Run the Consolidation Same Day Claims Process

Help Guide for NextGen® Enterprise PM 8

Create a Consolidated Services Claim

Open the Claim Request Lookup window. In the Request Status field select HOLD - H. Set any additional search criteria on the General tab. Select Find. The filtered claim data displays in the Claim Requests section of the window. Claim Request Lookup To select the claims for consolidation, enable the check box. Right-click and select Consolidate Same Day Claims. Consolidated Services Claim Report The Consolidated Services Claim report opens. Consolidated Services Claim Report The alerts may appear when you try to close the Consolidated Services Claim report. Alert Messages 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

Consolidate Claims by Time Span

The CSC process is initiated on the Claims Request Lookup window. You can search for claims on a time-span of daily, weekly, monthly, or case. This process provides a clear visual of all of the HOLD claims that can be processed when the CSC process is initiated. You can sort the encounters by selecting on the TS (time-span) column. From the menu, select Tasks > Lookup > Claims or select the Claims icon. The Claim Request Lookup window opens. Claim Request Lookup In the Request Status field, select Hold H. The Consolidated Services Claim Time Span field becomes active. In the Consolidated Services Claim Time Span field select one of the following options: <none> - to display all Hold claims. Consolidate Same Day Claims - to display all encounters that occurred on the same date. Consolidate Weekly Claims - to display all encounters during the same week. The week as defined in the CSC library, either Sunday through Saturday or Monday through Sunday. Consolidate Monthly Claims - to display

Help Guide for NextGen® Enterprise PM 8

Add Claim Consolidation Rules to a CSC Library

To enable claims consolidation, you must select the form types that you want to consolidate. Then you can choose to consolidate only encounter rate claims and/or claims with the same encounter rate SIM. These rules will apply to all of the payers in the Valid Payers list. Access the Consolidated Services Claim Maintenance window for the applicable library. Note: To access a CSC library, refer to the Accessing a Consolidated Services Claim Library procedure. After opening the Consolidated Services Claim Maintenance window, select a valid payer for the claim, then Claim Consolidation Rules. From the Claims Consolidation Rules tab, select a Claim Consolidation Rules row (CCR row) and open by doing one of the following: Right-click the library and select Open. Select the open menu button and select Open. The CSC Timespan Rules window opens for the library you selected. Complete the timespan rules. Note: When creating a new library, the Claim Consolidation Rules row (CCR row) is not require

File Maintenance Help for NextGen® Enterprise 8

Add Claim Consolidation Rules to a CSC Library

To enable claims consolidation, you must select the form types that you want to consolidate. Then you can choose to consolidate only encounter rate claims and/or claims with the same encounter rate SIM. These rules will apply to all of the payers in the Valid Payers list. Access the Consolidated Services Claim Maintenance window for the applicable library. Note: To access a CSC library, refer to the Accessing a Consolidated Services Claim Library procedure. After opening the Consolidated Services Claim Maintenance window, select a valid payer for the claim, then Claim Consolidation Rules. From the Claims Consolidation Rules tab, select a Claim Consolidation Rules row (CCR row) and open by doing one of the following: Right-click the library and select Open. Select the open menu button and select Open. The CSC Timespan Rules window opens for the library you selected. Complete the timespan rules. Note: When creating a new library, the Claim Consolidation Rules row (CCR row) is not require

Help Guide for NextGen® Enterprise PM 8

Set Up for Eligible Number of Patient Days Billing

Access File Maintenance. Select Libraries, and then Consolidated Services Claim library. The Consolidated Services Claim List window opens. Double-click to open the desired library. The Consolidated Services Claim Library Maintenance window opens. Select the open menu button . The Consolidated Services Claim Maintenance window opens. Complete the following fields: Effective Date Expiration Date Description Add the Valid Payers Select the Claim Consolidation Rules tab and then select the open menu button and select New. The CSC Timespan Rules window opens. Complete the following fields: In the Length of Timespan field, select Consolidate Monthly Claims. In the Description field, enter a description for this type of billing. In the Rollup Encounter Rate Service Line field, select Yes. In the Encounter Rate SIM Quantity field, select Number of Eligible Days. In the Encounter Rate Service Line Amount field, select Eligible Patient Days times Original Charge Amount. Select OK. Parent topic:

Run the Consolidation Same Day Claims Process

Recommendations

Create a Consolidated Services Claim

Consolidated Services Claim

Consolidate Claims by Time Span

Add Claim Consolidation Rules to a CSC Library

Add Claim Consolidation Rules to a CSC Library

Set Up for Eligible Number of Patient Days Billing