Claim status enables you to know the status of a claim and where it is placed in the adjudication process. Claim status inquiries can be submitted in batch mode or real-time for electronic claims with a status of archived. You can schedule claim status checks to run automatically in batch mode at set intervals throughNextGen® Background Business Processor. The results of the inquiry show you the status of the claim and the reason for rejection, if any.
The Claim Status Profile library in File Maintenance supports services rendered by professional, dental, or institutional service providers. The institutional claim status request file (276) sends the rendering provider or billing provider in 2100C loop to the real-time server (RTS).
Before you submit claim status inquiries, you need to open File Maintenance,
Claim Status Profilelibrary and specify the type of provider in the
Provider Name (2100C Loop NM1 Segments)section. The following types of service providers are available.
- Billing: The 276 file sends the billing service provider identifier from the claim to the RTS.
- Rendering for 837P/D or Attending for 837I (R): The 276 file sends the attending service provider identifier from the claim to the RTS.
- Rendering for 837P/D or Attending for 837I if populated else Billing (N): The 276 file sends the attending service provider identifier, if it exists. Otherwise, the billing service provider identifier is sent from the claim to the RTS.
The payers and clearing houses send theNextGen® Eligibility Verificationelectronic claim status response files (X12 277) in response to the Claims Status Request transactions (X12 266) submitted by the practice. The data on the claim status report is populated from the claim status X12 277 file.
The Claim Status report gives you an overview of the count of accepted and rejected claims, billed amount, and paid amount for accepted and rejected claims. You can run the report with the complete details. You can click and expand a record to view the details.
Note: The Claim Status report is enabled with enhanced reporting functionality.
In
NextGen® Enterprise PM, you can open and view the report from the following:
- Reportsmenu
- Encounter Lookupwindow
- Encounterstab in the Patient Chart
- Encounter Claim Requestswindow
- Clinical History/Notestab in the Patient Chart
