Submit Claims Based Correction Report

NextGen® Adaptive Content Engine Help Enterprise 8

Submitting Procedure Coded Measures

You can select and submit a procedure code to satisfy a claims-based measure. The Procedure Coded Measures panel on the Exceptions/Measures template displays a grid with configurable Quality measures (identified by QID) and HEDIS measures from the Provider CQM Maintenance template and Claims Based Reporting Setup panel. Measures that are excluded from claims-based reporting must be reported on the Exception/Measures template. You can submit exceptions for claims-based measures in the Procedure Coded Measures panel. The measures that display modifiers in the Modifier column are exceptions. Procedure Coded Measures Submit CPT II Procedure Codes and Measure Exceptions You can manually submit CPT II procedure codes and the measure exceptions in the Procedure Coded Measures panel on the Exceptions/Measures template. Submit Claims Based Correction Report You can generate the claims-based billing correction report to submit the new CPT II codes for manual billing. Parent topic: Viewing Except

NextGen® Adaptive Content Engine Help Enterprise 8

Configuring Claim Edits for CPT II Claims-Based Reporting

You must configure the claim edits from the Claims Edit Library for CPT II codes. For payers who require a diagnosis code on the CPT II code, you must activate one of the following claim edits in the Claim Edits Library in NextGen® Enterprise PM: 91-Charge Primary Diagnosis 117-CPT4(S) required specific Diagnosis Code(s) For more information about Claim Edit Library, go to NextGen Healthcare Success Community, and download the latest Claims Guide for NextGen® Enterprise PM. Submitting Procedure Coded Measures You can select and submit a procedure code to satisfy a claims-based measure. Parent topic: Manually Submitting CPT II Codes for Claims-Based Reporting

NextGen® Adaptive Content Engine Help Enterprise 8

Assign Diagnosis to CPT II Codes on Finalize

You can submit the CPT II codes to Superbill from the Finalize template. Open NextGen® Enterprise EHR. Open the Finalize template. In the CPT II Claims Based Measure Reporting panel, select a CPT II code in the Today’s CPT II Codes grid. The CPT II Description field is filled with the selected code. To add a diagnosis to the Today's Assessment grid, do the following: Select the Add Common Assessment link. Select a diagnosis. Select Save & Close. In the Today's Assessment grid, select a diagnosis code to assign to the CPT II code. You can select up to four diagnosis codes per CPT II code. If you try to add more than four codes, an alert appears indicating that only four codes can be associated with a CPT code. Note: To clear the diagnosis entered in error, select Clear. Select Submit to Superbill. The CPT II code is displayed in the Today's Submitted Charges grid. Note: If you select Submit to Superbill without assigning a diagnosis code, an alert appears stating that a diagnosis code i

NextGen® Adaptive Content Engine Help Enterprise 8

Configuring Settings for CPT II Claims Based Reporting

You can enable the CPT II reporting feature by configuring a set of prerequisites. You must complete the following common configurations to enable CPT II code claims-based reporting. Download the latest CPT code set. For more information about downloading the latest CPT code set, go to NextGen Healthcare Success Community, and download the latest CPT4 Utility Guide forNextGen®Enterprise. Configure each CPT II code in Service Item Library Maintenance to enable the submission of a $0 charge claim. Review the mapping or add additional measures on the Coded Results Mapping template. Configure and assign measures to providers on the Provider CQM Maintenance template. Configure CPT II codes for claims-based reporting in Service Item Library. After you complete the required configurations, you must complete the configurations specific to the CPT II code submission option (manual or automated) that your practice uses. See the corresponding section in this document for the remaining configurati

NextGen® Adaptive Content Engine Help Enterprise 8

CPT II Code Auto-Submission

The CPT Code Auto-Submission setting on the Practice Configuration template applies to practices that use CPT II procedure codes for claims-based measure reporting. Reporting measures can be set up and mapped on the Coded Results Mapping template. When documentation in the patient encounter meets the specific criteria set up on the Coded Results Mapping template, the CPT II code is automatically assigned. CPT Code Auto-Submission section The CPT II code automatic submission functionality consists of two options: Submit CPT II code without diagnosis code automatically assigns and sends the CPT II code to the Superbill without assigning a diagnosis code. Assign diagnosis code to CPT II on Finalize activates the CPT II Claims Based Measure Reporting panel on the Finalize template. This setting automatically assigns and sends the CPT II code to the Finalize template for provider to assign a diagnosis code before submitting to the Superbill. For more information on assigning diagnosis codes

NextGen® Adaptive Content Engine Help Enterprise 8

Submitting CPT II Codes Automatically without Diagnosis

You can to configure additional options to automatically submit the CPT II codes to Superbill. In addition to the CPT II configuration in the “Common Configuration for CPT II Claims Based Reporting” section, you also need to configure the following areas to automatically submit the CPT II codes without the diagnosis option: Claim Edit Library Practice Configuration When configured to automatically submit the CPT II codes, the codes are automatically assigned and submitted to Superbill for a patient documentation that meets the criteria mapped for a measure on the Coded Results Mapping template. The claim edits activated during the configuration select all claims without a diagnosis. The diagnosis can be added later in NextGen® Enterprise PM. You need to report measure exceptions on the Exceptions/Measures template for the CPT II code auto-submission functionality to work. Enable Automatic Submission of CPT II Codes You can automatically submit CPT II codes to the Superbill and Procedur

Submit Claims Based Correction Report

Recommendations

Submitting Procedure Coded Measures

Configuring Claim Edits for CPT II Claims-Based Reporting

Assign Diagnosis to CPT II Codes on Finalize

Configuring Settings for CPT II Claims Based Reporting

CPT II Code Auto-Submission

Submitting CPT II Codes Automatically without Diagnosis