Significant Events Administration

Encounter Level Significant Events	Message is issued when:	Message displays on the Clinical History Chart Notes window > Encounter
CSC Claim Created	A CSC claim is created	CSC Claim Created – Encounter Nbr (list all encounter numbers)
CSC Encounter Exempt Status Changed During Billing	During billing when one of the following check boxes is selected or cleared on the Consolidated Services Claim sub tab: Exempt from Primary Consolidated Services Claim Exempt from Secondary Consolidated Services Claim Exempt from Tertiary Consolidated Services Claim When one of the check boxes is selected the encounter will not be included in the consolidated claim. ( Consolidated Services Claim sub tab on the Claims tab of the Encounter Maintenance window)	CSC Primary Exempt Indicator Automatically Changed during Billing – Encounter XXX CSC Secondary Exempt Indicator Automatically Changed during Billing – Encounter XXX CSC Tertiary Exempt Indicator Automatically Changed during Billing – Encounter XXX
CSC Encounter Responsible Attending Changed During CSC Process	During billing the responsible attending physician is changed because of a selection in one of the following fields on the Consolidated Services Claim sub-tab: Primary Responsible Attending Secondary Responsible Attending TertiaryResponsible Attending ( Consolidated Services Claim sub tab on the Claims tab of the Encounter Maintenance window)	CSC Primary Responsible Attending Automatically Set during CSC Process – Encounter: XXX CSC Secondary Responsible Attending Automatically Set during CSC Process – Encounter: XXX CSC Tertiary Responsible Attending Automatically Set during CSC Process – Encounter: XXX
CSC Candidate Claim Requests Status Changed During CSC Process	During processing, when a CSC candidate claim request status is changed from: HOLD to Consolidated OR HOLD to Pending	CSC Candidate Claim Request Status Changed During CSC Process – Claim Nbr: (XXX)
Encounter Field Modified	A user manually changes the primary, secondary, or tertiary responsible attending provider on the Consolidated Services Claim sub-tab.	CSC Primary Responsible Attending Changed – Encounter: XXX CSC Secondary Responsible Attending Changed – Encounter: XXX CSC Tertiary Responsible Attending Changed – Encounter: XXX
	A user manually changes Exempt Encounter Charges from CSC for a primary, secondary, or tertiary payer on the Consolidated Services Claim sub-tab.	CSC Primary Exempt Indicator Changed CSC Secondary Exempt Indicator Changed CSC Tertiary Exempt Indicator Changed

Help Guide for NextGen® Enterprise PM 8

Mark a CSC Encounter as Exempt

CSC candidate encounters can be marked exempt either manually or automatically by the system. Automatic exemption of a claim occurs when the claim is suppressed as a result of File Maintenance settings. Exempt encounter charges are not included in a consolidated claim. Access the Consolidated Services Claim tab under the Claims tab on the Encounter Maintenance window. To identify the responsible attending provider for claim header, complete the Primary Responsible Attending, Secondary Responsible Attending, and Tertiary Responsible Attending fields. Select one of the following options for each applicable insurer: None - (default prior to billing) Responsible Attending Ancillary Provider To remove encounter charges from a primary, secondary, or tertiary CSC claim, select the applicable check box: Exempt from Primary Consolidated Services Claim An alert displays if a Primary HOLD claim is attached to the encounter: A HOLD claim exists for this encounter. Would you like to convert the HOL

Help Guide for NextGen® Enterprise PM 8

Add Claim Header Rules to a CSC Library

Access the Consolidated Services Claim Maintenance window for the applicable library. Note: To access a library, refer to the procedure Accessing a Consolidated Services Claim Library. Select the Claim Header Rules tab. In the Select Responsible Attending Provider by Specialty area, select Open Folder. The Attending Specialty Hierarchy window opens. On the Attending Specialty Hierarchy window, do one of the following: To add a specialty to the Included list, select the specialty in the Available list, and then select Include . The specialty moves from the Available list to the Included list. To remove a specialty from the Included list, select the specialty in the Included list, and then select Exclude . The specialty moves from the Included list to the Available list. Note: The list can be sorted numerically by selecting on Specialties column header or alphabetically by selecting the Description column header. Select OK. The Consolidated Services Claim Maintenance window displays with

