Working with the Report

Help Guide for NextGen® Enterprise PM 8

Claim Production Status Report

The Claim Production Status report is generated when charges are put through the edit process. Edit happens automatically when the charge is being billed as described in Billing Encounters. The edits include checking if the charges adhere to National Standard Format (NSF) criteria, and any other contractual criteria that might be required. The report lists out charges sorted by encounter, then 1500 or UB form type, rendering physician, payer name, insured's name, patient's name, and severity of the warning. There are no totals or additional filters for this report. The columns are encounter number, 1500 or UB form type, patient name, severity of the warning, error message, edit source, rendering physician, payer name, insured's name, error number, claim status, NSF ID, encounter referring provider, supervisor provider, SIM total charge amount, provider NPI, and SIM (Service Item Codes). Error, Warning, and Informational labels appear underneath the Severity column. Errors result in dir

Help Guide for NextGen® Enterprise PM 8

Claim Production Status Report

The Claim Production Status report is automatically generated when one or more encounters are billed in NextGen® Enterprise PM. After the claim edits process completes for all encounters, the report generates and appears on screen. The report identifies whether the encounters passed or failed claim edits by displaying each encounter in one of the following text colors: Green: Indicates the encounter passed all claim edits and a pending claim is created for the payer. Self-pay encounters also display in green if the Include Self-Pay Encounters In Claim Billing Report option is enabled in Practice Preferences > Claims. Blue: Indicates the encounter failed one or more claim edits that are set up in the Claim Edits Library with Severity = Warning, and a pending claim is created for the payer. Red: Indicates the encounter failed one or more claim edits that are set up in the Claim Edits Library with Severity = Build, Critical or Required, and a pending claim is not created for the payer. To

Help Guide for NextGen® Enterprise PM 8

Bill an Individual Encounter from the Charge or Payment Window

Open the Charge Posting or Payment Entry window for the desired patient encounter. From the toolbar, select the Bill Encounter button. The Encounter Bill window opens listing all charges on the encounter. If the encounter has a status of Unbilled, charges are pre-selected for billing and if the encounter has a status of Rebill, you must select the charges to be billed. To bill the selected charges, select OK. A message appears stating that do you want to bill this self-pay encounter. Select Yes. The encounter status changes from Unbilled or Rebill to Billed. If the encounter has insurance attached, the encounter goes through the claim edits process and the Claim Production Status report appears. The encounter is listed on the report with a message in one of the following colors. Green: An informational message indicating the encounter passed all claim edits. A pending claim is created. Blue: A warning message indicating the encounter passed all claim edits, but information is included

Help Guide for NextGen® Enterprise PM 8

Bill an Individual Encounter from the Patient Chart

Open the Patient Chart for the desired patient. Select the Encounters tab. From the Encounters list, select the encounter to be billed. Do one of the following: From the main toolbar, select Bill. From the Tasks menu, select Demand, and then Demand Bill. Right-click and select Bill. The Encounter Bill window opens listing all charges on the encounter. If the encounter has a status of Unbilled, charges are pre-selected for billing and if the encounter has a status of Rebill, charges to be billed must be selected. To bill the selected charges, select OK. A message appears stating that do you want to bill this self-pay encounter. Select Yes. The encounter status changes from Unbilled or Rebill to Billed. If the encounter has insurance attached, the encounter goes through the claim edits process and the Claim Production Status report appears. The encounter is listed on the report with a message in one of the following colors. Green: An informational message indicating the encounter passed

Help Guide for NextGen® Enterprise PM 8

Bill an Individual Encounter from Encounter Lookup

Open NextGen® Enterprise PM. Select Encounter. The Encounter Lookup window opens. In the Bill Status field, select Rebill or Unbilled. Note: Encounters with a status of Bad Debt, Billed or History have already been billed. Clear the Include records without charges check box to exclude encounters that do not have charges. Enter additional Search Criteria to locate the desired encounter. Select Find. Encounters matching the search criteria display in the Encounter List section of the window. Select Encounter List, and then select the encounter to be billed in the Enc Nbr column. Right-click the encounter, and then select Bill. If the encounter is a self-pay encounter with no insurance attached, a message appears stating that do you want to bill this self-pay encounter. Select Yes. The encounter status changes from Unbilled or Rebill to Billed. If the encounter has insurance attached, the encounter goes through the claim edits process and the Claim Production Status report appears. The en

Help Guide for NextGen® Enterprise PM 8

Run Claim Edits after Entering Charges

You must run claim edits on charges immediately after you enter charges. The edits identify errors that may need to be corrected before the encounter goes through the billing process to create a claim for the payer. Open the Patient Chart for the desired patient. On the Encounters tab, select the encounter to run the claim edits. From the main toolbar, select Edits and do one of the following: You can run edits from the Appointment Book using Edits on the appointment toolbar. You can run edits from an open claim. You can add edits to the autoflow process. When the claim edits run successfully, the Claim Production Status window opens displaying the following: Build, Critical, Custom, Required, Error, Warning, and Informational labels under the Severity column. Errors for encounters appearing in red that result in bad claims and prevent reimbursement. Warnings for encounters appearing in blue do not prevent a clean claim, but might be contractual, and should be addressed. Informational

Working with the Report

Recommendations

Claim Production Status Report

Claim Production Status Report

Bill an Individual Encounter from the Charge or Payment Window

Bill an Individual Encounter from the Patient Chart

Bill an Individual Encounter from Encounter Lookup

Run Claim Edits after Entering Charges

Claim Production Status Report

Claim Production Status Report

Bill an Individual Encounter from the Charge or Payment Window

Bill an Individual Encounter from the Patient Chart

Bill an Individual Encounter from Encounter Lookup

Run Claim Edits after Entering Charges