Guidelines for Running the CSC Process

Help Guide for NextGen® Enterprise PM 8

Automatic Identification of CSC Candidate Encounters

CSC candidate encounters are identified during the billing process and meet the following criteria: All services for a patient in a calendar. All services provided to a patient in a specific time-period that are submitted on a single claim. The time period is defined by the practice and can be daily, weekly, monthly, or on a case basis. The encounters meet the rules applied in the Consolidated Service Claim library for combining form types and encounter rate options. Note: Hold Claim Status: The Hold status is applied to all claims that meet the criteria for CSC candidate encounters. Non-coordinated or Non-covered Service SIMs: Encounters with SIMs for non-coordinated or non-covered services DO NOT qualify as CSC Candidate encounters. Guidelines for Running the CSC Process Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Guidelines for Running the CSC Process

Before you run the CSC process, it is recommended that you allow time for data entry of all encounter charges by using the following guidelines: Create all encounters and enter all charges that may need to be included on the same CSC claim. Calculate the number of days needed to allow for data entry of all CSC candidate encounters. Enter this number on the Modify Payer Information window, Other sub-tab in the Delay Billing Days from Enc Date field. The path for this sub-tab is File Maintenance > Master Files > Payers > Modify Payer Information > Practice > Other tab. Parent topic: Automatic Identification of CSC Candidate Encounters

Help Guide for NextGen® Enterprise PM 8

Create HOLD Claims for CSC Candidate Encounters

During the normal billing process, CSC Candidate Encounters are identified. These encounters must meet the following rules: Multiple encounters for the same patient, on the same day, week, month, or case. Each practice can setup the time-frame for encounter consolidation in the Consolidated Services Claim library. Encounters are attached to the same payer. Meet all claim rules defined in the Consolidated Services Claim library. Hold Status Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Create HOLD Claims for CSC Candidate Encounters

During the normal billing process, CSC Candidate Encounters are identified. These encounters must meet the following rules: Multiple encounters for the same patient, on the same day, week, month, or case. Each practice can setup the time-frame for encounter consolidation in the Consolidated Services Claim library. Encounters are attached to the same payer. Meet all claim rules defined in the Consolidated Services Claim library. Hold Status Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Automatic Identification of CSC Candidate Encounters

CSC candidate encounters are identified during the billing process and meet the following criteria: All services for a patient in a calendar. All services provided to a patient in a specific time-period that are submitted on a single claim. The time period is defined by the practice and can be daily, weekly, monthly, or on a case basis. The encounters meet the rules applied in the Consolidated Service Claim library for combining form types and encounter rate options. Note: Hold Claim Status: The Hold status is applied to all claims that meet the criteria for CSC candidate encounters. Non-coordinated or Non-covered Service SIMs: Encounters with SIMs for non-coordinated or non-covered services DO NOT qualify as CSC Candidate encounters. Guidelines for Running the CSC Process Parent topic: Consolidated Service Claims

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

Guidelines for Running the CSC Process

Recommendations

Automatic Identification of CSC Candidate Encounters

Guidelines for Running the CSC Process

Create HOLD Claims for CSC Candidate Encounters

Create HOLD Claims for CSC Candidate Encounters

Automatic Identification of CSC Candidate Encounters

Consolidated Service Claims

Automatic Identification of CSC Candidate Encounters

Guidelines for Running the CSC Process

Create HOLD Claims for CSC Candidate Encounters

Create HOLD Claims for CSC Candidate Encounters

Automatic Identification of CSC Candidate Encounters

Consolidated Service Claims