Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Claim Edit Columns

The following columns appear in the Claim Edit Library Maintenance window: Field Description Active Activates the claim edit, the claim edit will run when an encounter is billed and a claim is created using this Claim Edits Library. ID Displays a unique ID number that corresponds to each claim edit in the library. These ID numbers cannot be changed. If you sort by the ID number, it makes it easier to reference when new claim edits are added to the library. Claim Edit Displays the claim edits that are available in the Claim Edits Library. Help Text Displays the help text that corresponds to each of the claim edits. The text in these fields can be changed to display help text for a claim edit that best meets your needs when troubleshooting claim edit errors on the Claims Status report. Applicable To Indicates the area in the application where the applicable claim edit information is located. Knowing where in the application the claim edits information applies helps troubleshoot any claim

Help Guide for NextGen® Enterprise PM 8

Assign a Default Claim Edits Library

The default claim edits library is assigned on the Practice Preferences window. You can override the default library on the Libraries tab on the Practice tab under the Payers master file. You must assign a default Claim Edits Library on the Practice Preferences Libraries window. This enables users to bill encounters and generate claims. Access the Practice Preferences Libraries window. In the Claim Edits Library field, select the applicable library. Select OK. Libraries tab on the Practice tab Parent topic: Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Attach a Claim Edits Library to a Practice

A Claim Edits library must be attached to a practice to bill encounters and generate claims for the practice. Once a library is attached to a practice that library becomes the default Claim Edits library for the practice. In NextGen® Enterprise PM, select Admin > Preferences > Practice. The Practice Preferences window appears. Select Libraries. In the Claim Edits Library field, select a Claim Edit library. Select OK. Parent topic: Claim Edits Library

File Maintenance Help for NextGen® Enterprise

Claim Edits Library

The Claim Edits Libraries enable you to select the claim edits to run when billing encounters and generating claims. A default Claim Edits Library must be created and attached at the Practice Preferences level before you can bill encounters and generate claims. After, a default library is created and attached at the Practice Preferences level, you can then create payer-specific Claim Edits Libraries and attach them at the Payer Master level. These payer-specific claim edits libraries override the default Claim Edits Library. The application maintains a list of available claim edits in the Claim Edits Library, which you can access within File Maintenance. From the list of claim edits, you can do the following: Choose the edits you want to activate Customize the text of the edit messages Set a severity level for each edit You can set up multiple Claim Edit Libraries to use for different payer requirements. Reference: For a listing of claim edit options, refer to the section on Claim Edit

Help Guide for NextGen® Enterprise PM 8

Set Up the Claim Edits Library

In File Maintenance, select Libraries, and then select Claim Edits. The Claim Edits List window opens. Select Open Menu, and then select New. The Claim Edit Library Maintenance window opens. In Claim Edit Library, enter the name of the library. In Default Severity, select a severity level to be used as the default value for new claim edits. The severity of the new claim edit matches your selection in the Default Severity field. The severity level can be manually changed for the edit. The new field does not apply to edits that are already enabled. Note: Do not use the Quick Start field on the Claim Edit Library Maintenance window to avoid incorrect results. Parent topic: Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Claim Edits Library

Claim edits are a set of conditions that must be (or are suggested to be) met when you generate a claim. For example, is the patient's zip code required in the claim? Must the referring physician's first name appear on the claim? These are the kinds of requirements you can set up to control the information that appears in the claims you generate. The Claim Edits Libraries enable you to select the claim edits to run when billing encounters and generating claims. A default Claim Edits Library must be created and attached at the Practice Preferences level before you can bill encounters and generate claims. After, a default library is created and attached at the Practice Preferences level, you can then create payer-specific Claim Edits Libraries and attach them at the Payer Master level. These payer-specific claim edits libraries override the default Claim Edits Library. The application maintains a list of available claim edits in the Claim Edits Library, which you can access within File M

Claim Edits Library

Assign a Default Claim Edits Library