NextGen Knowledge Center

Set Up Dental EDI Claim Profile Rules

You can determine how the details appear in referring provider full middle name, the rendering provider loop, and the service facility location loop for 837D Electronic Data Interchange (EDI) claim files of specific payers.

  1. In File Maintenance, select Libraries > EDI Claim Profile.
  2. In EDI Claim Profile List, do one of the following:
    • To add a library, select Open Menu , and then select New.
    • To modify a library, select the corresponding row from the list, select Open Menu , and then select Open.
    The EDI Claim Profile Maintenance window opens.
  3. In EDI Claim Profile Name, enter a descriptive name for the library.
  4. In Payer Rules for EDI, do one of the following:
    • To add payer rules, select Open Menu , and then select New.
    • To modify payer rules, select the corresponding row from the list, select Open Menu , and then select Open.
    The EDI Claim Profile Maintenance window opens.
  5. Select Dental.
  6. To generate the full middle name instead of the middle initial of the referring provider in the EDI claim file, select the corresponding row in Setting for Send 2310A Referring Provider Full Middle Name.
  7. In Send 2420A Rendering Provider Loop, select Setting, and then do one of the following:
    • To generate the 2420D loop with same claim and line-level rendering providers, select Always.
    • To generate the 2420D loop with different claim and line-level rendering providers, select Only if claim and line level renderings are different.
  8. In Send 2420D Service Facility Location Loop, select Setting, and then do one of the following:
    • To generate the 2420C loop with same claim and line-level rendering providers, select Always.
    • To generate the 2420C loop with different claim and line-level rendering providers, select Only if claim and line level renderings are different.
  9. Select OK.
Set Up Dental EDI Claim Profile Rules