Setting Up Practice Preferences for UB Claims

Help Guide for NextGen® Enterprise PM 8

Setting Up a Payer for UB Claims

After you set up Practice Preferences, the following UB tabs display on the Modify Payer Information window of the Payers master file: On the System > Claims sub-tab, UB Claims tab displays in the Provider Secondary References section and the Provider Paper Qualifiers section. On Practice > Claims sub-tab, the UB Claims tab displays. On Practice > Secondary References sub-tab, the UB Claims tab displays. System Tab/Claims Tab/UB Claims Tab UB Claims Tab on Claims Tab UB Claims Tab on Secondary References Tab Practice tab on UB Tab Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

UB/General Tab

All the fields on the UB > General sub-tab can be automatically populated. The information on this tab can be overridden, but it is not recommended, especially if you are an Enhanced UB user and you want to use the automated UB claims process. Regular UB users should not use the fields on this window, except to change the Source of Admission field. Regular UB users should continue to use the Billing & Collections tab on the Encounter Maintenance window to review or change the values that display on the UB claim form. Encounter Maintenance Field Description Type of Bill This field is divided into three positions. The values for each position are described separately. First Position After the UB claim is billed, this position is populated automatically with the value that is in the Type of Facility field located on Modify Payer Information > Practice > UB sub-tab. If this field does not contain a value, this position is populated from the Type of Facility field in Practice Preferences >

Help Guide for NextGen® Enterprise PM 8

Setting Up Encounters for UB Claims

The following list outlines the areas of the Encounter Maintenance window that are important to the setup of UB claims: On the General tab, complete the Service Location field. On the UB tab, access the following sub-tabs: Condition Codes, Occurrence Codes, and Value Codes. Encounter Maintenance Note: For Enhanced UB users, the automated UB claims process only applies to payers who are considered primary. The automating of the Type of Bill field, the Occurrence codes, and the Value codes, which are explained in the following sections, only occurs for primary payers who have the required criteria. UB/General Tab UB/Condition Codes Tab UB/Occurrence Codes Tab UB/Value Codes Tab Setting Up Practice Preferences for UB Claims Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

Setting Up UB Claims for Enhanced UB Users

Setting up UB claims for Enhanced UB users is different from the set up for Regular UB users, especially if you want to use the automated claims process. For Enhanced UB users, the automated UB claims process only applies to payers who are considered the primary payer. The automated UB claims process is not for payers who are considered secondary or tertiary. The automating of the Type of Bill field, the Occurrence codes, and the Value codes only occurs for primary payers who have the required criteria. Set Up Payers for Enhanced UB Users Set Up Encounters for Enhanced UB Claims (Before Billing) Set Up Encounters for Enhanced UB Claims (After Billing) Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

Set Up Electronic UB Claims

To submit claims electronically, you need to set up the UB Claims tab for the payer on the Add/Modify Payer Information window. Following is a list and explanation of the fields and check boxes in the UB Claims section to enable UB claims generation and electronic claim submission: The Field Locator 51 field The Media Type (Primary, Secondary, Tertiary) fields The When Primary, force Secondary claims to paper check box The When Secondary, force Tertiary claims to paper check box The Suppress Claim check box The fields and check boxes on the UB Claims tab are listed below with an explanation. The Field Locator 51 field. This is a free-form text entry field. Enter the number provided to you by the payer. This field must be completed when creating a UB claim. If it is left blank, then an edit will occur during the claims process, which reads: Loc 51 Provider Number is missing. The Media Type (Primary, Secondary, Tertiary) fields. The two Media Type options available are Paper and Electron

Help Guide for NextGen® Enterprise PM 8

UB Claims

This section provides information about the process of setting up UB claims for a regular UB user and an enhanced UB user. The rules for setting up and billing UB claims are different for the two types of users. Therefore, as a user, you should fit into one of the following two categories, if your practice processes UB claims: A Regular UB user is a practice that does some, but not exclusive UB claims billing. For example, if your practice primarily does 1500 claims processing and a small percentage of UB claims, then you would be considered a Regular UB user. An Enhanced UB user is a doctor or multiple doctors at a specific practice location that exclusively does UB claims billing. For example, a clinical rehabilitation practice with specific doctors at separate locations for Physical Therapy, Occupational Therapy, and Speech Therapy that exclusively process UB claims at one location would be considered an Enhanced UB user. UB claims must be set up by entering configuration informatio

Setting Up Practice Preferences for UB Claims

Recommendations

Setting Up a Payer for UB Claims

UB/General Tab

Setting Up Encounters for UB Claims

Setting Up UB Claims for Enhanced UB Users

Set Up Electronic UB Claims

UB Claims

Setting Up a Payer for UB Claims

UB/General Tab

Setting Up Encounters for UB Claims

Setting Up UB Claims for Enhanced UB Users

Set Up Electronic UB Claims

UB Claims