Significant Events for Consolidated Claims

Help Guide for NextGen® Enterprise PM 8

Consolidated Services Claim Library

The Consolidated Services Claim (CSC) library enables you to establish rules for consolidating multiple encounter charges into a single consolidated services claim (CSC). The purpose of this library is to configure billing and claim form type rules for payers. This section includes the following topics: Security rights for user groups Consolidated Services Claim library CSC configuration rules for the consolidation of daily, weekly, monthly, and case related claims Provider hierarchy for claim headers Bill for eligible patient days You can generate the Consolidated Services Claim Library Listing report and the CSC Library with Timespan Details report from the Consolidated Services Claim library. For more information go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Set Up Security Access Rights for Consolidated Services Claims Consolidated Services Claim Library Setup Create a CSC Library Access a Consolidated Services Cla

Help Guide for NextGen® Enterprise PM 8

Consolidated Services Claim

The claims services consolidation process is activated from the Claim Request Lookup window. The user will select the applicable claims to consolidate and then the application automatically consolidates the candidate claims into a Consolidated Services Claim (CSC). This process produces a Consolidated Services Claim report and alerts the user to any further actions that need to be taken before a CSC claim can be created. Note: The Consolidate Same Day Claims option is active when a CSC library is selected on the Practice Preferences Library window. Only claims with a Hold status can be consolidated by the CSC process. Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Create a Consolidated Services Claim

Open the Claim Request Lookup window. In the Request Status field select HOLD - H. Set any additional search criteria on the General tab. Select Find. The filtered claim data displays in the Claim Requests section of the window. Claim Request Lookup To select the claims for consolidation, enable the check box. Right-click and select Consolidate Same Day Claims. Consolidated Services Claim Report The Consolidated Services Claim report opens. Consolidated Services Claim Report The alerts may appear when you try to close the Consolidated Services Claim report. Alert Messages Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Create an Audit Trail for CSC Events

To create an audit trail for the creation and modification of consolidated service claims, you can select the type of events that you want to track on the Significant Event Information window. In NextGen® Enterprise PM, select the Admin menu, select Preferences, and then Significant Events. The Significant Event Information window opens. Select Find. Enter CSC or Encounter Field Modified in the Find What field. Significant Event Information Select the applicable significant events and then select OK. Significant Events Administration 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

X12 EDI Format of CSC Claims

Consolidated Service Claims are sent in an EDI file in the X12 837 standard format and includes the following criteria: The header data is populated from the header claim. A header claim can be automatically or manually identified to consolidate all claim details by doing the following: Manually identify a header claim - In NextGen® Enterprise PM access the Encounter Maintenance window, and then select Claims > Consolidated Service Claim tab. In the Primary Responsible Attending field select Responsible Attending. Automatically identify a header claim - In File Maintenance access the Consolidated Services Claim library. On the Attending Specialty Hierarchy window, you can identify the Attending Specialty Hierarchy. Claims in the status of Copy of, Hold, and Consolidated are viewable. Charges are in the same order as in the original claim. Non-covered services are not included in the claim data. Parent topic: Consolidated Service Claims

Significant Events for Consolidated Claims

Recommendations

Consolidated Services Claim Library

Consolidated Services Claim

Create a Consolidated Services Claim

Create an Audit Trail for CSC Events

CSC Terms

X12 EDI Format of CSC Claims

Consolidated Services Claim Library

Consolidated Services Claim

Create a Consolidated Services Claim

Create an Audit Trail for CSC Events

CSC Terms

X12 EDI Format of CSC Claims