Setting Up Encounters for UB Claims

Help Guide for NextGen® Enterprise PM 8

UB Claims

This section provides information about the process of setting up UB claims for a regular UB user and an enhanced UB user. The rules for setting up and billing UB claims are different for the two types of users. Therefore, as a user, you should fit into one of the following two categories, if your practice processes UB claims: A Regular UB user is a practice that does some, but not exclusive UB claims billing. For example, if your practice primarily does 1500 claims processing and a small percentage of UB claims, then you would be considered a Regular UB user. An Enhanced UB user is a doctor or multiple doctors at a specific practice location that exclusively does UB claims billing. For example, a clinical rehabilitation practice with specific doctors at separate locations for Physical Therapy, Occupational Therapy, and Speech Therapy that exclusively process UB claims at one location would be considered an Enhanced UB user. UB claims must be set up by entering configuration informatio

Help Guide for NextGen® Enterprise PM 8

Setting Up UB Claims for Enhanced UB Users

Setting up UB claims for Enhanced UB users is different from the set up for Regular UB users, especially if you want to use the automated claims process. For Enhanced UB users, the automated UB claims process only applies to payers who are considered the primary payer. The automated UB claims process is not for payers who are considered secondary or tertiary. The automating of the Type of Bill field, the Occurrence codes, and the Value codes only occurs for primary payers who have the required criteria. Set Up Payers for Enhanced UB Users Set Up Encounters for Enhanced UB Claims (Before Billing) Set Up Encounters for Enhanced UB Claims (After Billing) Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

Setting Up Encounters for UB Claims

The following list outlines the areas of the Encounter Maintenance window that are important to the setup of UB claims: On the General tab, complete the Service Location field. On the UB tab, access the following sub-tabs: Condition Codes, Occurrence Codes, and Value Codes. Encounter Maintenance Note: For Enhanced UB users, the automated UB claims process only applies to payers who are considered primary. The automating of the Type of Bill field, the Occurrence codes, and the Value codes, which are explained in the following sections, only occurs for primary payers who have the required criteria. UB/General Tab UB/Condition Codes Tab UB/Occurrence Codes Tab UB/Value Codes Tab Setting Up Practice Preferences for UB Claims Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

Encounter Maintenance - UB Tab

The UB tab includes information about the patient’s encounter that may be needed on electronic 837I or paper UB claims for the encounter. Note: This tab displays only if the default Type of Facility and Bill Classification options have been enabled in the Claims preferences under Practice Preferences. The UB tab has the following sub-tabs: General Condition Codes Occurrence Codes Value Codes UB General Sub-Tab UB Condition Codes Sub-Tab UB Occurrence Codes Sub-Tab Occurrence Codes define specific events relating to a bill that may affect payer processing. You can select one Occurrence Code and Date for field locators 31a - 34b, or up to eight (8) codes and dates per encounter. UB Value Codes Sub-Tab Value codes indicate the code and related dollar amounts that identify monetary data required for processing claims. You can modify the code and the dollar amount when specific codes and amounts are needed on the UB claim for the encounter. Parent topic: Encounter Maintenance

Help Guide for NextGen® Enterprise PM 8

Encounter Maintenance - UB Tab

The UB tab includes information about the patient’s encounter that may be needed on electronic 837I or paper UB claims for the encounter. Note: This tab displays only if the default Type of Facility and Bill Classification options have been enabled in the Claims preferences under Practice Preferences. The UB tab has the following sub-tabs: General Condition Codes Occurrence Codes Value Codes UB General Sub-Tab UB Condition Codes Sub-Tab UB Occurrence Codes Sub-Tab Occurrence Codes define specific events relating to a bill that may affect payer processing. You can select one Occurrence Code and Date for field locators 31a - 34b, or up to eight (8) codes and dates per encounter. UB Value Codes Sub-Tab Value codes indicate the code and related dollar amounts that identify monetary data required for processing claims. You can modify the code and the dollar amount when specific codes and amounts are needed on the UB claim for the encounter. Parent topic: Encounter Maintenance

Help Guide for NextGen® Enterprise PM 8

Set Up an Encounter for Regular UB Users

Access the Encounter Maintenance window for the patient and encounter the UB claim is being created for if you want occurrence and value codes to display on the UB claim. In NextGen® Enterprise PM, select Chart on the main toolbar. The Patient Lookup window appears. Enter the search criteria and then select Find. To open the chart, right-click the chart and then select Open. On the Encounters tab, right-click the encounter and then select open menu icon . The Encounter Maintenance window appears. Select the UB tab, then the Occurrence Codes sub-tab. Enter the occurrence codes and dates in the field locator fields, if applicable. To enter the value codes and associated dollar value or unit value, select the Value Codes tab and enter the data in the Field Locator fields. Select OK. To enter the charges for the patient and the encounter, open the Charge Posting window. Bill the encounter and create the UB claim. Parent topic: Set Up UB Claims for Regular UB Users

Setting Up Encounters for UB Claims

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