Claim Print Options When the Payer is Primary

Help Guide for NextGen® Enterprise PM 8

UB92 Options

Field UB92 Options Description Exceptions: When Payer is Primary Tab [FL55] Estimated Amount Due Displays the following options for [FL55] Estimated Amount Due: Blank Charge Amt minus Box 54 Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are A1 or A2 Non-Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are B1, B2, C1, or C2 Parent topic: Claim Print Options When the Payer is Primary

Help Guide for NextGen® Enterprise PM 8

ADA (2019 and 2024) Form Options For Primary Payer

ADA Options Description [4] Other Dental or Medical Coverage One of the following options display the payer details when the patient has coverage under any dental or medical plan: BlankNote: If you select Blank, then nothing prints in Boxes 5-11. Dental/Medical Checks Dental box, if other coverage is the non-primary payer and the Payer Defaults 2 tab is selected. Checks Medical box when payer is primary. Note: Boxes 5-11 print with correct data for both types of coverage. [31a] Other Fee(s) – Line 1 – When zero dollar amount, display One of the following options display the fee of the other charges applicable to dentist services when the amount is zero-dollar: 0.00 Blank [31a] Other Fee(s) – Line 1 One of the following options display the fee of the other charges applicable to dentist services: Adjustments onlyIncludes all previous adjustments (payer or contractual) from all COB levels. All payer paymentsIncludes all previous payer payments from all COB levels. All payer payments + Adj

Help Guide for NextGen® Enterprise PM 8

1500 CMS Options (2012)

Field CMS1500 (2012) Description Exceptions: When Payer is Primary Tab [1] Insured's program Select one of the following options: <none> Blank Use Legacy Standards Current Program with X Current Program with P [1a] Insured's ID number Select one of the following options: <none> Blank Use Legacy Standards Current payer's insured's policy # Insured's override # if not blank; else insured's policy # Social Security Nbr Current payer's policy # + Plan Code [2 and 4] Enable Commas Select this option to delimit first, last, and middle initial by commas. [4] Insured's name Select one of the following options: 'SAME' if Medicare 2nd and patient addr = insured addr; else LastName FirstName MI of insured 'SAME' if Medicare 2nd/3rd and patient addr = insured addr; else LastName FirstName MI of insured 'SAME' if patient and insured are same; else Blank 'SAME' if patient and insured are same; else LastName FirstName MI of insured 'SAME' if patient and insured are same; else UCase(LastName FirstName

Help Guide for NextGen® Enterprise PM 8

Set Up Exceptions for the Primary Payer

The Claim Printing options available for the 1500 form on the Exceptions: When Payer is Primary tab apply only when the payer associated with the library is the primary payer. In File Maintenance, select Libraries, and then select Claim Printing. The Claim Printing List window opens. Double-click the applicable library or select Open Menu, and then select New. Select Exceptions: When Payer is Primary. Select the claim type in 1500 Claims, UB Claims, or the ADA Claims. Select OK. Parent topic: Claim Print Options in Claim Printing Library

Help Guide for NextGen® Enterprise PM 8

Claim Print Options When the Payer is Secondary

This following sections consist of the Claim Printing options in the Exceptions: When Payer is Secondary tab: CMS 1500 (2012) UB04 & UB92 Options ADA (2019 and 2024) Form Options for Secondary Payer Coordination of Benefits Options For more information on how to set up the Claim Printing options in the Exceptions: When Payer is Secondary tab, refer to Set Up Exceptions for a Secondary Payer. CMS 1500 (2012) UB04 & UB92 Options There are several claim print options applicable to UB04 and UB92 claim form for all payers. ADA (2019 and 2024) Form Options for Secondary Payer There are several common claim print options applicable to ADA 2019 and ADA 2024 claim forms for the secondary payer. Coordination of Benefits Options Parent topic: Claim Printing Options

Help Guide for NextGen® Enterprise PM 8

Claim Print Options When the Payer is Tertiary

This following sections consist of the Claim Printing options in the Exceptions: When Payer is Tertiary tab: 1500 CMS Options (2012) UB04 and UB92 Options ADA (2019 and 2024) Form Options for Tertiary Payer Coordination of Benefits Options For more information on how to set up the Claim Printing options in the Exceptions: When Payer is Tertiary tab, refer to Set Up Exceptions for a Tertiary Payer. 1500 CMS Options (2012) UB04 and UB92 Options ADA (2019 and 2024) Form Options for Tertiary Payer There are several common claim print options applicable to ADA 2019 and ADA 2024 claim forms for the tertiary payer. Coordination of Benefits Options Parent topic: Claim Printing Options

Claim Print Options When the Payer is Primary

Recommendations

UB92 Options

ADA (2019 and 2024) Form Options For Primary Payer

1500 CMS Options (2012)

Set Up Exceptions for the Primary Payer

Claim Print Options When the Payer is Secondary

Claim Print Options When the Payer is Tertiary

UB92 Options

ADA (2019 and 2024) Form Options For Primary Payer

1500 CMS Options (2012)

Set Up Exceptions for the Primary Payer

Claim Print Options When the Payer is Secondary

Claim Print Options When the Payer is Tertiary