Claims Attachments Sub-Tab

Help Guide for NextGen® Enterprise PM 8

Claims Attachments Sub-Tab

The Attachments sub-tab on the Claims tab includes information about electronic attachments, or reports, that are sent in addition to the electronic claim for the encounter. The Attachmentssub-tab on the Claims tab includes the following fields: Attachment Report Type: Select the type of claim attachment associated with the encounter. The selected option populates PWK01. The available options are: 77 - Support for Verification Referral AS - Admission Summary B2 - Prescription B3 - Physician Order B4 - Referral Order CT - Certification DA - Dental Modules DG - Diagnosis Report DS - Discharge Summary EB - Explanation of Benefits MT - Modules NN - Nursing Notes OB - Operation Note OZ - Support Data for Claim P6 - Periodontal Charts PN - Physical Therapy Notes PO - Prosthetics or Orthotic Certification PZ - Physical Therapy Certification RB - Radiology Films RR - Radiology Reports RT - Report of Tests and Analysis Report Transmission Code: Select how the attachment will be sent. The select

Help Guide for NextGen® Enterprise PM 8

Fields in the Claims Tab of Encounter Maintenance

The Claims tab includes three sub-tabs: General Attachments Consolidated Services Claim The Claims > General tab includes the following fields: Field Description Special Program Select the Special Program to which the encounter is related, if applicable. The selected program will include a corresponding indicator in the 2300 loop / CLM012 segment on an electronic claim for the encounter. Available options include: Disability EPSDT or CHAP Ind Abortion - Danger to Life Ind Abortion - Rape or Incest Phys Handicapped Child Program Second Opinion or Surgery Special Federal Funding Serv Auth Except Code Select the Service Authorization Exception Code as a reason an authorization was not obtained for the encounter, if applicable. The selected code will include a corresponding indicator on an electronic claim for the encounter. Available options include: 1 – Immed/Urgent Care 2 – Svc Rend Retroactive 3 – Emergency Care 4 – Client Temp Medicaid 5 – Rq 2nd Opin Recip 6 – Rq Override Pending 7 –

Help Guide for NextGen® Enterprise PM 8

Fields in the Claims Tab of Encounter Maintenance

The General sub-tab under Claims tab includes information about the patient’s encounter that may be needed on an electronic or paper claim for the encounter. The Claims tab includes three sub-tabs: General Attachments Consolidated Services Claim The Claims > General tab includes the following fields: Field Description Special Program Select the Special Program to which the encounter is related, if applicable. The selected program will include a corresponding indicator in the 2300 loop / CLM012 segment on an electronic claim for the encounter. Available options include: Disability EPSDT or CHAP Ind Abortion - Danger to Life Ind Abortion - Rape or Incest Phys Handicapped Child Program Second Opinion or Surgery Special Federal Funding Serv Auth Except Code Select the Service Authorization Exception Code as a reason an authorization was not obtained for the encounter, if applicable. The selected code will include a corresponding indicator on an electronic claim for the encounter. Available

Help Guide for NextGen® Enterprise PM 8

Claims Tab on the Practice Tab of Payer Information

Field Description Submitter Profile Select the submitter profile that you want to apply to 1500 or form template claims. Electronic Transmitter ID Enter the payer-assigned electronic transmitter ID to generate a claim with an electronic transmitter ID. Note: This field only displays when you select a submitter profile. Practice Payer Opt Val Enter the practice/payer-specific value. Payer Alias Enter an alternative payer name when a name that differs from the name that appears in the Payers master file is required. Primary, Secondary, and Tertiary Media Types Enter the primary media type accepted by the clearing house as being electronic or paper. If you set it as electronic, then you can also set how the secondary and tertiary claims should be submitted. When Primary, force Secondary claims to paper Enable this check box if you want the claim being sent to the secondary insurance to be generated on paper after payment from the primary insurance has been received. This action overrides

File Maintenance Help for NextGen® Enterprise

Claims Tab on the Practice Tab of Payer Information

Field Description Submitter Profile Select the submitter profile that you want to apply to 1500 or form template claims. Electronic Transmitter ID Enter the payer-assigned electronic transmitter ID to generate a claim with an electronic transmitter ID. Note: This field only displays when you select a submitter profile. Practice Payer Opt Val Enter the practice/payer-specific value. Payer Alias Enter an alternative payer name when a name that differs from the name that appears in the Payers master file is required. Primary, Secondary, and Tertiary Media Types Enter the primary media type accepted by the clearing house as being electronic or paper. If you set it as electronic, then you can also set how the secondary and tertiary claims should be submitted. When Primary, force Secondary claims to paper Enable this check box if you want the claim being sent to the secondary insurance to be generated on paper after payment from the primary insurance has been received. This action overrides

Help Guide for NextGen® Enterprise PM 8

General Information about Patient Encounter

The General tab on the Encounter Maintenance window includes high-level information about the patient's encounter, which is used for general reporting purposes and, specifically, for billing and claim purposes. Field Name Description Patient Type Displays the types of patients available in the master list on the Master Lists window in File Maintenance. Condition Related to Employment Indicates that the encounter of the patient is related to the patient's employment. This option populates box 10a on the CMS 1500 paper claim form. Remarks Displays additional information related to the patient encounter. Same/Similar Date Displays the date when the patient first experienced the same or similar symptoms. This option populates box 15 on the CMS 1500 paper claim forms. Complaints Displays the text complaints for the patient encounter, up to 40 alpha-numeric characters. Date Last Seen Displays the date of encounter on which the patient was last seen for the same or similar symptoms or conditi

Claims Attachments Sub-Tab

Recommendations

Claims Attachments Sub-Tab

Fields in the Claims Tab of Encounter Maintenance

Fields in the Claims Tab of Encounter Maintenance

Claims Tab on the Practice Tab of Payer Information

Claims Tab on the Practice Tab of Payer Information

General Information about Patient Encounter

Claims Attachments Sub-Tab

Fields in the Claims Tab of Encounter Maintenance

Fields in the Claims Tab of Encounter Maintenance

Claims Tab on the Practice Tab of Payer Information

Claims Tab on the Practice Tab of Payer Information

General Information about Patient Encounter