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For additional details about the settings on this tab, see the latest Claims Guide for NextGen® Enterprise PM.
The options in the Claims-2 section work for all electronic claims regardless of COB.
| Field | Description |
|---|---|
| Enable NDC coding for electronic claims | If you select this check box and the NDC information has been added to a SIM, then the 2410 LIN and CTP segments are created in the electronic claim file. |
| Populate 2410 CTP segment | Select this option to populate the 2410 CTP segment. |
| Populate 2400 PS1 purchase service segment | Select this check box to populate the Purchase Service Amount in the 2400 loop/PS1 segment for electronic claims. |
| Populate foreign country code in subscriber loop | Select this check box to populate Patient and Subscriber loops with a two-character country code in electronic claims. Currently, this setting only supports Canada and Mexico as valid foreign countries. |
| Populate PCP in 2310A loop (professional only) | Select this check box to create the 2310A PCP iteration of the 837P electronic file and populate it with the referring provider's information. |
| Populate PRV in 2000A with group taxonomy for group claims | Select this check box and, if there is a taxonomy code in the Group master file, the group taxonomy code is used in the 2000A PRV segment in the 837P and in the 837I. For example, select this check box, if the taxonomy code is required but your practice bills as a group and each group has a taxonomy code. This check box enables you to use the group taxonomy code in the 2000A PRV segment. |
| Populate 2300 CN1 if group billing | Select this option for group billed claims to create a CN1 segment when the 837 professional claim file is generated for the payer.
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| Populate CLIA number on claims | Select this option to populate the CLIA number in the electronic file for this payer even if the payer is not a Medicare or Medicaid claim type. |
| Enable Health Safety Net EDI | Select this option to enable Health Safety Net Office. Along with this option, the Payer Alias Name field on the Payer Defaults -1 tab must have an entry of HSNO. |
| Enable Chart MRN for 2300 REF*EA | Select this option to display the medical record number from the chart in the 2300 loop REF*EA. If this option is not selected, a random medical record number is used instead. This option applies to 837 Professional and Institutional claims. It does not apply to dental claims. |
| Populate subscriber secondary ID with SSN | Activate this option to generate a REF segment in the 2310BA loop, with ‘SY’ (Social Security number) as the qualifier. If this option is enabled, an example REF segment would be: REF*SY*<999999999>. This option overrides the Populate Secondary Identification with Subscriber SSN (REF) option in the Subscriber Information [2010BA Loop Segments] section of the Exception Options tab in the Submitter Profiles library. |
| Send patient as subscriber | Select this option to send the patient information as the subscriber. For example, the dependent would be sent in the 2010BA with the dependent ID. |
| Send diagnosis codes on dental claims | Select this option to send diagnosis codes on electronic dental claims using the 5010 format. |
| Populate 2420B Purchased Service Provider (5010 only) | Select this check box to populate the Purchased Service Provider in the 2420B loop for the purchased service items for the 5010 format. The Purchased Server Provider NPI now populates in the PS102 loop. |
| Default admit date to encounter date (5010 only) | Select this option to populate the admit date on the institutional 5010 file with the encounter date even if it is not populated on the encounter. |
| Populate Reason for Visit Diagnosis (5010 only) | Select this option to populate the reason for visit code at the payer level. |
| Populate Pregnancy Indicator on 837P (5010 only) | Select this option to populate the pregnancy indicator with " Y " on the 5010 837P professional claim. To enable this option in File Maintenance you must also select the Pregnancy Indicator check box on the Other tab of the Diagnosis Code Library window. |
| Populate the Property and Casualty Claim Number in 2010BA/2010CA | Select this option to populate the property and casualty claim numbers for all of the 5010 file types including 837P, 837I, and 837D when the subscriber/insured and patient are different.
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| Enable NPI on electronic claims | Select how you want to handle enabling the NPI from the following options:
The payer master file setting on the Electronic Claims tab under the System overrides the submitter profile setting for enabling the NPI. |
| Suppress Rendering/ Attending Loop | Select the option to determine whether the Attending (2310A) and Rendering (2310B) loops should be suppressed. |
| Suppress Facility Loop | To suppress the Facility loop for a place of service (POS), select one of the following place of service (POS) or combination of POS options:
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| Allow the following # of diagnoses on claims | This setting enables you to specify how many diagnosis codes can be sent electronically. You can select: <none>, 4 diagnosis codes, 8 diagnosis codes, or 12 diagnosis codes (5010 only). The 12 diagnosis codes option does not apply to dental claims. The first four diagnosis codes are associated with the CPT4 code. Codes 5-8 are applied at the encounter level and are not attached to a charge. Codes 9-12 are for 5010 only. The diagnosis codes display on the Charge Posting window in <PM> and can be sent on the 837 electronic claim. This setting:
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| Allow <> dx codes on 837i claims (5010 only) | Select this option to send an 837I claim with 1 to 25 diagnosis codes on a 5010 claim with the first diagnosis as the Principal Diagnosis (HI*BK for ICD) and the remaining 24 diagnoses as the Other Diagnosis Information (HI*BF for ICD). When you select this option, the box to the left of dx codes is enabled so that you can enter the number (from 1 to 25) of diagnoses for the claim. |
| Alternate Claim send methods for Auth/Referrals | To attach and send professional claim authorizations or referrals at the claim level (default), the line level, or both the line and claim level, select one of the following electronic transfer options:
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