Mark a CSC Encounter as Exempt

Help Guide for NextGen® Enterprise PM 8

Exempting CSC Encounters

CSC options can be set manually on the Consolidated Services Claim tab under the Claims tab on the Encounter Maintenance window. The options set on this tab override the rules in the Consolidated Services Claims library. On the Consolidated Services Claim sub-tab, you can you can do the following: Identify the responsible attending physician to display in the claim header for primary, secondary, and tertiary payers. Identify specific encounters to be exempt from a consolidated services claim. If there is an eligibility overlap during billing, the application displays the following error in the Claim Production Status report: CSC Eligibility Dates overlap with HOLD claims for encounter(s). Correct Eligibility. Parent topic: Claims Consolidated Services Claim Sub-Tab Parent topic: Consolidated Service Claims

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

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

Mark a CSC Encounter as Exempt

CSC candidate encounters can be marked exempt either manually or automatically by the system. Automatic exemption of a claim occurs when the claim is suppressed as a result of File Maintenance settings. Exempt encounter charges are not included in a consolidated claim. Access the Consolidated Services Claim tab under the Claims tab on the Encounter Maintenance window. To identify the responsible attending provider for claim header, complete the Primary Responsible Attending, Secondary Responsible Attending, and Tertiary Responsible Attending fields. Select one of the following options for each applicable insurer: None - (default prior to billing) Responsible Attending Ancillary Provider To remove encounter charges from a primary, secondary, or tertiary CSC claim, select the applicable check box: Exempt from Primary Consolidated Services Claim An alert displays if a Primary HOLD claim is attached to the encounter: A HOLD claim exists for this encounter. Would you like to convert the HOL

Help Guide for NextGen® Enterprise PM 8

Significant Events Administration

The following table shows the significant events that you should select while creating a audit trail for CSC events. Encounter Level Significant Events Message is issued when: Message displays on the Clinical History Chart Notes window > Encounter CSC Claim Created A CSC claim is created CSC Claim Created – Encounter Nbr (list all encounter numbers) CSC Encounter Exempt Status Changed During Billing During billing when one of the following check boxes is selected or cleared on the Consolidated Services Claim sub tab: Exempt from Primary Consolidated Services Claim Exempt from Secondary Consolidated Services Claim Exempt from Tertiary Consolidated Services Claim When one of the check boxes is selected the encounter will not be included in the consolidated claim. ( Consolidated Services Claim sub tab on the Claims tab of the Encounter Maintenance window) CSC Primary Exempt Indicator Automatically Changed during Billing – Encounter XXX CSC Secondary Exempt Indicator Automatically Changed

Help Guide for NextGen® Enterprise PM 8

Significant Events Administration

The following table shows the significant events that you should select while creating a audit trail for CSC events. Encounter Level Significant Events Message is issued when: Message displays on the Clinical History Chart Notes window > Encounter CSC Claim Created A CSC claim is created CSC Claim Created – Encounter Nbr (list all encounter numbers) CSC Encounter Exempt Status Changed During Billing During billing when one of the following check boxes is selected or cleared on the Consolidated Services Claim sub tab: Exempt from Primary Consolidated Services Claim Exempt from Secondary Consolidated Services Claim Exempt from Tertiary Consolidated Services Claim When one of the check boxes is selected the encounter will not be included in the consolidated claim. ( Consolidated Services Claim sub tab on the Claims tab of the Encounter Maintenance window) CSC Primary Exempt Indicator Automatically Changed during Billing – Encounter XXX CSC Secondary Exempt Indicator Automatically Changed

Mark a CSC Encounter as Exempt

Recommendations

Exempting CSC Encounters

CSC Terms

Automatic Identification of CSC Candidate Encounters

Mark a CSC Encounter as Exempt

Significant Events Administration

Significant Events Administration

Exempting CSC Encounters

CSC Terms

Automatic Identification of CSC Candidate Encounters

Mark a CSC Encounter as Exempt

Significant Events Administration

Significant Events Administration