Select All Lines for Bill to Next Insurance

Help Guide for NextGen® Enterprise PM 8

Create Zero Balance Claims to Subsequent Payers

A practice may have a need to send a claim to the next payer even though the previous payer paid the claim in full. For example, an FQHC practice reports to a secondary “wrap” payer by sending a claim showing services that were completely paid by the primary payer. Line item charges that have been paid in full by the previous ERA payer, and now have a $0.00 balance, can be settled to the next subsequent payer so a claim is created in NextGen® Enterprise PM for that secondary/tertiary payer. Access File Maintenance. Select Master Files, then System, and then Payers. The Payers List window appears. From the list, select and open the desired payer. The Modify Payer Information window appears. Select the Practice tab, and then the Other sub-tab. Select the ERA – Create Zero Dollar Total Balance Claims to Selected Subsequent Payer(s) check box. In the field to the right, select the subsequent Payer(s). To save changes and close the window, select OK. Additional Information Parent topic: Set

Help Guide for NextGen® Enterprise PM 8

ERA Payer Number

The ERA Payer Number is the electronic remittance carrier number received in the 835 file. Each payer is assigned a unique number. The number is entered on the Payer > Payer Defaults-1 tab. The number is used in NextGen® Enterprise PM to allocate the ERA transactions to the appropriate payer. Identify the ERA Payer Number from the ERA Posting Process You can identify the ERA payer number from the ERA posting process. Enter the ERA Payer Number for a Payer Enter the ERA Payer Number for an Alternate Payer You can enter the ERA payer number for an alternate payer in File Maintenance. Parent topic: Setting Up Payers for ERA

Help Guide for NextGen® Enterprise PM 8

Setting Up Payers for ERA

All payers from whom ERA 835 files will be received must be configured prior to importing the electronic files in NextGen® Enterprise PM. If there are multiple master files for the same payer (e.g. Aetna, Aetna HMO, Aetna PPO, etc.), the setup should be done to all master files for that payer. ERA Payer Number Cross-over Indicator Select All Lines for Bill to Next Insurance Create Zero Balance Claims to Subsequent Payers Set Up Default Transaction Codes for a Payer Set Up Default Transaction Codes for an Alternate Payer You can set up default transaction codes for an alternate payer in File Maintenance. Reason Code Library Remittance Profile Library Parent topic: Setting Up ERA

Help Guide for NextGen® Enterprise PM 8

Additional Information

If a patient has a payer with the ERA – Create Zero Dollar Total Balance Claims to Selected Subsequent Payer(s) check box enabled, whether the payer is primary or secondary, and the patient’s next payer is one of the selected subsequent payers, then when an ERA 835 file is processed for that payer and an adjustment is posted from the CAS segment, the following occurs: Transaction Detail Status for charge line items associated with the claim default to Settled move to subsequent payer. Charge line items associated with the claim are flagged for rebill. The encounter status changes from Billed to Rebill. When the ERA – Create Zero Dollar Total Balance Claims to Selected Subsequent Payer(s) check box is not enabled for the payer and an adjustment reason code is defined with a Transaction Detail Status of Settled moved to secondary or Settled moved to tertiary, the following occurs when an ERA 835 file with that adjustment reason code is processed: Transaction Detail Status for charge line

Help Guide for NextGen® Enterprise PM 8

Identify the ERA Payer Number from the ERA Posting Process

You can find the ERA payer number in the ERA 835 file that you receive from the trading partner. The ERA payer number can be for a payer or for an alternate payer. The number must be entered on the Practice tab of the Payers master file for the payer and on the Alt payer Transaction options tab of the Payers-Alt Payers master file for alternate payer before importing the ERA 835 file. In NextGen® Enterprise PM select File menu, and then select Processes > ERA Posting. The Import Remittance window opens. Select Directory Import. Select the Open File . The Browse for Folder window opens. Select the folder where the downloaded ERA file saved and then select OK. On the Import Remittance window, select Find. The File Contents section of the window displays ERA files in the selected folder. Select the applicable file to view the Payer number and Check number. Make note of the ERA payer number. To close the window without importing the file, select Cancel. Note: ERA payer number in GS02 is us

Help Guide for NextGen® Enterprise PM 8

Start the ERA Posting Process

The Electronic Remittance Advice (ERA) Posting process is not automatic. You must start it from the Import Remittance window. Note: The ERA Import function uses the CLP02 element to determine which COB to use if both primary and secondary payers have the same ERA Payer Number. The Default for Contract <> Payment Allowed Amount and Default for Contract <> ERA Payment Amount options are applicable only for the primary payer (CLP02=1). Note: You must create and assign an automated Encounter task in Task Types master file in File Maintenance along with the custom user-defined reason code to track the discrepancy in ERA payment amount and contractual reimbursed amount when 835/ERA file is posted in NextGen® Enterprise PM. For more information about creating and assigning the automated task, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise From the File menu, select Processes, and then ERA Posting. The Import Remit

Select All Lines for Bill to Next Insurance

Recommendations

Create Zero Balance Claims to Subsequent Payers

ERA Payer Number

Setting Up Payers for ERA

Additional Information

Identify the ERA Payer Number from the ERA Posting Process

Start the ERA Posting Process

Create Zero Balance Claims to Subsequent Payers

ERA Payer Number

Setting Up Payers for ERA

Additional Information

Identify the ERA Payer Number from the ERA Posting Process

Start the ERA Posting Process