Attach a Submitter Profile to the Payer Master

Help Guide for NextGen® Enterprise PM 8

Attach a Submitter Profile to the Payer Master

A submitter profile must be attached to each Payer master file. Note: 837 electronic files cannot be created for payers that do not have a submitter profile set up in their payer master file. In addition, to maintain HIPAA compliance when submitting electronic claims, a provider secondary reference qualifier must be set up at the Payer master file level as well. The provider secondary reference qualifier identifies, based on the claim type, the type of provider in the 837. In File Maintenance, select Master Files > System > Payers. The Add/Modify Payer Information window opens. Select the payer, and then select the Practice tab and then Claims tab and then click either the 1500 Claims, UB Claims, or ADA Claims sub-tab. Select the applicable Submitter Profile from the Submitter Profile drop-down menu (If applicable, attach a Submitter Profile for 1500 Claims, UB Claims, or ADA Claims). Select OK. Parent topic: Payers Master File

Help Guide for NextGen® Enterprise PM 8

System Tab

To set up provider secondary references, use the ADA Claims tab on the Claims sub-tab on the System tab of the Modify Payer Information window. Use the following table to set up your Provider Secondary References for dental payers. Provider Secondary Reference Qualifier / Data Element Billing Tab Employer ID Number (EI) / Tax ID Referring Tab <none> / <none> Rendering Tab <none> / <none> Service Facility Tab <none> / <none> Payer Billing Tab <none> / <none> Note: For more information on provider secondary references, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise, and then refer to the Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs section. Parent topic: Payers Master File for Dental Billing

Help Guide for NextGen® Enterprise PM 8

System Tab

To set up provider secondary references, use the ADA Claims tab on the Claims sub-tab on the System tab of the Modify Payer Information window. Modify Payer Information Use the following table to set up your Provider Secondary References for dental payers. Provider Secondary Reference Qualifier / Data Element Billing Tab Employer ID Number (EI) / Tax ID Referring Tab <none> / <none> Rendering Tab <none> / <none> Service Facility Tab <none> / <none> Payer Billing Tab <none> / <none> Note: For more information on provider secondary references, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise, and then refer to the Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs section. Parent topic: Payers Master File for Dental Billing

Help Guide for NextGen® Enterprise PM 8

Create an 837 Electronic File

Use the General tab to search for claims by form type, claim type, CPT4 codes, and by date. To access this window, select the EDI File toolbar button. The 837 Electronic File Creation window opens. On the General tab use the following table to identify your search criteria. Field Description Submitter Profile Library (required) Select the applicable submitter profile library. Pending claims that were created with this submitter profile attached to the payer will be returned in the search. The 837 electronic files are created based on submitter profiles because the settings in the submitter profile are specific to the payer, which maintains HIPAA compliancy. Claim Form (required) Select one of the following claim forms: 1500 ADA (Dental) UB. You can only include one claim form type in an 837 electronic file. This corresponds to the submitter profile option, Number of functional groups per file. Claim Type Select the claim type to narrow the search for pending claims based on the claim t

Help Guide for NextGen® Enterprise PM 8

Create an 837 Electronic File

Use the General tab to search for claims by form type, claim type, CPT4 codes, and by date. To access this window, select the EDI File toolbar button. The 837 Electronic File Creation window opens. On the General tab use the following table to identify your search criteria. Field Description Submitter Profile Library (required) Select the applicable submitter profile library. Pending claims that were created with this submitter profile attached to the payer will be returned in the search. The 837 electronic files are created based on submitter profiles because the settings in the submitter profile are specific to the payer, which maintains HIPAA compliancy. Claim Form (required) Select one of the following claim forms: 1500 ADA (Dental) UB. You can only include one claim form type in an 837 electronic file. This corresponds to the submitter profile option, Number of functional groups per file. Claim Type Select the claim type to narrow the search for pending claims based on the claim t

File Maintenance Help for NextGen® Enterprise

Set Up Submitter Profiles

The information in a submitter profile includes a combination of your submitter information and electronic file options that are specified by the clearinghouse and direct payer, which allow the electronic claim to be accepted and processed without rejection. The Submitter Profile Library Maintenance security right enables users to access the Submitter Profile library and to create and modify submitter profiles. Note: If you want electronic claims to be created for certain payers, payer-specific submitter profiles must be attached at the payer master level. Open File Maintenance and select Libraries > Submitter Profiles. The Submitter Profiles List window opens. Select the open menu button and then select New The Submitter Profile window opens. Note: You can double-click an existing submitter profile to modify the values. Enter a library name in the Submitter Profile Library field. Select the appropriate version from the ANSI X12 Version list. Configure the following tab options: Common

Attach a Submitter Profile to the Payer Master

Recommendations

Attach a Submitter Profile to the Payer Master

System Tab

System Tab

Create an 837 Electronic File

Create an 837 Electronic File

Set Up Submitter Profiles

Attach a Submitter Profile to the Payer Master

Attach a Submitter Profile to the Payer Master

System Tab

System Tab

Create an 837 Electronic File

Create an 837 Electronic File

Set Up Submitter Profiles