Control Segments

Help Guide for NextGen® Enterprise PM 8

Electronic Claims File Structure

s Compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the ANSI ASC X12N 837 Health Care Claims (837) transaction for professional claims and/or encounters to contain specific standardized information. The standardization of health care information allows health care providers to submit 837 electronic files within the NextGen In-line Edits environment. There are three types of 837 electronic files: Professional (1500 claim forms) Institutional (UB claim forms) Dental ADA Each type has the same basic electronic file structure. The 837 electronic file is structured to deliver control segments of information, which include: Interchange Control Segments Functional Group Control Segments Transaction Control Segments Loop Control Segments Interchange Acknowledgment Control Segments Each control segment usually has a beginning header label and an ending trailer label. The table below outlines each of the control segments and their identifying labels

Help Guide for NextGen® Enterprise PM 8

Control Segments

Each of the control segments contain groups of logically related information that are referred to as segments. These segments are made up of multiple elements. Within an element there can be multiple components. The following diagram explains how segments, elements, and components make up the control segments, which make up the electronic claim file. Parent topic: Processing Electronic Claims - 837 Files

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

NextGen® Enterprise EHR Help

Shared Elements

Each category of the Communication component shares three shared elements in the action panel. The elements are: Call Information Contact Information Call Status Call Information Contact Information Call Status Parent topic: Use the Communication Component

Help Guide for NextGen® Enterprise PM 8

Electronic Claims File Structure

Compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the ANSI ASC X12N 837 Health Care Claims (837) transaction for professional claims and/or encounters to contain specific standardized information. The standardization of health care information allows health care providers to submit 837 electronic files within the NextGen In-line Edits environment. There are three types of 837 electronic files: Professional (1500 claim forms) Institutional (UB claim forms) Dental ADA Each type has the same basic electronic file structure. The 837 electronic file is structured to deliver control segments of information, which include: Interchange Control Segments Functional Group Control Segments Transaction Control Segments Loop Control Segments Interchange Acknowledgment Control Segments Each control segment usually has a beginning header label and an ending trailer label. The table below outlines each of the control segments and their identifying labels.

Help Guide for NextGen® Enterprise PM 8

837 File Structure

This section provides a detailed description of the 837 file structure. 837 File Structure Parent topic: Claims

Control Segments

Recommendations

Electronic Claims File Structure

Control Segments

Processing Electronic Claims - 837 Files

Shared Elements

Electronic Claims File Structure

837 File Structure

Control Segments

Electronic Claims File Structure

Control Segments

Processing Electronic Claims - 837 Files

Shared Elements

Electronic Claims File Structure

837 File Structure