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

Claim Edits Library

This section contains a listing of all of the available claim edits in the application. Claim Edit Columns Claim Edit Descriptions This section describes the various claim edits available. System-Level Claim Edit Descriptions Parent topic: Claims

Help Guide for NextGen® Enterprise PM 8

Claim Edits

This chapter includes information about the Claim Edits library and the various types of edits that can be applied to a claim during claim processing. This section includes: Claim Edits Library PQRI Edits CCI Edits Local Medical Review Policy ICD Diagnosis Edits Claim Edits Library PQRI Edits CCI Edits Local Medical Review Policy Parent topic: Setting Up Claims

File Maintenance Help for NextGen® Enterprise 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

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

File Maintenance Help for NextGen® Enterprise

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

Claim Edits Library

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