X12 EDI Format of CSC Claims

Consolidated Service Claims are sent in an EDI file in the X12 837 standard format and includes the following criteria:

• The header data is populated from the header claim.
• A header claim can be automatically or manually identified to consolidate all claim details by doing the following:
  • Manually identify a header claim - In NextGen® Enterprise PM access the Encounter Maintenance window, and then select Claims > Consolidated Service Claim tab. In the Primary Responsible Attending field select Responsible Attending.
  • Automatically identify a header claim - In File Maintenance access the Consolidated Services Claim library. On the Attending Specialty Hierarchy window, you can identify the Attending Specialty Hierarchy.
• Claims in the status of Copy of, Hold, and Consolidated are viewable.
• Charges are in the same order as in the original claim.
• Non-covered services are not included in the claim data.