Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Discharge Date and Time Rules for Consolidated Institutional Fields in CSC Claims

When you consolidate two or more claims, one claim is considered as the king claim. The other claims are referred to as candidate claims. When you consolidate the claim, the following rules are applied. If the values are different in King claim and in Candidate claims, a conflicting error message appears in the CSC report. If the values are the same in the King claim and in Candidate claims, the same value appears in the CSC report. If the value is missing in the King claim, the value is taken from the Candidate claims. An error message appears when there is a conflicting data, and an alert message appears when there is a missing data. The following table describes the messages. Encounter Message Message Type Help Text Occurs When Enc1, Enc2, Enc3, Enc4 System unable to consolidate due to conflicting Discharge Date on encounters <Enc1> and <Enc3>. Error Correct conflicting data on all encounters and rebill. The user has entered different discharge date in <Enc1> and <Enc3>. The Dischar

Help Guide for NextGen® Enterprise PM 8

Consolidated Service Claims

This section explains the process of creating a Consolidated Services Claim (CSC). This process enables you to consolidate claims when a patient has more than two encounters and the same payers are attached for billing. Claims can be consolidated by a single date, week, calendar month, or case. This section covers the following topics: CSC Terms Rules for Claims Consolidation Automatic Identification of CSC Candidate Encounters Consolidate Claims by Time Span Create HOLD Claims for CSC Candidate Encounters Set Up CSC Options for an Encounter Create a Consolidated Services Claim Rebill a Consolidated Services Claim Significant Events for Consolidated Claims Create a CSC Event Audit Trail Claim Production Status report for CSC Candidate Encounters Create Tasks from the Consolidated Services Claim report EDI Format of CSC Claims CSC Terms Rules for Claims Consolidation in a Hold Status Rules for CSC Claims - Condition, Value and Occurrence Codes Admission Date and Time Rules for Consolida

Help Guide for NextGen® Enterprise PM 8

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

When you consolidate two or more claims, one claim is considered as the King claim. The other claims are referred to as Candidate claims. When you consolidate the claim, the following rules are applied. If the values are different in King claim and in Candidate claims, a conflicting error message appears in the CSC report. If the values are the same in the King claim and in Candidate claims, the same value appears in the CSC report. If the value is missing in the King claim, the value is taken from the Candidate claims. An error message appears when there is a conflicting data, and an alert message appears when there is missing data. The following table describes the messages displayed. Encounter Message Message Type Help Text Occurs When System unable to consolidate due to conflicting Admit Date on encounters <Enc1> and <Enc3> Enc1, Enc2, Enc3, Enc4 Correct conflicting data on all encounters and rebill. The user has entered different admission dates in <Enc1> and <Enc3>. The Admission

Help Guide for NextGen® Enterprise PM 8

CSC Terms

The following table provides a list of terms associated with the consolidation process of claims. Term Description TS Time Span - claims that occur on the same date, week, month, or case. The time-span is identified in the CSC library. CCCP Case Claim Consolidation Program – The program rules established in the Consolidated Services Claim library to consolidate all claims attached to a Case. CCR Consolidated Claims Rules CSC Consolidated Services Claim CSC Candidate Encounter When a patient has multiple encounters per day. Each encounter can be a CSC candidate encounter. CSC Hold Claims These are the claims created after billing a CSC Candidate Encounter but prior to running the CSC process. Consolidated Claim After the charges from the CSC Hold Claims are consolidated into a CSC, the CSC Hold Claims become Consolidated claims. Claim-Header Encounter The claim header details are derived from this encounter. Primary Attending is selected in the Primary Responsible Attending field from t

Help Guide for NextGen® Enterprise PM 8

Consolidated Services Claim Library

The Consolidated Services Claim (CSC) library enables you to establish rules for consolidating multiple encounter charges into a single consolidated services claim (CSC). The purpose of this library is to configure billing and claim form type rules for payers. This section includes the following topics: Security rights for user groups Consolidated Services Claim library CSC configuration rules for the consolidation of daily, weekly, monthly, and case related claims Provider hierarchy for claim headers Bill for eligible patient days You can generate the Consolidated Services Claim Library Listing report and the CSC Library with Timespan Details report from the Consolidated Services Claim library. For more information go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Set Up Security Access Rights for Consolidated Services Claims The Consolidated Services Claims security rights must be assigned to a user's group for combining

Help Guide for NextGen® Enterprise PM 8

Rules for Claims Consolidation in a Hold Status

The CSC process consolidates CSC candidate claims by using the following rules for claims in a HOLD status. The rules for claims consolidation are setup in the Consolidated Services Claim library. CSC candidate encounters are in a HOLD status. The claims are in a HOLD status and are released for processing. When only one of the patient HOLD claims is selected on the Claim Request Lookup window in the Claim Requests list, all patient HOLD claims are combined into a CSC claim for the specified time-frame. Suppressed or exempt claim charges are not included in the claim due amount. Hold Status Changes to Consolidated or Pending Parent topic: Consolidated Service Claims

Consolidated Service Claims

Recommendations

Discharge Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Consolidated Service Claims

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

CSC Terms

Consolidated Services Claim Library

Rules for Claims Consolidation in a Hold Status

Consolidated Service Claims

Discharge Date and Time Rules for Consolidated Institutional Fields in CSC Claims

Consolidated Service Claims

Admission Date and Time Rules for Consolidated Institutional Fields in CSC Claims

CSC Terms

Consolidated Services Claim Library

Rules for Claims Consolidation in a Hold Status