Set Claim Status Request to Run Automatically

Help Guide for NextGen® Enterprise PM 8

Resubmit Claim Request from Clinical History/Notes

Before you begin Submit a claim status request for the encounter. After you submit a claim request, you can resubmit the same request from the Clinical History/Notes tab in the patient's chart. In NextGen® Enterprise PM, open the Patient Chart and select the Clinical History/Notes tab. From Topics, select Claims Status Result located under Chart Notes. The Details pane displays the claim status results attached to the patient. Right-click the desired encounter or claim number and select Claim Status Request. A message appears indicating that the application will process the claims and submit them in real time. It also indicates that you will experience pauses while it communicates with the server and the process can be lengthy depending on the number of claims selected. Select OK The system submits the claim status request. The request is added to the list in the Details pane. The Claim Status report opens displaying the following: Claim status response date and time. Statistical view

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

Help Guide for NextGen® Enterprise PM 8

Open Claim Status Report from Encounter

Before you begin Submit a claim status request for an encounter. In NextGen® Enterprise PM, do one of the following to open the Encounter Lookup window. On the toolbar, select Encounter. From the Tasks menu, select Lookup > Encounters. The Encounter Lookup window opens. Enter the search criteria to find the desired encounters and select Find. The Encounter List section displays the encounters matching the search criteria. Double-click the desired encounter. The Encounters tab on the Patient Chart opens displaying the details of the encounter. The Claim Status section displays the eligibility verification claim status details such as the claim status date and claim status result. The claim status result is a link. Select the claim status result link in Status. The Claim Status report opens displaying the following: Claim status response date and time. Statistical view of the claim status (accepted or rejected), bill amount, and paid amount. Collapsed view of the claim status requested f

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

Claim Status

Claim status enables you to know the status of a claim and where it is placed in the adjudication process. Claim status inquiries can be submitted in batch mode or real-time for electronic claims with a status of archived. You can schedule claim status checks to run automatically in batch mode at set intervals throughNextGen® Background Business Processor. The results of the inquiry show you the status of the claim and the reason for rejection, if any. The Claim Status Profile library in File Maintenance supports services rendered by professional, dental, or institutional service providers. The institutional claim status request file (276) sends the rendering provider or billing provider in 2100C loop to the real-time server (RTS). Before you submit claim status inquiries, you need to open File Maintenance,Claim Status Profilelibrary and specify the type of provider in theProvider Name (2100C Loop NM1 Segments)section. The following types of service providers are available. Billing: Th

Help Guide for NextGen® Enterprise PM 8

Submit Eligibility in Batch Mode Using Background Business Processor

Before you can run eligibility inquiries in batch mode, the eligibility profiles library must be defined. This library enables you to set up rules to automatically complete the required fields and additional data in batch mode that you would manually enter in NextGen® Eligibility Verification in real time. These libraries are set up during implementation by your administrator with the help of an analyst. Prior to submitting eligibility inquiries in batch mode using NextGen® Background Business Processor, two jobs must be created: NextGen® Eligibility Verification request and NextGen® Eligibility Verification response. The request job queries the appointments and submits the data to NextGen for processing while your response job later takes the results from the NextGen server and delivers the response to your database. For information on creating a job in NextGen® Background Business Processor for eligibility requests and responses, go to NextGen Healthcare Success Community and downloa

Set Claim Status Request to Run Automatically

Recommendations

Resubmit Claim Request from Clinical History/Notes

Resubmit Claim Status Request from Encounter Claim Request

Open Claim Status Report from Encounter

Open Claim Status Report from Encounter Lookup

Claim Status

Submit Eligibility in Batch Mode Using Background Business Processor

Resubmit Claim Request from Clinical History/Notes

Resubmit Claim Status Request from Encounter Claim Request

Open Claim Status Report from Encounter

Open Claim Status Report from Encounter Lookup

Claim Status

Submit Eligibility in Batch Mode Using Background Business Processor