Set Up the Remittance Profile

Help Guide for NextGen® Enterprise PM 8

Default Settings in Remittance Profile

The following table describes the settings for the Default tab in Remittance Profile. Option Description Encounter Payer Matching (After GS02 Payer Nbr) Use the following Encounter Payer Matching option To identify the payer during ERA matching, you can select one of the following options: Select Payer using Claim Status (Default): After identifying the payer using the GS02 and the ERA payer number, match will further include the CLP02 claim status returned in the 835 file. The following are the most common claim statuses. 1 = Primary Payer 2 = Secondary Payer 3 = Tertiary Payer 19 = Forwarded 22 = Reversal Select Payer using Claim Status with Policy NumberAfter identifying the payer using the GS02 and the ERA payer ID, it will also match the claim status and the policy number returned in the 835 file. The ERA matches the Encounter Payer's policy number using the claim status. An ineligible policy number is produced when matching fails on both policy number and claim status. Selecting

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

Generate a Remittance Profile Library Listing Report

Generate a Remittance Profile Library Listing Report Generate a Remittance Profile Library Listing Report The Remittance Profile Library Listing report is available for printing from File Maintenance. Report columns display information related to the setup of each library. Access File Maintenance. Select on Libraries, and then Remittance Profiles. The Remittance Profiles List window opens. Select the Open Menu and select Print. The NextGen Report Filter window opens. Select the desired columns, filters and sorting for the report To generate the report, select OK. Parent topic: Set Up a Remittance Profile Library

Help Guide for NextGen® Enterprise PM 8

Set Up a Remittance Profile Library

The Remittance Profile Library defines various parameters and rules that are used when importing and processing ERA 835 files downloaded from payers into NextGen® Enterprise PM. The Default Remittance Profile library in File Maintenance is pre-installed in the application and includes a few recommended pre-set options. All remaining options are set based on your organizational preferences or in response to the payer’s ERA 835 file configuration. Practice Level vs. Payer Level Libraries A default Remittance Profile Library must be selected in Practice Preferences > Libraries. The default library is used for all ERA payers in the practice that do not have a specific library linked. A different Remittance Profile Library to be used for a specific payer/financial class can be linked on the Payer > Practice > Libraries sub-tab. This library overrides the default library in Practice Preferences for the payer/financial class. Any payers that do not have a Remittance Profile Library attached u

File Maintenance Help for NextGen® Enterprise 8

Remittance Profiles Library

You can set the options for ERA import profiles in the Remittance Profiles so that your system properly interprets the ERA information it receives from a payer or clearinghouse. The options are not specific to the reason codes in the Reason Code library. The Default Remittance Profile library is pre-loaded and is configured with the most common ERA settings. You will need to review the default settings and verify if they are in compliance with your primary, secondary, and tertiary payers. In addition to the Default Remittance Profile library, you can create additional libraries as needed. You can then attach the Remittance Profile library to payers. The Remittance Profiles Library has the following tabs: Remittance Profile Library Default Tab The Default tab is for setting payment options and posting rules for claim level and encounter level transactions. CSC Options tab The CSC tab is for setting payment options for consolidated service claims. Set Up the Remittance Profile - Default

Set Up the Remittance Profile - Default Tab

Recommendations

Default Settings in Remittance Profile

Set Up the Remittance Profile - CSC Options Tab

Set Up the Remittance Profile - Reversals and Corrections Tab

Generate a Remittance Profile Library Listing Report

Set Up a Remittance Profile Library

Remittance Profiles Library

Default Settings in Remittance Profile

Set Up the Remittance Profile - CSC Options Tab

Set Up the Remittance Profile - Reversals and Corrections Tab

Generate a Remittance Profile Library Listing Report

Set Up a Remittance Profile Library

Remittance Profiles Library