UB92 Options

Field	UB92 Options Description Exceptions: When Payer is Primary Tab
[FL55] Estimated Amount Due	Select one of the following options: Blank Charge Amt minus Box 54 Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are A1 or A2 Non-Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are B1, B2, C1, or C2

Help Guide for NextGen® Enterprise PM 8

ADA (2019 and 2024) Form Options For Primary Payer

ADA Options Description [4] Other Dental or Medical Coverage One of the following options display the payer details when the patient has coverage under any dental or medical plan: BlankNote: If you select Blank, then nothing prints in Boxes 5-11. Dental/Medical Checks Dental box, if other coverage is the non-primary payer and the Payer Defaults 2 tab is selected. Checks Medical box when payer is primary. Note: Boxes 5-11 print with correct data for both types of coverage. [31a] Other Fee(s) – Line 1 – When zero dollar amount, display One of the following options display the fee of the other charges applicable to dentist services when the amount is zero-dollar: 0.00 Blank [31a] Other Fee(s) – Line 1 One of the following options display the fee of the other charges applicable to dentist services: Adjustments onlyIncludes all previous adjustments (payer or contractual) from all COB levels. All payer paymentsIncludes all previous payer payments from all COB levels. All payer payments + Adj

File Maintenance Help for NextGen® Enterprise 8

UB92 Options

Field UB92 Options Description Exceptions: When Payer is Primary Tab [FL55] Estimated Amount Due Select one of the following options: Blank Charge Amt minus Box 54 Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are A1 or A2 Non-Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are B1, B2, C1, or C2 Parent topic: Set Up Exceptions for the Primary Payer

Help Guide for NextGen® Enterprise PM 8

Claim Print Options When the Payer is Primary

This following sections consist of the Claim Printing options in the Exceptions: When Payer is Primary tab: 1500 CMS Options (2012) UB92 Options ADA (2019 and 2024 Form Options For Primary Payer) 1500 CMS Options (2012) UB92 Options ADA (2019 and 2024) Form Options For Primary Payer There are several common claim print options applicable to ADA 2019 and ADA 2024 for the primary payer. Parent topic: Claim Printing Options

Help Guide for NextGen® Enterprise PM 8

UB04 & UB92 Options

Field UB04 & UB92 Options Description Exceptions: When Payer is Secondary Tab [FL 50-53] Blank if Medicare Primary Select this option to suppress primary payer information in these fields if Medicare is primary. When this option is selected, the secondary and tertiary payer information in FL 50-66 moves to the primary and secondary positions (Lines A & B). [FL54] Prior Payment Select one of the following options: Blank Blank if Medicare is Prim Prior Payer Payments [FL55] Estimated Amount Due Select one of the following options: Blank Charge Amt minus Box 54 Charge Amt minus Box 54 minus Value Code amounts (Deductible and Coinsurance only) Charge Amt minus first Value Code amt (share of cost only) Charge Amt minus Value Code amounts (Deductible and Coinsurance only) Enc Rate SIM amount [FL64] Document Control Number Select one of the following options: Default – No selection Blank – Use to remove a selection or no selection. Resub Ref # (from Claim Maintenance) - Select to print the Re

File Maintenance Help for NextGen® Enterprise 8

UB04 & UB92 Options

Field UB04 & UB92 Options Description Exceptions: When Payer is Secondary Tab [FL 50-53] Blank if Medicare Primary Select this option to suppress primary payer information in these fields if Medicare is primary. When this option is selected, the secondary and tertiary payer information in FL 50-66 moves to the primary and secondary positions (Lines A & B). [FL54] Prior Payment Select one of the following options: Blank Blank if Medicare is Prim Prior Payer Payments [FL55] Estimated Amount Due Select one of the following options: Blank Charge Amt minus Box 54 Charge Amt minus Box 54 minus Value Code amounts (Deductible and Coinsurance only) Charge Amt minus first Value Code amt (share of cost only) Charge Amt minus Value Code amounts (Deductible and Coinsurance only) Enc Rate SIM amount [FL64] Document Control Number Select one of the following options: Default – No selection Blank – Use to remove a selection or no selection. Resub Ref # (from Claim Maintenance) - Select to print the Re

Help Guide for NextGen® Enterprise PM 8

UB04 and UB92 Options

Field UB04 and UB92 Options Description Exceptions: When Payer is Tertiary Tab [FL54] Prior Payment Select one of the following options: Blank Prior Payer Payments [FL55] Estimated Amount Due Select one of the following options: Blank Charge Amt minus Box 54 Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are A1 or A2. Non-Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are B1, B2, C1, or C2. [FL64] Document Control Number Select one of the following options: Default – No selection Blank – Use to remove a selection or no selection. Resub Ref # (from Claim Maintenance) - When this is selected, the Resubmission Reference Number in the Claims Maintenance Claims Detail “Resubmission Code field. This is an alpha numeric field with a maximum length of 26 characters. Prior Payer Ref # (from Claim Maintenance) – When this is selected the Prior Payer Resubmission Reference Number will print from the new field “Prior Payer Reference Number” in Claims M

UB92 Options

Recommendations

ADA (2019 and 2024) Form Options For Primary Payer

UB92 Options

Claim Print Options When the Payer is Primary

UB04 & UB92 Options

UB04 & UB92 Options

UB04 and UB92 Options

ADA (2019 and 2024) Form Options For Primary Payer

UB92 Options

Claim Print Options When the Payer is Primary

UB04 & UB92 Options

UB04 & UB92 Options

UB04 and UB92 Options