Set Up Exceptions for CCI, OCE, and LMRP Edits

Help Guide for NextGen® Enterprise PM 8

Activate Claim Edits

The Claim Edits Library contains a list of the available claim edits you can apply to the claims you generate. In File Maintenance, select Libraries > Claim Edits and select the applicable Claim Edits Library. The Claim Edit Library Maintenance window opens. Select the claim edit you want to activate by selecting in the Active column. A check mark displays to indicate the claim edit is active. To edit the Help Text, select the Help Text field and enter the new description for the Help Text. To change the edit severity level, select in the Severity field, and select one of the following severity levels: Warning Critical Custom Required After you make your selections, select OK. Parent topic: Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Configure Claim Edits

When active, some claim edits display in blue when they require additional parameters to be set up for the description. If the parameters are not set up, then the claim edit displays in red and the library cannot be saved. In addition, several claim edits have variable numeric values that can be changed. Typically, these claim edits display in black and do not require changes because the value in the description is valid. For example, the claim edit "Line Item Charge is equal to $0.00" does not require a change because zero is a valid value. Right-click the claim edit description that displays with blue text, and then select Open. The Claim Edit Options window opens. The parameters that display on this window vary depending on the claim edit description you opened. Enter the applicable parameters. Select OK. After you have set up the additional parameters, the claim edit displays with black text. To save the library, select OK on the Claim Edit Library Maintenance window. Parent topic:

Help Guide for NextGen® Enterprise PM 8

Assign a Default Claim Edits Library

The default claim edits library is assigned on the Practice Preferences window. You can override the default library on the Libraries tab on the Practice tab under the Payers master file. You must assign a default Claim Edits Library on the Practice Preferences Libraries window. This enables users to bill encounters and generate claims. Access the Practice Preferences Libraries window. In the Claim Edits Library field, select the applicable library. Select OK. Libraries tab on the Practice tab 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

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

Activate Claim Edits

Configure Claim Edits

Assign a Default Claim Edits Library

Claim Edits Library

Select Mutually Exclusive Edits in the Claim Edit Library

Activating CCI Edits

Activate Claim Edits

Configure Claim Edits

Assign a Default Claim Edits Library

Claim Edits Library

Select Mutually Exclusive Edits in the Claim Edit Library

Activating CCI Edits