Set Up Institutional EDI Claim Profile Rules

Help Guide for NextGen® Enterprise PM 8

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. In File Maintenance, select Libraries > EDI Claim Profile. 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. In EDI Claim Profile Name, enter a descriptive name for the library. 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. Select Dental. To generate the full middle name instead of the middle initial of the referring provider in the EDI claim fi

Help Guide for NextGen® Enterprise PM 8

Set Up Professional EDI Claim Profile Rules

On the Professional tab of the EDI Claim Profile Maintenance window, you can determine how the details appear in the rendering provider loop, the service facility location loops, and the referring provider full middle name for the 837P Electronic Data Interchange (EDI) claim files of specific payers. In File Maintenance, select Libraries > EDI Claim Profile. 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. In EDI Claim Profile Name, enter a descriptive name for the library. 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. Select Professional. To generate the location

Help Guide for NextGen® Enterprise PM 8

Add or Modify EDI Claim Profile Library

The EDI Claim Profile library enables you to store and configure Electronic Data Interchange (EDI) claim settings. You can configure EDI claim settings based on payer requirements and control the setup involved when payers require service line level segments to be reported in the 837 claim file. The settings in this library also provide support for the 2400 loops and segments requested by payers when the details are different per charge. After you set up the EDI Claim Profile library, you can do the following: Select a practice specific EDI Claim Profile library on the Libraries tab of the Practice Preferences window. Generate an EDI Claim Profile report to review the library name, dates, default EDI rules, and valid payers. Select the EDI Claim Profile library on the Alt Payer tab of the Add Payer Information or Modify Payer Information window. In File Maintenance, select Libraries > EDI Claim Profile. In EDI Claim Profile List, do one of the following: To add a library, select Open M

File Maintenance Help for NextGen® Enterprise

Set Up Institutional EDI Claim Profile Rules

On the Institutional tab of the EDI Claim Profile Maintenance window, you can determine how the details appear in rendering provider loop and the referring provider full middle name for the 837I Electronic Data Interchange (EDI) claim files of specific payers. In File Maintenance, select Libraries > EDI Claim Profile. 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. In EDI Claim Profile Name, enter a descriptive name for the library. 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. Select Institutional. To generate the full middle name instead of the middle initial o

Help Guide for NextGen® Enterprise PM 8

Set Up Institutional EDI Claim Profile Rules

On the Institutional tab of the EDI Claim Profile Maintenance window, you can determine how the details appear in rendering provider loop and the referring provider full middle name for the 837I Electronic Data Interchange (EDI) claim files of specific payers. In the EDI Claim Profile Maintenance window, select the Institutional tab. 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 the Setting column for the Send 2310F Referring Provider Full Middle Name option. For the Send 2420C Rendering Provider Loop Setting option, do one of the following in the Setting column: 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. Select OK. Parent topic: EDI Claim Profile Library

File Maintenance Help for NextGen® Enterprise 8

Set Up Institutional EDI Claim Profile Rules

On the Institutional tab of the EDI Claim Profile Maintenance window, you can determine how the details appear in rendering provider loop and the referring provider full middle name for the 837I Electronic Data Interchange (EDI) claim files of specific payers. In the EDI Claim Profile Maintenance window, select the Institutional tab. 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 the Setting column for the Send 2310F Referring Provider Full Middle Name option. For the Send 2420C Rendering Provider Loop Setting option, do one of the following in the Setting column: 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. Select OK. Parent topic: EDI Claim Profile Library

Set Up Institutional EDI Claim Profile Rules

Recommendations

Set Up Dental EDI Claim Profile Rules

Set Up Professional EDI Claim Profile Rules

Add or Modify EDI Claim Profile Library

Set Up Institutional EDI Claim Profile Rules

Set Up Institutional EDI Claim Profile Rules

Set Up Institutional EDI Claim Profile Rules

Set Up Dental EDI Claim Profile Rules

Set Up Professional EDI Claim Profile Rules

Add or Modify EDI Claim Profile Library

Set Up Institutional EDI Claim Profile Rules

Set Up Institutional EDI Claim Profile Rules

Set Up Institutional EDI Claim Profile Rules