Significant Events for Consolidated Claims

Help Guide for NextGen® Enterprise PM 8

Significant Events for Consolidated Claims

When a consolidated claim is created the following significant events occur: CSC claim created for <type of claim> Electronic Type of Timespan:Daily CSC claim created for <type of claim> Electronic Type of Timespan:Weekly CSC claim created for <type of claim> Electronic Type of Timespan:Monthly CSC claim created for <type of claim> Electronic Type of Timespan:Case 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

Consolidate Claims by Time Span

The CSC process is initiated on the Claims Request Lookup window. You can search for claims on a time-span of daily, weekly, monthly, or case. This process provides a clear visual of all of the HOLD claims that can be processed when the CSC process is initiated. You can sort the encounters by clicking on the TS (time-span) column. From the menu, click Tasks > Lookup > Claims or click the Claims icon. The Claim Request Lookup window opens. In the Request Status field, select Hold H. The Consolidated Services Claim Time Span field becomes active. In the Consolidated Services Claim Time Span field select one of the following options: <none> - to display all Hold claims. Consolidate Same Day Claims - to display all encounters that occurred on the same date. Consolidate Weekly Claims - to display all encounters during the same week. The week as defined in the CSC library, either Sunday through Saturday or Monday through Sunday. Consolidate Monthly Claims - to display all encounters for the

Help Guide for NextGen® Enterprise PM 8

Consolidated Services Claim Library

The Consolidated Services Claim (CSC) library enables you to establish rules for consolidating multiple encounter charges into a single consolidated services claim (CSC). The purpose of this library is to configure billing and claim form type rules for payers. This section includes the following topics: Security rights for user groups Consolidated Services Claim library CSC configuration rules for the consolidation of daily, weekly, monthly, and case related claims Provider hierarchy for claim headers Bill for eligible patient days You can generate the Consolidated Services Claim Library Listing report and the CSC Library with Timespan Details report from the Consolidated Services Claim library. For more information go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Set Up Security Access Rights for Consolidated Services Claims The Consolidated Services Claims security rights must be assigned to a user's group for combining

Help Guide for NextGen® Enterprise PM 8

Consolidated Service Claims

This section explains the process of creating a Consolidated Services Claim (CSC). This process enables you to consolidate claims when a patient has more than two encounters and the same payers are attached for billing. Claims can be consolidated by a single date, week, calendar month, or case. This section covers the following topics: CSC Terms Rules for Claims Consolidation Automatic Identification of CSC Candidate Encounters Consolidate Claims by Time Span Create HOLD Claims for CSC Candidate Encounters Set Up CSC Options for an Encounter Create a Consolidated Services Claim Rebill a Consolidated Services Claim Significant Events for Consolidated Claims Create a CSC Event Audit Trail Claim Production Status report for CSC Candidate Encounters Create Tasks from the Consolidated Services Claim report EDI Format of CSC Claims CSC Terms Rules for Claims Consolidation in a Hold Status Rules for CSC Claims - Condition, Value and Occurrence Codes Admission Date and Time Rules for Consolida

Help Guide for NextGen® Enterprise PM 8

Consolidate Claims by Time Span

The CSC process is initiated on the Claims Request Lookup window. You can search for claims on a time-span of daily, weekly, monthly, or case. This process provides a clear visual of all of the HOLD claims that can be processed when the CSC process is initiated. You can sort the encounters by selecting on the TS (time-span) column. From the menu, select Tasks > Lookup > Claims or select the Claims icon. The Claim Request Lookup window opens. Claim Request Lookup In the Request Status field, select Hold H. The Consolidated Services Claim Time Span field becomes active. In the Consolidated Services Claim Time Span field select one of the following options: <none> - to display all Hold claims. Consolidate Same Day Claims - to display all encounters that occurred on the same date. Consolidate Weekly Claims - to display all encounters during the same week. The week as defined in the CSC library, either Sunday through Saturday or Monday through Sunday. Consolidate Monthly Claims - to display

Significant Events for Consolidated Claims

Recommendations

Significant Events for Consolidated Claims

CSC Terms

Consolidate Claims by Time Span

Consolidated Services Claim Library

Consolidated Service Claims

Consolidate Claims by Time Span

Significant Events for Consolidated Claims

Significant Events for Consolidated Claims

CSC Terms

Consolidate Claims by Time Span

Consolidated Services Claim Library

Consolidated Service Claims

Consolidate Claims by Time Span