Select Media Types

Help Guide for NextGen® Enterprise PM 8

Practice Tab

In the File Maintenance > Master Files > System > Payers, the Practice tab of the Add/Modify Payer Information window contains several tabs. The following topics provide information about the sub-tabs on the Practice tab. Claims Tab Secondary References Sub-Tab Other Sub-Tab UB Sub-Tab Setting Up Claims to Print NextGen Document Management Images Transactions Sub-Tab Add Libraries to a Practice Post Multiple Transactions Parent topic: Payers Master File

Help Guide for NextGen® Enterprise PM 8

Activate and Assign a Payer to a Practice

When you select Practice access for payer master file, the payers can be defined at the practice level, and you can restrict which practices have access to them. After all the practices have been set up with or without access to the selected payer, specific areas in the application where that practice, depending on their access, will or will not see the payer: File Maintenance The Group Information window in File Maintenance NextGen® Enterprise PM The Payer Lookup window The Eligibility Referral Lookup window The Claim Request Lookup window The Add/Modify Provider Information window The following areas of the application show all the payers in the enterprise regardless of the practice's access settings: Reports Service Item Library Maintenance Activate Practice Access to the Payer Master File Assign a Practice to a Payer You can assign access to practices for a payer. Parent topic: Payers Master File

Help Guide for NextGen® Enterprise PM 8

Attach a Submitter Profile to the Payer Master

A submitter profile must be attached to each Payer master file. Note: 837 electronic files cannot be created for payers that do not have a submitter profile set up in their payer master file. In addition, to maintain HIPAA compliance when submitting electronic claims, a provider secondary reference qualifier must be set up at the Payer master file level as well. The provider secondary reference qualifier identifies, based on the claim type, the type of provider in the 837. In File Maintenance, select Master Files > System > Payers. The Add/Modify Payer Information window opens. Select the payer, and then select the Practice tab and then Claims tab and then click either the 1500 Claims, UB Claims, or ADA Claims sub-tab. Select the applicable Submitter Profile from the Submitter Profile drop-down menu (If applicable, attach a Submitter Profile for 1500 Claims, UB Claims, or ADA Claims). Select OK. Parent topic: Payers Master File

Help Guide for NextGen® Enterprise PM 8

Set Up Electronic UB Claims

To submit claims electronically, you need to set up the UB Claims tab for the payer on the Add/Modify Payer Information window. Following is a list and explanation of the fields and check boxes in the UB Claims section to enable UB claims generation and electronic claim submission: The Field Locator 51 field The Media Type (Primary, Secondary, Tertiary) fields The When Primary, force Secondary claims to paper check box The When Secondary, force Tertiary claims to paper check box The Suppress Claim check box The fields and check boxes on the UB Claims tab are listed below with an explanation. The Field Locator 51 field. This is a free-form text entry field. Enter the number provided to you by the payer. This field must be completed when creating a UB claim. If it is left blank, then an edit will occur during the claims process, which reads: Loc 51 Provider Number is missing. The Media Type (Primary, Secondary, Tertiary) fields. The two Media Type options available are Paper and Electron

Help Guide for NextGen® Enterprise PM 8

Payers Master File

Payers are the third-party entities, other than guarantors or employers, that you expect to receive reimbursement from. Some examples of payers are commercial insurance companies, Medicaid, and Medicare. In the Payers master file, you can specify the contract associated with the payer, the participating providers, how to submit claims, and other general payer information. You can generate Payers Master File reports from the Payers master file. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Auditing Payers Master File Add or Modify a Payer Payer Defaults - 1 Tab Defaults - 2 Tab System Tab Practice Tab Configuring Alternate Payers You an use the Alternate Payer Simultaneous Billing feature to associate an alternate payer to a payer. External Tab for Payer Information Co-Pays Tab Changing the Payer Address and Associated Patient Records Activate and Assign a Payer to a Practice You can limit a practi

File Maintenance Help for NextGen® Enterprise 8

Fields in the Claims Tab of Modify Payer Information

Field Description Submitter Profile Select the submitter profile that you want to apply to 1500 or form template claims. Electronic Transmitter ID Enter the payer-assigned electronic transmitter ID to generate a claim with an electronic transmitter ID. Note: This field only displays when you select a submitter profile. If there are multiple payers with the same transmitter ID, then a message displays stating there is more than one payer with the same ID. Practice Payer Opt Val Enter the practice/payer-specific value. Payer Alias Enter an alternative payer name when a name that differs from the name that appears in the Payers master file is required. Primary, Secondary, and Tertiary Media Types Enter the primary media type accepted by the clearing house as being electronic or paper. If you set it as electronic, then you can also set how the secondary and tertiary claims should be submitted. When Primary, force Secondary claims to paper Enable this check box if you want the claim being s

Select Media Types

Recommendations

Practice Tab

Activate and Assign a Payer to a Practice

Attach a Submitter Profile to the Payer Master

Set Up Electronic UB Claims

Payers Master File

Fields in the Claims Tab of Modify Payer Information

Practice Tab

Activate and Assign a Payer to a Practice

Attach a Submitter Profile to the Payer Master

Set Up Electronic UB Claims

Payers Master File

Fields in the Claims Tab of Modify Payer Information