Set Up Medicare and Medicaid Claim Types

Help Guide for NextGen® Enterprise PM 8

Set Up Medicare Claims

Select one of the Medicare claim types from the drop-down list in the Process as Claim Type field. Enter the values in the required fields and select OK. Parent topic: Set Up Medicare and Medicaid Claim Types

Help Guide for NextGen® Enterprise PM 8

Set Up Medicaid Claims

Select one of the Medicaid claim types from the drop-down list in the Process as Claim Type field. Enable the Medipass check box if you are submitting a claim in Florida and the patient has Medipass. Enable the KenPAK check box if you are submitting a claim in Kentucky and the patient has KenPAK. Enable the GA Better Health check box if you are submitting a claim in Georgia and the patient has GA Better Health (GA Medicaid). Select the payment type in the Source of Payment Typology field. Select OK. Parent topic: Set Up Medicare and Medicaid Claim Types

Help Guide for NextGen® Enterprise PM 8

Claims Sub-Tab

Field Description Process as Claim Type Enter the type of claim to process for this payer. When you make a selection, the system populates the Billing tab with the Qualifier as Employers ID Number (EI) and the Data Element as Tax ID. Both 4010 and 5010 claim formats require the EI and Tax ID to be populated for the Billing Loop. The secondary reference qualifiers can be manually set or they may be set using a claims utility if additional qualifiers and data elements are needed. Note: If you select Blue Cross/Blue Shield (BL), then the Plan Code field changes to BCBS Plan Code. If you select one of these claim types (Blue Cross/Blue Shield, Champus, Commercial, Medicaid, Medicare, or Worker's Compensation), then default values for the claim type are automatically filled in for the Provider Secondary References section. If there are existing secondary references, they are replaced with new ones. Financial Class Enter the financial class associated with this payer. Insurance Type Code Ent

File Maintenance Help for NextGen® Enterprise 8

Set Up Medicare and Medicaid Claim Types

These options enable you to run claims processing for Medicare and Medicaid claim types without receiving edits due to the format requirements of these claim types. In File Maintenance, access the Payers Master file. Select Payers. From the Payers List File Maintenance window, double-click the appropriate payer. Select the System tab and then the Claims sub-tab. Set up medicare claim or medicaid claim. Set Up Medicare Claims Set Up Medicaid Claims Parent topic: Claims Sub-Tab

File Maintenance Help for NextGen® Enterprise 8

Set Up Medicare Claims

Select one of the Medicare claim types from the drop-down list in the Process as Claim Type field. Enter the values in the required fields and select OK. Parent topic: Set Up Medicare and Medicaid Claim 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

Set Up Medicare and Medicaid Claim Types

Recommendations

Set Up Medicare Claims

Set Up Medicaid Claims

Claims Sub-Tab

Set Up Medicare and Medicaid Claim Types

Set Up Medicare Claims

Select Media Types