File Maintenance Help for NextGen® Enterprise 8

Add Claim Header Rules to a CSC Library

Access the Consolidated Services Claim Maintenance window for the applicable library. Note: To access a library, refer to the procedure Accessing a Consolidated Services Claim Library. Select the Claim Header Rules tab. In the Select Responsible Attending Provider by Specialty area, select Open Folder. The Attending Specialty Hierarchy window opens. On the Attending Specialty Hierarchy window, do one of the following: To add a specialty to the Included list, select the specialty in the Available list, and then select Include . The specialty moves from the Available list to the Included list. To remove a specialty from the Included list, select the specialty in the Included list, and then select Exclude . The specialty moves from the Included list to the Available list. Note: The list can be sorted numerically by selecting on Specialties column header or alphabetically by selecting the Description column header. Select OK. The Consolidated Services Claim Maintenance window displays with

Help Guide for NextGen® Enterprise PM 8

Exempting CSC Encounters

CSC options can be set manually on the Consolidated Services Claim tab under the Claims tab on the Encounter Maintenance window. The options set on this tab override the rules in the Consolidated Services Claims library. On the Consolidated Services Claim sub-tab, you can you can do the following: Identify the responsible attending physician to display in the claim header for primary, secondary, and tertiary payers. Identify specific encounters to be exempt from a consolidated services claim. If there is an eligibility overlap during billing, the application displays the following error in the Claim Production Status report: CSC Eligibility Dates overlap with HOLD claims for encounter(s). Correct Eligibility. Parent topic: Claims Consolidated Services Claim Sub-Tab Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

CSC Terms

The following table provides a list of terms associated with the consolidation process of claims. Term Description TS Time Span - claims that occur on the same date, week, month, or case. The time-span is identified in the CSC library. CCCP Case Claim Consolidation Program – The program rules established in the Consolidated Services Claim library to consolidate all claims attached to a Case. CCR Consolidated Claims Rules CSC Consolidated Services Claim CSC Candidate Encounter When a patient has multiple encounters per day. Each encounter can be a CSC candidate encounter. CSC Hold Claims These are the claims created after billing a CSC Candidate Encounter but prior to running the CSC process. Consolidated Claim After the charges from the CSC Hold Claims are consolidated into a CSC, the CSC Hold Claims become Consolidated claims. Claim-Header Encounter The claim header details are derived from this encounter. Primary Attending is selected in the Primary Responsible Attending field from t

Help Guide for NextGen® Enterprise PM 8

UnBilled Encounters Report Columns

The following columns are available on the UnBilled Encounters report: Column Name Description Data Populates From Enc UD 1 - 4 Encounter User Defined 1 - 4 Fields Note: User defined names are from Practice Preferences > Encounters. Encounter Maintenance > General tab Enc Spec UD 1 - 50 Encounter Specific 1 - 50 Fields Note: User defined names are from Practice Preferences > Encounters. Encounter Maintenance > Encounter Specifics tab Enc Bill & Collect UD 1 - 4 Encounter Billing/Collections 1 - 4 Fields Note: User defined names are from Practice Preferences > Encounters. Encounter Maintenance > Billing & Collections tab Acc Occur Cd Accident Occurrence Code Encounter Maintenance Acc Occur St Accident Occurrence State Encounter Maintenance Addr1 Line 1 of patient mailing address Patient Information Addr2 Line 2 of patient mailing address Patient Information Admit Dt Admit Date Encounter Maintenance Admit Tm Admit Time Encounter Maintenance Admitting Admitting Provider Encounter Maintena

Significant Events Administration

Recommendations

Mark a CSC Encounter as Exempt

Add Claim Header Rules to a CSC Library

Add Claim Header Rules to a CSC Library

Exempting CSC Encounters

CSC Terms

UnBilled Encounters Report Columns

Mark a CSC Encounter as Exempt

Add Claim Header Rules to a CSC Library

Add Claim Header Rules to a CSC Library

Exempting CSC Encounters

CSC Terms

UnBilled Encounters Report Columns