Using Twelve Diagnoses for Electronic Claims

Help Guide for NextGen® Enterprise PM 8

Run Claim Edits on Appointments or Encounters

You can run batch claim edits from the Appointment Lookup and Encounter Lookup windows when you select multiple appointments or encounters, and then select Claim Edits from the right-click menu. Batch editing generates the report (and tasks if configured to do so) but does not actually create claims. Perform a search for appointments in the Appointment Lookup window or for encounters in the Encounter Lookup window. In the list of matching results, select the check boxes to enable the appointments or encounters you want to run the claim edits for. Right-click in the results list, and then select Claim Edits. Parent topic: Generating Secondary Electronic Claims

Help Guide for NextGen® Enterprise PM 8

Generating Secondary Electronic Claims

If you are using electronic remittances, you can generate a secondary electronic claim for COB-specific 837 segments. Setting the Optional Segments for the 837 Format Enable Segments for Claim-level Approved Amounts and Adjustments Display the Family Planning Indicator on All Claims Run Claim Edits on Appointments or Encounters Force the Secondary Claim to Bill to the Primary Claim Provider Exempt Patient Co-Payments Run the Consolidation Same Day Claims Process Using Twelve Diagnoses for Electronic Claims Force Claims to Paper by ICD Code Setting Up a Release of Information Default Parent topic: Coordination of Benefits Electronic and Manual Processing

NextGen® Enterprise EHR Help

Add Diagnoses to Order Items

Before you begin Ensure that you select the Require Assessment Status check box under Assessment in the Practice Configuration template to prevent adding any of your diagnosis selections in CPOE, to the following: As a new problem (Dx) under the selected encounter. As a new assessment under the My Plan tab in the SOAP, Intake, and other generated NextGen® Adaptive Content Engine templates. As a new assessment in the Diagnoses tab. Note: For more information on practice templates, go to NextGen Healthcare Success Community and download the latest Practice Configuration Template User Guide for NextGen® Adaptive Content Engine. You can select diagnoses in the Assign Diagnosis section, which displays the patient's diagnoses for the current and any previous encounters, and add them to your order items. Note: For an immunization order item, Computerized Physician Order Entry (CPOE) automatically adds the default ICD-10-CM Z23 diagnosis code. Open CPOE. Select an order item. Note: You can sel

Help Guide for NextGen® Enterprise PM 8

Encounter-Level Diagnosis Codes

Diagnosis codes are typically entered during charge posting. Charge-level diagnosis codes then display in the ICD-CM section on the General sub-tab on the Encounters tab in the Patient Chart. After charge posting, you can add additional encounter-level diagnosis codes, if needed. You can also add encounter-level diagnosis codes prior to charge posting, so they default to each charge during charge posting. Note: Diagnosis codes added to an appointment from the Ins/Diag tab in the Add/Modify Appointment window automatically default to the ICD-CM section on the General sub-tab in the Patient Chart > Encounters tab when the appointment is checked-in and the encounter is created. Add Encounter-Level Diagnosis Codes You can add diagnosis codes at an encounter-level for a patient. Select an Admitting Diagnosis for UB Claims You can use the admitting diagnosis as an institutional claim to indicate the patient's primary diagnosis at the time of inpatient admission. Enter Present on Admission In

NextGen® Therapy Suite Help 30.3.13.0

Apply Different Diagnoses to CPT Codes

If needed for a claim, each CPT Code in the Charges grid can have a different Dx Code attached. Select the CPT Codes in the Charges grid. When a charge is selected, a check mark appears in the first column for that charge line and the buttons below the grid become active. Select the Remove DX button to remove all diagnoses from the selected CPT Codes. In the Diagnosis grid, select the diagnoses that you want to apply to the selected charges. Select the diagnoses in the order of priority. The diagnosis listed as 1 will be the primary diagnosis assigned to the CPT codes. Do any of the following: To apply the selected diagnosis to the selected CPT Code(s), select Apply DX. To apply the selected diagnosis to all CPT Code(s), select Apply DX to All. Parent topic: Change Applied Diagnosis Codes

File Maintenance Help for NextGen® Enterprise 8

Configurations in Claim Practice Preferences

The following table provides descriptions for the fields located in Claims Practice Preferences. Field Description Enable Qualifying Encounter Billing Activates qualifying encounter billing for all encounters with line items marked as a qualifying SIM Note: To complete the setup for qualifying encounter billing, you must configure one or more SIMs to be a qualifying SIM. Suppress zero balance claims Suppresses claims with a $0 (zero) balance during batch billing. Suppress CLIA ID from mammography claims Makes mammography certification codes and Clinical Laboratory Improvement Amendments (CLIA) IDs mutually exclusive on electronic claims. When you select this option, NextGen® Enterprise PM identifies a mammography code on a claim and prints the mammography code, and not the CLIA ID for Medicare claims. When you clear this option, both the mammography code and the CLIA codes are printed on the claim. Note: To suppress CLIA ID from mammography claims, you must set a SIM as mammography cod

Using Twelve Diagnoses for Electronic Claims

Recommendations

Run Claim Edits on Appointments or Encounters

Generating Secondary Electronic Claims

Add Diagnoses to Order Items

Encounter-Level Diagnosis Codes

Apply Different Diagnoses to CPT Codes

Configurations in Claim Practice Preferences

Run Claim Edits on Appointments or Encounters

Generating Secondary Electronic Claims

Add Diagnoses to Order Items

Encounter-Level Diagnosis Codes

Apply Different Diagnoses to CPT Codes

Configurations in Claim Practice Preferences