Setting Up Payers for ERA

Help Guide for NextGen® Enterprise PM 8

Setting Up Practice Preferences for ERA

You can configure the following ERA settings in Practice Preferences. Go to Practice Preferences, then Libraries and select Remittance Profile Library to set the default library to be used for all ERA payers that do not have a specific library linked in the practice. Go to Practice Preferences, then Transactions and select Default Reason Code Library to set the default library to be used for all payers (ERA and non-ERA) in the practice, that do not have a specific library linked. Note: NextGen Healthcare recommends the use of the HIPAA X12 Standard Reason Codes library as the default for a practice for all payers. Use settled up status with ERA. You can select this check box to default the Settled moved to Primary transaction status onto ERA payment or adjustment transactions received from the secondary payer before the primary payer. When a secondary transaction is received before primary, a credit balance is normally created in the secondary payer (Ins2 Amt) bucket in Balance Control

Help Guide for NextGen® Enterprise PM 8

Set Up Default Transaction Codes for an Alternate Payer

When you are using the alternate payer functionality, you might find that the main payer on the Payer master file, and the alternate payer on the Payers-Alt Payer master file has different Default Transaction Codes. In File Maintenance, select Master Files > System > PM > Payers-Alt Payers. The Payers-Alt Payers List window opens. From the Payers-Alt Payers List window, select and open the applicable alternate payer. The Modify Alt- Payer Information - Demo Payer window opens. Select the Alt Payer Transaction Option tab. The fields under the Alt Payer Transaction Option tab appear. Select default transaction codes for the alternate payer. For more information, see Settings - default transaction codes for the alternate payer To save the changes and close the window, select OK. Note: For more information on the Payers-Alt Payers master file go to NextGen Healthcare Success Community and download the latest Claims User Guide for NextGen® Enterprise PM. Settings - default transaction codes

Help Guide for NextGen® Enterprise PM 8

Select All Lines for Bill to Next Insurance

When an ERA 835 file from a payer is imported, if any line item on the encounter is selected to be rebilled to the next payer, the practice can choose to instead rebill all line items to the next payer. When the below option is selected for a payer and an ERA file is imported, all line items will flag to rebill if one line item is selected to rebill, including those with a $0.00 balance. All line item charges are settled to the next subsequent payer so a claim is created in NextGen® Enterprise PM for that secondary/tertiary payer. Access File Maintenance. Select Master Files, then System, and then Payers. The Payers List window appears. From the list, select and open the desired payer. The Modify Payer Information window appears. Select the Practice tab, and then the Other sub-tab. Select the ERA – If any line is selected for bill, select all lines for bill to next insurance check box. To save changes and close the window, select OK. Parent topic: Setting Up Payers for ERA

Help Guide for NextGen® Enterprise PM 8

Setting Up ERA

The ERA posting process requires the following set up in File Maintenance: Remittance Profile Library Reason Code Library Payers: Enter an ERA Payer Number Select a Remittance Profile Library for specific ERA payers, if applicable Select a Reason Codes Library for specific payers, if applicable Practice Preferences: Select a default Remittance Profile Library for all ERA payers Select a default Reason Codes Library for all payers Configure Patient Pay Import options, if applicable Set Up a Remittance Profile Library Setting Up Reason Codes for ERA You can use the Reason Codes Library to configure business rules to automate ERA transaction posting. Setting Up Payers for ERA You can define the various parameters in Payers Master File related to ERA. Setting Up Enterprise Preferences for ERA Setting Up Practice Preferences for ERA You can set preferences for all payers in the practice. Parent topic: Electronic Remittance Advice

Help Guide for NextGen® Enterprise PM 8

ERA Payer Number

The ERA Payer Number is the electronic remittance carrier number received in the 835 file. Each payer is assigned a unique number. The number is entered on the Payer > Payer Defaults-1 tab. The number is used in NextGen® Enterprise PM to allocate the ERA transactions to the appropriate payer. Identify the ERA Payer Number from the ERA Posting Process You can identify the ERA payer number from the ERA posting process. Enter the ERA Payer Number for a Payer Enter the ERA Payer Number for an Alternate Payer You can enter the ERA payer number for an alternate payer in File Maintenance. Parent topic: Setting Up Payers for ERA

Help Guide for NextGen® Enterprise PM 8

Create Zero Balance Claims to Subsequent Payers

A practice may have a need to send a claim to the next payer even though the previous payer paid the claim in full. For example, an FQHC practice reports to a secondary “wrap” payer by sending a claim showing services that were completely paid by the primary payer. Line item charges that have been paid in full by the previous ERA payer, and now have a $0.00 balance, can be settled to the next subsequent payer so a claim is created in NextGen® Enterprise PM for that secondary/tertiary payer. Access File Maintenance. Select Master Files, then System, and then Payers. The Payers List window appears. From the list, select and open the desired payer. The Modify Payer Information window appears. Select the Practice tab, and then the Other sub-tab. Select the ERA – Create Zero Dollar Total Balance Claims to Selected Subsequent Payer(s) check box. In the field to the right, select the subsequent Payer(s). To save changes and close the window, select OK. Additional Information Parent topic: Set

Setting Up Payers for ERA

Recommendations

Setting Up Practice Preferences for ERA

Set Up Default Transaction Codes for an Alternate Payer

Select All Lines for Bill to Next Insurance

Setting Up ERA

ERA Payer Number

Create Zero Balance Claims to Subsequent Payers