Submitter Profile Library

File Maintenance Help for NextGen® Enterprise 8

Submitter Profiles Library

A Submitter Profile needs to be created for each clearinghouse and direct payer that you use for submitting electronic claims. The information in a submitter profile includes a combination of your submitter information and electronic file options that are specified by the clearinghouse and direct payer, which allow the electronic claim to be accepted and processed without rejection. The Submitter Profile Library Maintenance security right enables users to access the Submitter Profile Library and to create and modify Submitter Profiles. Note: If you want electronic claims to be created for certain payers, payer-specific submitter profiles must be attached at the Payer master level. Set Up Submitter Profiles

Help Guide for NextGen® Enterprise PM 8

Attach a Submitter Profile to the Payer Master

A submitter profile must be attached to each Payer master file. Note: 837 electronic files cannot be created for payers that do not have a submitter profile set up in their payer master file. In addition, to maintain HIPAA compliance when submitting electronic claims, a provider secondary reference qualifier must be set up at the Payer master file level as well. The provider secondary reference qualifier identifies, based on the claim type, the type of provider in the 837. In File Maintenance, select Master Files > System > Payers. The Add/Modify Payer Information window opens. Select the payer, and then select the Practice tab and then Claims tab and then click either the 1500 Claims, UB Claims, or ADA Claims sub-tab. Select the applicable Submitter Profile from the Submitter Profile drop-down menu (If applicable, attach a Submitter Profile for 1500 Claims, UB Claims, or ADA Claims). Select OK. Parent topic: Payers Master File

Help Guide for NextGen® Enterprise PM 8

Additional Information on Alternate Payer Billing Options

The following table provides additional information on the alternate payer billing options. Field Description Submitter Profile Library You must use the Submitter Profile library while creating electronic claims for the alternate payer. When you do not select the Submitter Profile library for the alternate payer, the alternate payer will use the Submitter Profile library of the payer. When you change the submitter profile in the Payers-Alt Payers master file, a message appears listing the number of pending alternate payer claims (with in the practice) whose submitter profile is flagged for processing. The message also states that if the user proceeds by changing the submitter profile, then the pending claims flagged for processing will be archived and the encounters associated with them will be flagged to rebill. Claim Edit Library When you do not select the Claim Edit library for the alternate payer, the alternate payer will use the Claim Edit library of the payer. Claim Print Library

File Maintenance Help for NextGen® Enterprise 8

Additional Information on Alternate Payer Billing Options

The following table provides additional information on the alternate payer billing options. Field Description Submitter Profile Library You must use the Submitter Profile library while creating electronic claims for the alternate payer. When you do not select the Submitter Profile library for the alternate payer, the alternate payer will use the Submitter Profile library of the payer. When you change the submitter profile in the Payers-Alt Payers master file, a message appears listing the number of pending alternate payer claims (with in the practice) whose submitter profile is flagged for processing. The message also states that if the user proceeds by changing the submitter profile, then the pending claims flagged for processing will be archived and the encounters associated with them will be flagged to rebill. Claim Edit Library When you do not select the Claim Edit library for the alternate payer, the alternate payer will use the Claim Edit library of the payer. Claim Print Library

File Maintenance Help for NextGen® Enterprise 8

Claim Status Profile Library

The Claim Status Profile library is required for submitting claim status inquiries. This library enables you to set up rules to automatically complete the required fields and additional data for batch mode processing. Create a Claim Status Profile Library Creating a Claim Status Profile Library You can create a claim status profile library using the field's description.

File Maintenance Help for NextGen® Enterprise 8

Create a Claim Status Profile Library

In File Maintenance, select Libraries > Claim Status Profile. Select open menu button and select New. The Claim Status Profile window opens. Select the options and setting as described in the following table and then select OK. Parent topic: Claim Status Profile Library

Submitter Profile Library

Recommendations

Submitter Profiles Library

Attach a Submitter Profile to the Payer Master

Additional Information on Alternate Payer Billing Options

Additional Information on Alternate Payer Billing Options

Claim Status Profile Library

Create a Claim Status Profile Library

Submitter Profiles Library

Attach a Submitter Profile to the Payer Master

Additional Information on Alternate Payer Billing Options

Additional Information on Alternate Payer Billing Options

Claim Status Profile Library

Create a Claim Status Profile Library