Set Up Exceptions for CCI, OCE, and LMRP Edits

Help Guide for NextGen® Enterprise PM 8

Set Up Exceptions for CCI, OCE, and LMRP Edits

You can prevent CCI records from triggering claim edits for specified CPT4 codes (or pairs of codes). Activate the edit. Right-click on the edit and select the Open option from the short-cut menu. The Claim Edit Options window opens. Select the open menu button or select the blank field into which you want to insert the CPT4 code. Locate or select the code you want to apply as an exception. Select OK. Parent topic: Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Claim Edits Library

Claim edits are a set of conditions that must be (or are suggested to be) met when you generate a claim. For example, is the patient's zip code required in the claim? Must the referring physician's first name appear on the claim? These are the kinds of requirements you can set up to control the information that appears in the claims you generate. The Claim Edits Libraries enable you to select the claim edits to run when billing encounters and generating claims. A default Claim Edits Library must be created and attached at the Practice Preferences level before you can bill encounters and generate claims. After, a default library is created and attached at the Practice Preferences level, you can then create payer-specific Claim Edits Libraries and attach them at the Payer Master level. These payer-specific claim edits libraries override the default Claim Edits Library. The application maintains a list of available claim edits in the Claim Edits Library, which you can access within File M

Help Guide for NextGen® Enterprise PM 8

Claim Edits Library

The Claim Edits Libraries enable you to select the claim edits to run when billing encounters and generating claims. A default Claim Edits Library must be created and attached at the Practice Preferences level before you can bill encounters and generate claims. After, a default library is created and attached at the Practice Preferences level, you can then create payer-specific Claim Edits Libraries and attach them at the Payer Master level. These payer-specific claim edits libraries override the default Claim Edits Library. The application maintains a list of available claim edits in the Claim Edits Library, which you can access within File Maintenance. From the list of claim edits, you can do the following: Choose the edits you want to activate Customize the text of the edit messages Set a severity level for each edit You can set up multiple Claim Edit Libraries to use for different payer requirements. Reference: For a listing of claim edit options, refer to the section on Claim Edit

Help Guide for NextGen® Enterprise PM 8

Select Mutually Exclusive Edits in the Claim Edit Library

Check √ the appropriate CCI Mutually Exclusive edits as needed. You can set the CCI Mutually Exclusive edits with a Severity level based on business practices. Mutually Exclusive Edit Example Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

Select Mutually Exclusive Edits in the Claim Edit Library

Check √ the appropriate CCI Mutually Exclusive edits as needed. You can set the CCI Mutually Exclusive edits with a Severity level based on business practices. Mutually Exclusive Edit Example Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

Activating CCI Edits

If you want to include CCI edits among your activated Claim Edits, then you can select all the CCI edits. Selecting only some of the CCI Edits is not a best practice, this enables improper coding combinations to be applied to generated claims. Parent topic: CCI Edits

Set Up Exceptions for CCI, OCE, and LMRP Edits

Recommendations

Set Up Exceptions for CCI, OCE, and LMRP Edits

Claim Edits Library

Claim Edits Library

Select Mutually Exclusive Edits in the Claim Edit Library

Select Mutually Exclusive Edits in the Claim Edit Library

Activating CCI Edits

Set Up Exceptions for CCI, OCE, and LMRP Edits

Set Up Exceptions for CCI, OCE, and LMRP Edits

Claim Edits Library

Claim Edits Library

Select Mutually Exclusive Edits in the Claim Edit Library

Select Mutually Exclusive Edits in the Claim Edit Library

Activating CCI Edits