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

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 Practice Preferences for UB Claims

To set up a payer for UB claims, two fields must be set up in Practice Preferences > Claims in the UB Claim > Form section: Type of Facility Bill Classification When the above fields are populated, a UB tab displays in the following areas on the Modify Payer Information window: System > Claims > Provider Secondary References > UB Claims Practice > Claims > UB Claims Practice > Secondary References > UB Claims Practice > UB Parent topic: Setting Up Encounters for UB Claims Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

Set Up Encounters for Enhanced UB Claims (Before Billing)

Access the Create Encounter or Encounter Maintenance window for the patient and encounter the UB claim is being created for. In NextGen® Enterprise PM, select the Chart button on the main toolbar. The Patient Lookup window opens. Enter Search Criteria to locate the desired patient and then select Find. From the Matching Records section, double-click to open the desired patient. The Patient Chart window opens. Select the Encounters tab. Right-click the encounter, and then select Open. The Encounter Maintenance window opens. Encounter Maintenance Enter the date the patient first began experiencing symptoms, in the Onset Date field. Select a service location in the Service Location field. The service location must be the same as the service location that was selected on the UB tab of the Modify Payer Information window. Select OK. Parent topic: Setting Up UB Claims for Enhanced UB Users

Help Guide for NextGen® Enterprise PM 8

Set Up Encounters for Enhanced UB Claims (Before Billing)

Access the Create Encounter or Encounter Maintenance window for the patient and encounter the UB claim is being created for. In NextGen® Enterprise PM, select the Chart button on the main toolbar. The Patient Lookup window opens. Enter Search Criteria to locate the desired patient and then select Find. From the Matching Records section, double-click to open the desired patient. The Patient Chart window opens. Select the Encounters tab. Right-click the encounter, and then select Open. The Encounter Maintenance window opens. Enter the date the patient first began experiencing symptoms, in the Onset Date field. Select a service location in the Service Location field. The service location must be the same as the service location that was selected on the UB tab of the Modify Payer Information window. Select OK. Parent topic: Setting Up UB Claims for Enhanced UB Users

UB Claims

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Setting Up Encounters for UB Claims

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UB Claims

Setting Up Encounters for UB Claims

UB Claims

Setting Up UB Claims for Enhanced UB Users

Setting Up Practice Preferences for UB Claims

Set Up Encounters for Enhanced UB Claims (Before Billing)

Set Up Encounters for Enhanced UB Claims (Before Billing)