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Claim Setup Options for Health Centers
Claim Setup Options for Health Centers
Depending on the payer, Health Centers may file claims in any of the following formats:
Professional Claims:
Electronic 837P or Paper 1500
Institutional Claims:
Electronic 837I or Paper UB
Dental Claims:
Electronic 837D or Paper ADA
UB Claims
Help Guide for NextGen® Enterprise PM 8
Claim Setup Options for Health Centers
Depending on the payer, Health Centers may file claims in any of the following formats: Professional Claims: Electronic 837P or Paper 1500 Institutional Claims: Electronic 837I or Paper UB Dental Claims: Electronic 837D or Paper ADA Professional 1500 Claims UB Claims Parent topic: Charge and Billing Options for Health Centers
Help Guide for NextGen® Enterprise PM 8
Dental Billing
This section provides information on dental billing for Health Centers that perform dental services. Specific setup in File Maintenance is required so that dental charges can be entered on encounters and then billed to dental payers on either 1500, ADA or UB claim forms. The type of claim form generated is determined by the setup for each dental payer. The following claim formats are supported in NextGen® Enterprise PM: 1500: Electronic 837PPaper CMS 1500 Form (2012) ADA: Electronic 837D Paper ADA Form (2024) UB: Electronic 837IPaper UB04 Form (2004) Dental billing in NextGen® Enterprise PM involves the following setup in File Maintenance: Practice Preferences Code Tables CPT4 Codes SIM library Claim Edits library Claim Printing library Transaction Codes Payers Set Up Practice Preferences for Dental Billing View Code Tables for Dental Billing Service Items Library for Dental Billing Claim Edits for Dental Billing Claim Printing Library for ADA Claims Payers Master File for Dental Billi
Help Guide for NextGen® Enterprise PM 8
Dental Billing
This section provides information on dental billing for Health Centers that perform dental services. Specific setup in File Maintenance is required so that dental charges can be entered on encounters and then billed to dental payers on either 1500, ADA or UB claim forms. The type of claim form generated is determined by the setup for each dental payer. The following claim formats are supported in NextGen® Enterprise PM: 1500: Electronic 837PPaper CMS 1500 Form (2012) ADA: Electronic 837D Paper ADA Form (2024) UB: Electronic 837IPaper UB04 Form (2004) Dental billing in NextGen® Enterprise PM involves the following setup in File Maintenance: Practice Preferences Code Tables CPT4 Codes SIM library Claim Edits library Claim Printing library Transaction Codes Payers Set Up Practice Preferences for Dental Billing View Code Tables for Dental Billing Service Items Library for Dental Billing Claim Edits for Dental Billing Claim Printing Library for ADA Claims Payers Master File for Dental Billi
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
Help Guide for NextGen® Enterprise PM 8
Payers Master File for Dental Billing
Three areas in the Payers master file must be set up for dental claims. These setup requirements are on the following tabs of the Payers master file: Payer Defaults - 2: Used to set up a payer for dental billing and ADA claims. System: Used to set up provider secondary references. Practice: Used to set up electronic claims. Defaults-2 Tab System Tab Practice Tab Parent topic: Dental Billing
