Set Up Rules for Consolidation of Case Claims

Field	Description
Claim Form Type	To consolidate claim types select one of the following options: 837P/1500 837I/UB Both Note: You must select one of the options to enable claims consolidation.
Encounter Rate Claims	Select this option to consolidate encounter rate claims for the following options: Encounter Rate claims only Claims only claims with the same Encounter Rate SIM A green check mark displays in these fields.
Encounter Rate SIM Service Line	The default for this section is set to NO. To enable this option: In the Rollup Encounter Rate Service Line field, select YES. The Encounter Rate SIM Service Lines and Encounter Rate Service Line Dates of Service fields become active. Encounter Rate SIM Quantity - Select: Sum of ER Service Lines - default value OR the value 1. Encounter Rate Service Line Amount - Select: Sum of ER Lines Amounts - default value OR Original Charge Amount.
Encounter Rate Service Line Dates of Service	Select this option to consolidate encounter rate service line dates of service for the following options: From Date - is populated with First Date of Eligibility. To Date - is populated with Last Date of Eligibility.

File Maintenance Help for NextGen® Enterprise 8

Claim Consolidation Rules

The following table lists the claim consolidation rules to be set for a selected time span. Field Description Claim Form Type To enable claims consolidation select one of the following options: 837P/1500 837I/UB Both Encounter Rate Claims Select one or both of these options to consolidate encounter rate claims: Consolidate Encounter Rate claims only. Consolidate only claims with the same Encounter Rate SIM. A green check mark appears in these fields. Consolidate Encounter Rate SIM Service Line Rollup Encounter Rate Service Line In this field select either: No - encounter rate SIM claims will not be consolidated. The remaining fields are not available. Yes - to consolidate encounter rate SIM claims. Complete the fields that are active for the selected timespan. Encounter Rate SIM Quarterly Same Day Claims Select either: Sum of ER Service Lines 1 Weekly Claims The default value in this field is 1. The value cannot be changed. Monthly Claims Select either: 1 Sum of ER Service Lines Number

Help Guide for NextGen® Enterprise PM 8

Claim Consolidation Rules

The following table lists the claim consolidation rules to be set for a selected time span. Field Description Claim Form Type To enable claims consolidation select one of the following options: 837P/1500 837I/UB Both Encounter Rate Claims Select one or both of these options to consolidate encounter rate claims: Consolidate Encounter Rate claims only. Consolidate only claims with the same Encounter Rate SIM. A green check mark appears in these fields. Consolidate Encounter Rate SIM Service Line Rollup Encounter Rate Service Line In this field select either: No - encounter rate SIM claims will not be consolidated. The remaining fields are not available. Yes - to consolidate encounter rate SIM claims. Complete the fields that are active for the selected timespan. Encounter Rate SIM Quarterly Same Day Claims Select either: Sum of ER Service Lines 1 Weekly Claims The default value in this field is 1. The value cannot be changed. Monthly Claims Select either: 1 Sum of ER Service Lines Number

Help Guide for NextGen® Enterprise PM 8

Set Up for Eligible Number of Patient Days Billing

Access File Maintenance. Select Libraries, and then Consolidated Services Claim library. The Consolidated Services Claim List window opens. Double-click to open the desired library. The Consolidated Services Claim Library Maintenance window opens. Select the open menu button . The Consolidated Services Claim Maintenance window opens. Complete the following fields: Effective Date Expiration Date Description Add the Valid Payers Select the Claim Consolidation Rules tab and then select the open menu button and select New. The CSC Timespan Rules window opens. Complete the following fields: In the Length of Timespan field, select Consolidate Monthly Claims. In the Description field, enter a description for this type of billing. In the Rollup Encounter Rate Service Line field, select Yes. In the Encounter Rate SIM Quantity field, select Number of Eligible Days. In the Encounter Rate Service Line Amount field, select Eligible Patient Days times Original Charge Amount. Select OK. Parent topic:

File Maintenance Help for NextGen® Enterprise 8

Set Up for Eligible Number of Patient Days Billing

Access File Maintenance. Select Libraries, and then Consolidated Services Claim library. The Consolidated Services Claim List window opens. Double-click to open the desired library. The Consolidated Services Claim Library Maintenance window opens. Select the open menu button . The Consolidated Services Claim Maintenance window opens. Complete the following fields: Effective Date Expiration Date Description Add the Valid Payers Select the Claim Consolidation Rules tab and then select the open menu button and select New. The CSC Timespan Rules window opens. Complete the following fields: In the Length of Timespan field, select Consolidate Monthly Claims. In the Description field, enter a description for this type of billing. In the Rollup Encounter Rate Service Line field, select Yes. In the Encounter Rate SIM Quantity field, select Number of Eligible Days. In the Encounter Rate Service Line Amount field, select Eligible Patient Days times Original Charge Amount. Select OK. Parent topic:

Help Guide for NextGen® Enterprise PM 8

Add Claim Consolidation Rules to a CSC Library

To enable claims consolidation, you must select the form types that you want to consolidate. Then you can choose to consolidate only encounter rate claims and/or claims with the same encounter rate SIM. These rules will apply to all of the payers in the Valid Payers list. Access the Consolidated Services Claim Maintenance window for the applicable library. Note: To access a CSC library, refer to the Accessing a Consolidated Services Claim Library procedure. After opening the Consolidated Services Claim Maintenance window, select a valid payer for the claim, then Claim Consolidation Rules. From the Claims Consolidation Rules tab, select a Claim Consolidation Rules row (CCR row) and open by doing one of the following: Right-click the library and select Open. Select the open menu button and select Open. The CSC Timespan Rules window opens for the library you selected. Complete the timespan rules. Note: When creating a new library, the Claim Consolidation Rules row (CCR row) is not require

File Maintenance Help for NextGen® Enterprise 8

Add Claim Consolidation Rules to a CSC Library

To enable claims consolidation, you must select the form types that you want to consolidate. Then you can choose to consolidate only encounter rate claims and/or claims with the same encounter rate SIM. These rules will apply to all of the payers in the Valid Payers list. Access the Consolidated Services Claim Maintenance window for the applicable library. Note: To access a CSC library, refer to the Accessing a Consolidated Services Claim Library procedure. After opening the Consolidated Services Claim Maintenance window, select a valid payer for the claim, then Claim Consolidation Rules. From the Claims Consolidation Rules tab, select a Claim Consolidation Rules row (CCR row) and open by doing one of the following: Right-click the library and select Open. Select the open menu button and select Open. The CSC Timespan Rules window opens for the library you selected. Complete the timespan rules. Note: When creating a new library, the Claim Consolidation Rules row (CCR row) is not require

Set Up Rules for Consolidation of Case Claims

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