Configure Claim Edits

Help Guide for NextGen® Enterprise PM 8

Set Up the Claim Edits Library

In File Maintenance, select Libraries, and then select Claim Edits. The Claim Edits List window opens. Select Open Menu, and then select New. The Claim Edit Library Maintenance window opens. In Claim Edit Library, enter the name of the library. In Default Severity, select a severity level to be used as the default value for new claim edits. The severity of the new claim edit matches your selection in the Default Severity field. The severity level can be manually changed for the edit. The new field does not apply to edits that are already enabled. Note: Do not use the Quick Start field on the Claim Edit Library Maintenance window to avoid incorrect results. Parent topic: Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Clear Parameter Settings in a Claim Edit

In File Maintenance, select Libraries, and then select Claim Edits. The Claim Edits List window opens. Double-click the claim edit or select the Open Menu, and then select New. The Claim Edit Library Maintenance window opens. Right-click the claim edit, and then select Clear. The claim edit reverts to the default and displays in blue if it remains active. Select OK. The modification to the claim edit is saved. Parent topic: Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Activate Claim Edits

The Claim Edits Library contains a list of the available claim edits you can apply to the claims you generate. In File Maintenance, select Libraries > Claim Edits and select the applicable Claim Edits Library. The Claim Edit Library Maintenance window opens. Select the claim edit you want to activate by selecting in the Active column. A check mark displays to indicate the claim edit is active. To edit the Help Text, select the Help Text field and enter the new description for the Help Text. To change the edit severity level, select in the Severity field, and select one of the following severity levels: Warning Critical Custom Required After you make your selections, select OK. Parent topic: Claim Edits Library

Help Guide for NextGen® Enterprise PM 8

Claim Edit Help Text

In File Maintenance, select Libraries, and then select Claim Edits. The Claim Edits List window opens. Select Open Menu, and then select New. The Claim Edit Library Maintenance window opens. Double-click Help Text. Modify the text that you want to display in relation to the claim edit. Select OK. To change the help text back to the default setting, open the Claim Edit Library Maintenance window, right-click the help text, and then select Reset Help Text. Select OK. Parent topic: Claim Edits Library

File Maintenance Help for NextGen® Enterprise

Configure Claim Edits

Some claim edits display in blue when they are active and require additional parameters to set up the description. If the parameters are not set up, then the claim edit displays in red and the library cannot be saved. In addition, several claim edits have variable numeric values that can be changed. Typically, these claim edits display in black and do not require changes because the value in the description is valid. If the claim edit line item charge is equal to $0.00, it does not require a change because zero is a valid value. In File Maintenance, select Libraries, and then select Claim Edits. The Claim Edits List window opens. Double-click the claim edit or select the Open Menu, and then select New. The Claim Edit Library Maintenance window opens. Right-click the claim edit description that displays with blue text, and then select Open. Claim Edit Library Maintenance Window The Claim Edit Options window opens. The parameters that display on this window depends on the claim edit desc

File Maintenance Help for NextGen® Enterprise 8

Configure Claim Edits

When active, some claim edits display in blue when they require additional parameters to be set up for the description. If the parameters are not set up, then the claim edit displays in red and the library cannot be saved. In addition, several claim edits have variable numeric values that can be changed. Typically, these claim edits display in black and do not require changes because the value in the description is valid. For example, the claim edit "Line Item Charge is equal to $0.00" does not require a change because zero is a valid value. Right-click the claim edit description that displays with blue text, and then select Open. The Claim Edit Options window opens. The parameters that display on this window vary depending on the claim edit description you opened. Enter the applicable parameters. Select OK. After you have set up the additional parameters, the claim edit displays with black text. To save the library, select OK on the Claim Edit Library Maintenance window. Parent topic:

Configure Claim Edits

Recommendations

Set Up the Claim Edits Library

Clear Parameter Settings in a Claim Edit

Activate Claim Edits

Claim Edit Help Text

Configure Claim Edits

Configure Claim Edits

Set Up the Claim Edits Library

Clear Parameter Settings in a Claim Edit

Activate Claim Edits

Claim Edit Help Text

Configure Claim Edits

Configure Claim Edits