continue billing the selected encounters, select OK. The encounters go through the claim edits process and the Claim Production Status report appears. Each encounter is listed o

Help Guide for NextGen® Enterprise PM 8

Search from the Encounter Lookup Window

To access the Encounter Lookup window, do one of the following: From the main toolbar, select Encounter. From the Tasks menu, select Lookup and then Encounters. The Encounter Lookup window opens. Enter details in the Search Criteria to find the desired encounters. You can use multiple parameters to search, like Bill Status, Billable Date Range, Rendering Physician, or Service Location. Select Find. Encounters that match the search criteria entered display in the Encounter List section at the bottom of the window. Total Encounter Balances displays the total outstanding balance for all encounters listed. Records Found displays the total number of encounters listed. From the Encounter List, do one of the following: Double-click to select an encounter. The Patient Chart > Encounters tab opens. The selected encounter is highlighted in the Encounters list on the left. Right-click an encounter and select Open from the menu. The Encounter Maintenance window opens. Select one or more encounters

Help Guide for NextGen® Enterprise PM 8

Resubmit Claim Status Request from Encounter Claim Request

Before you begin Submit a claim request for an encounter. The Encounter Claim Request window enables you to resubmit a claim status request. In NextGen® Enterprise PM, do one of the following to open the Encounter Lookup window. On the main toolbar, select Encounter. From the Tasks menu, select Lookup > Encounters. The Encounter Lookup window opens. Enter the search criteria to find the desired encounter and select Find. The Encounter List section displays the encounters matching the search criteria. Double-click the desired encounter. The Patient Chart opens displaying the encounter details on the Encounter tab. Do one of the following. In the Encounters list, right-click the desired encounter and select Claims. Select Claims on the taskbar. On the Tasks menu, select Lookup > Claims. The Encounter Claims Request window opens displaying the claim request for the selected encounter. Right-click the claim request and select Claim Status Request. A message appears stating that the applica

Run Claim Edits on Appointments or Encounters

Recommendations

Open Claim Status Report from Encounter Lookup

Run Claim Edits after Entering Charges

Billing Process Work Flow

Bill Multiple Encounters (Batch Billing)

Search from the Encounter Lookup Window

Resubmit Claim Status Request from Encounter Claim Request

Open Claim Status Report from Encounter Lookup

Run Claim Edits after Entering Charges

Billing Process Work Flow

Bill Multiple Encounters (Batch Billing)

Search from the Encounter Lookup Window

Resubmit Claim Status Request from Encounter Claim Request