Claims Processing

Help Guide for NextGen® Enterprise PM 8

Processing Electronic Claims - 837 Files

This section explains how electronic claims (837 files) are processed. The basic steps include: Select the EDI file icon. The 837 Electronic File Creation window opens. Select a Submitter Profile library. Select options applicable to the types of claims that you want to send electronically. Select the Process button. Electronic Claims File Structure Control Segments Application Setup for the 837 File 837 Electronic File Creation Window Electronic Send Report Set Up Automatic Task Completion for Clean Claims Submitting Electronic Claims Archiving and Retrieving 837 Electronic Files Tracking Records of Reprinted Archived Claims Parent topic: Claims Processing

Help Guide for NextGen® Enterprise PM 8

Coordination of Benefits Electronic and Manual Processing

You can view information on all the payers for EDI claims in the Coordination of Benefits Information (COB) window. The Coordination of Benefits Information window provides information on all payers for EDI claims. This includes primary, secondary, and tertiary payers for 837I, 837P, and 837D claims. A summary of all COB activity by charge lines on an encounter for all previous transactions will display on the Coordination of Benefits Information window. When viewing COB1, COB2, COB 3, or All Payer data fields are editable by transaction line. ERA File When the ERA file contains a CAS segment with a charge line that has two identical reason codes, one CAS segment is created for the two identical reason codes in the 837 file. The reason codes are combined and display on a single line in the 837 file. Example: The COB window contains CO45 $50 and CO45 $25 and a PR2 on a single service line, the CAS segment will create CAS*CO*45*75 in the 837 file to represent the CO45 amounts and continu

Help Guide for NextGen® Enterprise PM 8

Claims Processing

Claims can be processed on demand or in batch mode. This section explains: Paper claims Electronic claims - 837 files 997 files 277 files ERA - 835 files COB - manual posting Processing Paper Claims Claim Production Status Report Processing Electronic Claims - 837 Files Process Claim Requests for Multiple Encounters 997/999 File 277 File Coordination of Benefits Electronic and Manual Processing You can view information on all the payers for EDI claims in the Coordination of Benefits Information window. Parent topic: Claims

Help Guide for NextGen® Enterprise PM 8

Processing Electronic Claims - 837 Files

This section explains how electronic claims (837 files) are processed. The basic steps include: Select the EDI file button. The 837 Electronic File Creation window opens. Select a Submitter Profile library. Select options applicable to the types of claims that you want to send electronically. Select the Process button. Electronic Claims File Structure Control Segments Application Setup for the 837 File 837 Electronic File Creation Window Electronic Send Report Set Up Automatic Task Completion for Clean Claims Submitting Electronic Claims Archiving and Retrieving 837 Electronic Files Tracking Records of Reprinted Archived Claims Parent topic: Claims Processing

Help Guide for NextGen® Enterprise PM 8

Create an EDI File by Practice

Select the EDI File toolbar button. The 837 Electronic File Creation window opens. Complete the following required fields: Submitter Profile Library Claim Form Send File Name Batch Type Select the Practices tab. You can search for claims by a single practice, multiple practices, or all practices within your enterprise. To search for claims by single or multiple practices go to Step 5. To search for claims for All Practices in your enterprise go to Step 7. To search for pending claims associated with a single or multiple practices, select the open record icon. The Practices window opens. Select the Flashlight icon to search for practices. Move the applicable practices to the Included section. Select OK. To search for pending claims across all practices, enable the All Practices check box. Enable any of the following check boxes to update claims, create a report, or send a test file. Update claim requests as processed Report results - to display the report after it is processed. Use test

Help Guide for NextGen® Enterprise PM 8

Create an EDI File by Practice

Select the EDI File toolbar button. The 837 Electronic File Creation window opens. Complete the following required fields: Submitter Profile Library Claim Form Send File Name Batch Type Select the Practices tab. You can search for claims by a single practice, multiple practices, or all practices within your enterprise. To search for claims by single or multiple practices go to Step 5. To search for claims for All Practices in your enterprise go to Step 7. To search for pending claims associated with a single or multiple practices, select the open record icon. The Practices window opens. Select the Flashlight icon to search for practices. Move the applicable practices to the Included section. Select OK. To search for pending claims across all practices, enable the All Practices check box. Enable any of the following check boxes to update claims, create a report, or send a test file. Update claim requests as processed Report results - to display the report after it is processed. Use test

Claims Processing

Recommendations

Processing Electronic Claims - 837 Files

Coordination of Benefits Electronic and Manual Processing

Claims Processing

Processing Electronic Claims - 837 Files

Create an EDI File by Practice

Create an EDI File by Practice

Processing Electronic Claims - 837 Files

Coordination of Benefits Electronic and Manual Processing

Claims Processing

Processing Electronic Claims - 837 Files

Create an EDI File by Practice

Create an EDI File by Practice