UB/Condition Codes Tab

Help Guide for NextGen® Enterprise PM 8

UB/Occurrence Codes Tab

UB All the fields on UB > Occurrence Codes correspond to the Field Locators on the UB claim form. For example, the occurrence code and date that is entered in the 32a field will populate the first line, which is considered line a, of Field Locator 32 on the UB claim form. Field 32b would correspond with the second line, which is line b, of Field Locator 32 on the UB claim. Note: All entries must be added starting with 32A before 33A can be added. The following example shows the top half of a UB04 claim form with lines a and b of the occurrence code fields. The UB > Occurrence Codes is used differently, depending on the type of user. If you are a Regular UB user, you can use the fields on this tab to manually enter the occurrence codes and dates that you want to print on the UB claim. Select the drop-down menu to display the list of occurrence codes. The occurrence codes and dates that are entered in these fields must be entered in the order that the fields display on the window. When o

Help Guide for NextGen® Enterprise PM 8

UB/Value Codes Tab

UB Each field on the UB / Value Codes tab is labeled with a number (39, 40, or 41) followed by a letter (a, b, c, or d). The value codes that are entered in these fields will have an associated dollar amount or unit value associated with it that is entered in the field to the right of the numbered fields. When a value code is entered in one of the numbered fields and you tab to the associated field to the right, the application automatically converts the field to accept a dollar value or a unit value. If a dollar value is the required entry, the field displays with $0.00. If a unit value is the required entry, the field displays blank. All the fields on this tab correspond to the Field Locators on the UB claim form. For example, the value code and associated dollar amount or unit value that is entered in the 39a field will populate the first line, which is considered line a, of Field Locator 39 on the UB04 claim form. Field 39b would correspond with the second line, which is line b, of

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

Encounter Maintenance - UB Tab

The UB tab includes information about the patient’s encounter that may be needed on electronic 837I or paper UB claims for the encounter. Note: This tab displays only if the default Type of Facility and Bill Classification options have been enabled in the Claims preferences under Practice Preferences. The UB tab has the following sub-tabs: General Condition Codes Occurrence Codes Value Codes UB General Sub-Tab UB Condition Codes Sub-Tab UB Occurrence Codes Sub-Tab Occurrence Codes define specific events relating to a bill that may affect payer processing. You can select one Occurrence Code and Date for field locators 31a - 34b, or up to eight (8) codes and dates per encounter. UB Value Codes Sub-Tab Value codes indicate the code and related dollar amounts that identify monetary data required for processing claims. You can modify the code and the dollar amount when specific codes and amounts are needed on the UB claim for the encounter. Parent topic: Encounter Maintenance

Help Guide for NextGen® Enterprise PM 8

UB Condition Codes Sub-Tab

Condition codes indicate a set of conditions that apply to a bill that can affect processing and payment of the claim. This two-digit code can indicate many different reasons that will affect claim processing such as: if a claim is employment related, a non-terminal condition for Hospice, or a private room is medically necessary. You can select one Condition Code for field locators 18 - 28, or up to ten (11) codes per encounter. Example: When you select 02 (Condition is Employment Related) in row 18, the condition code 02 displays in field locator 18 on UB claim forms for the encounter. Parent topic: Encounter Maintenance - UB Tab

Help Guide for NextGen® Enterprise PM 8

UB Value Codes Sub-Tab

Value codes indicate the code and related dollar amounts that identify monetary data required for processing claims. This information is required for benefit determination. Value codes are two character alpha-numeric codes that print in Field Locators 39-41 on UB claims. You can modify the code and the dollar amount when specific codes and amounts are needed on the UB claim for the encounter. You can select one Value Code and associated Dollar Amount in rows 39a - 41d, or up to 12 codes and amounts per encounter. Example: When you select 21 (Catastrophic) in row 31a and enter a dollar amount, the condition code 21 and the amount display in field locator 39a on UB claim forms for the encounter. Note: A default Value Code may have been linked to the Revenue Code that prints in Field Locator #42 on UB claims for the service. The default is defined in File Maintenance > PM System Master Files > Revenue Codes. Parent topic: Encounter Maintenance - UB Tab

UB/Condition Codes Tab

Recommendations

UB/Occurrence Codes Tab

UB/Value Codes Tab

Setting Up Encounters for UB Claims

Encounter Maintenance - UB Tab

UB Condition Codes Sub-Tab

UB Value Codes Sub-Tab

UB/Occurrence Codes Tab

UB/Value Codes Tab

Setting Up Encounters for UB Claims

Encounter Maintenance - UB Tab

UB Condition Codes Sub-Tab

UB Value Codes Sub-Tab