Set Up a Remittance Profile Library

Help Guide for NextGen® Enterprise PM 8

Set Up the Remittance Profile - Default Tab

To set up the Default tab in a Remittance Profile library, do the following: Open File Maintenance. Select Libraries and then select Remittance Profiles. The Remittance Profiles List window opens. Open the profile library. The Remittance Profile window opens. Select the Default tab. Select settings for default options. For more information, see Default Tab - Options and Settings. When you're done setting options, select OK to save changes and close the window. Default Settings in Remittance Profile You can define the parameters in the Remittance Profile Library Default tab settings that are used for processing the ERA 835 file. Parent topic: Set Up a Remittance Profile Library

Help Guide for NextGen® Enterprise PM 8

Set Up the Remittance Profile - CSC Options Tab

The CSC Options tab in the Remittance Profile library is used to set options for handling ERA transactions for services that were combined for the same patient on the same day through the Consolidated Services Claim process. Note: The CSC Options tab is available when a Consolidate Services Claim library is attached in Practice Preferences > Libraries. To set up the CSC Options tab in a Remittance Profile library, do the following: Open File Maintenance. Select Libraries, and then select Remittance Profiles. The Remittance Profiles List window opens. Open the profile library. The Remittance Profile window opens. Select the CSC Options tab. Select settings for CSC options. When you're done setting options, select OK to save changes and close the window. CSC Options Tab - Options and Settings Parent topic: Set Up a Remittance Profile Library

Help Guide for NextGen® Enterprise PM 8

Set Up the Remittance Profile - Reversals and Corrections Tab

The Reversals and Corrections tab in the Remittance Profile library is used to set options for handling the following types of ERA transactions: Reversals and Corrections Writing Off Balances resulting from Overpayments or Underpayments To set up the Reversals and Corrections tab in a Remittance Profile library, do the following: Open File Maintenance. Select Libraries, and then select Remittance Profiles. The Remittance Profiles List window opens. Open the profile library. The Remittance Profile window opens. Select the Reversals and Corrections tab. Select settings for reversal and correction options. For more information, see Reversals and Corrections Tab - Options and Settings. When you're done setting options, select OK to save changes and close the window. Reversals and Corrections Tab - Options and Settings Parent topic: Set Up a Remittance Profile Library

Help Guide for NextGen® Enterprise PM 8

Setting Up Practice Preferences for ERA

You can configure the following ERA settings in Practice Preferences. Go to Practice Preferences, then Libraries and select Remittance Profile Library to set the default library to be used for all ERA payers that do not have a specific library linked in the practice. Go to Practice Preferences, then Transactions and select Default Reason Code Library to set the default library to be used for all payers (ERA and non-ERA) in the practice, that do not have a specific library linked. Note: NextGen Healthcare recommends the use of the HIPAA X12 Standard Reason Codes library as the default for a practice for all payers. Use settled up status with ERA. You can select this check box to default the Settled moved to Primary transaction status onto ERA payment or adjustment transactions received from the secondary payer before the primary payer. When a secondary transaction is received before primary, a credit balance is normally created in the secondary payer (Ins2 Amt) bucket in Balance Control

Help Guide for NextGen® Enterprise PM 8

Setting Up Reason Codes for ERA

Reason codes are used by payers within the ERA 835 file to describe how the services are adjudicated. Payers are required to use HIPAA compliant codes in the ERA file that include a “Group” pre-fix, along with the actual code. (e.g. CO45) Group Codes: CO – Contractual Obligation PR – Patient Responsibility OA – Other Adjustment PI – Payer Initiated The HIPAA X12 Standard Reason Codes library in File Maintenance is pre-installed in the application and contains the industry standard Reason Codes. Important: The HIPAA X12 Standard Reason Codes library should never be hidden or renamed. The COB functionality in NextGen® Enterprise PM that is used for electronic secondary/tertiary claims, references the HIPAA X12 Standard Reason Codes library. It is important to remember that only HIPAA standard codes can be transmitted electronically for secondary/tertiary claims. Practice Level vs. Payer Level Libraries A Default Reason Code Library must be selected in Practice Preferences > Transactions.

Help Guide for NextGen® Enterprise PM 8

Setting Up ERA

The ERA posting process requires the following set up in File Maintenance: Remittance Profile Library Reason Code Library Payers: Enter an ERA Payer Number Select a Remittance Profile Library for specific ERA payers, if applicable Select a Reason Codes Library for specific payers, if applicable Practice Preferences: Select a default Remittance Profile Library for all ERA payers Select a default Reason Codes Library for all payers Configure Patient Pay Import options, if applicable Set Up a Remittance Profile Library Setting Up Reason Codes for ERA You can use the Reason Codes Library to configure business rules to automate ERA transaction posting. Setting Up Payers for ERA You can define the various parameters in Payers Master File related to ERA. Setting Up Enterprise Preferences for ERA Setting Up Practice Preferences for ERA You can set preferences for all payers in the practice. Parent topic: Electronic Remittance Advice

Set Up a Remittance Profile Library

Recommendations

Set Up the Remittance Profile - Default Tab

Set Up the Remittance Profile - CSC Options Tab

Set Up the Remittance Profile - Reversals and Corrections Tab

Setting Up Practice Preferences for ERA

Setting Up Reason Codes for ERA

Setting Up ERA

Set Up the Remittance Profile - Default Tab

Set Up the Remittance Profile - CSC Options Tab

Set Up the Remittance Profile - Reversals and Corrections Tab

Setting Up Practice Preferences for ERA

Setting Up Reason Codes for ERA

Setting Up ERA