Select Media Types

Help Guide for NextGen® Enterprise PM 8

Select Media Types

You can select the media type for secondary and tertiary COB levels in the Payer master file. You can set the default media type for primary, secondary, and tertiary claims to be different for a particular payer. To access this window, open File Maintenance, select Master Files > PM > Payers, and then select the applicable payer. On the Modify Payer Information window, select the Practice tab and then the Claims sub-tab. In addition, you can set the Payer master file to force secondary and tertiary claims to paper for another payer. In other words, regardless of the media type setting in the Payer master file for the next payer, you can override those settings and force the claim to paper for the payers getting the secondary and tertiary claim. To force secondary and tertiary claims to paper for the next payer, activate the following options on the Practice Parameters tab of the Payer master file: When Primary, force Secondary claims to paper When Secondary, force Tertiary claims to pa

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

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

Help Guide for NextGen® Enterprise PM 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

Select Media Types

Set Up Electronic UB Claims

Set Up Electronic UB Claims

Payers Master File

Fields in the Claims Tab of Modify Payer Information

Fields in the Claims Tab of Modify Payer Information

Select Media Types

Select Media Types

Set Up Electronic UB Claims

Set Up Electronic UB Claims

Payers Master File

Fields in the Claims Tab of Modify Payer Information

Fields in the Claims Tab of Modify Payer Information