Set Up a Remittance Profile Library

Help Guide for NextGen® Enterprise PM 8

Set Up the Remittance Profile - Default Tab

To set up the Default tab in a Remittance Profile library, do the following: Open File Maintenance. Select Libraries and then select Remittance Profiles. The Remittance Profiles List window opens. Open the profile library. The Remittance Profile window opens. Select the Default tab. Select settings for default options. For more information, see Default Tab - Options and Settings. When you're done setting options, select OK to save changes and close the window. Default Settings in Remittance Profile You can define the parameters in the Remittance Profile Library Default tab settings that are used for processing the ERA 835 file. Parent topic: Set Up a Remittance Profile Library

Help Guide for NextGen® Enterprise PM 8

Set Up the CSC (Consolidated Service Claim) Parameters in Remittance Profile

Note: The CSC Options tab is available when a Consolidate Services Claim library is attached in Practice Preferences > Libraries. Open File Maintenance. Select Libraries > Remittance Profiles. The Remittance Profiles List window opens. Select and open a profile library. The Remittance Profile window opens. Select the CSC Options tab. Make the desired settings for CSC Options. For more information, see Settings in CSC Options of Remittance Profile. Settings in CSC Options of Remittance Profile Parent topic: Set Up a Remittance Profile Library

Help Guide for NextGen® Enterprise PM 8

Set Up the Remittance Profile - Reversals and Corrections Tab

The Reversals and Corrections tab in the Remittance Profile library is used to set options for handling the following types of ERA transactions: Reversals and Corrections Writing Off Balances resulting from Overpayments or Underpayments To set up the Reversals and Corrections tab in a Remittance Profile library, do the following: Open File Maintenance. Select Libraries, and then select Remittance Profiles. The Remittance Profiles List window opens. Open the profile library. The Remittance Profile window opens. Select the Reversals and Corrections tab. Select settings for reversal and correction options. For more information, see Reversals and Corrections Tab - Options and Settings. When you're done setting options, select OK to save changes and close the window. Settings for Reversals and Corrections in Remittance Profile Parent topic: Set Up a Remittance Profile Library

Help Guide for NextGen® Enterprise PM 8

Setting Up Practice Preferences for ERA

You can configure the following ERA settings in Practice Preferences. Go to Practice Preferences, then Libraries and select Remittance Profile Library to set the default library to be used for all ERA payers that do not have a specific library linked in the practice. Go to Practice Preferences, then Transactions and select Default Reason Code Library to set the default library to be used for all payers (ERA and non-ERA) in the practice, that do not have a specific library linked. Note: NextGen Healthcare recommends the use of the HIPAA X12 Standard Reason Codes library as the default for a practice for all payers. Use settled up status with ERA. You can select this check box to default the Settled moved to Primary transaction status onto ERA payment or adjustment transactions received from the secondary payer before the primary payer. When a secondary transaction is received before primary, a credit balance is normally created in the secondary payer (Ins2 Amt) bucket in Balance Control

Help Guide for NextGen® Enterprise PM 8

Set Up a Remittance Profile Library

The Remittance Profile Library defines various parameters and rules that are used when importing and processing ERA 835 files downloaded from payers into NextGen® Enterprise PM. The Default Remittance Profile library in File Maintenance is pre-installed in the application and includes a few recommended pre-set options. All remaining options are set based on your organizational preferences or in response to the payer’s ERA 835 file configuration. Practice Level vs. Payer Level Libraries A default Remittance Profile Library must be selected in Practice Preferences > Libraries. The default library is used for all ERA payers in the practice that do not have a specific library linked. A different Remittance Profile Library to be used for a specific payer/financial class can be linked on the Payer > Practice > Libraries sub-tab. This library overrides the default library in Practice Preferences for the payer/financial class. Any payers that do not have a Remittance Profile Library attached u

Help Guide for NextGen® Enterprise PM 8

Setting Up ERA

The ERA posting process requires the following set up in File Maintenance: Remittance Profile Library Reason Code Library Payers: Enter an ERA Payer Number Select a Remittance Profile Library for specific ERA payers, if applicable Select a Reason Codes Library for specific payers, if applicable Practice Preferences: Select a default Remittance Profile Library for all ERA payers Select a default Reason Codes Library for all payers Configure Patient Pay Import options, if applicable Set Up a Remittance Profile Library Setting Up Reason Codes for ERA You can use the Reason Codes Library to configure business rules to automate ERA transaction posting. Setting Up Payers for ERA You can define the various parameters in Payers Master File related to ERA. Setting Up Enterprise Preferences for ERA Setting Up Practice Preferences for ERA You can set preferences for all payers in the practice.

Set Up a Remittance Profile Library

Recommendations

Set Up the Remittance Profile - Default Tab

Set Up the CSC (Consolidated Service Claim) Parameters in Remittance Profile

Set Up the Remittance Profile - Reversals and Corrections Tab

Setting Up Practice Preferences for ERA

Set Up a Remittance Profile Library

Setting Up ERA

Set Up a Remittance Profile Library

Set Up the Remittance Profile - Default Tab

Set Up the CSC (Consolidated Service Claim) Parameters in Remittance Profile

Set Up the Remittance Profile - Reversals and Corrections Tab

Setting Up Practice Preferences for ERA

Set Up a Remittance Profile Library

Setting Up ERA