IB Library with Payer Exception Claim Rules Report

Column	Description	Data Populates From
Lib Name	Library Name	Institutional Billing Library Name field
Desc	Description	Payer Exception Claim Rules window > Description field
Eff Dt	Effective Date	Payer Exception Claim Rules window > Effective Date field
Exp Dt	Expiration Date	Payer Exception Claim Rules window > Expiration Date field
Rev Cd	Rev Code	Payer Exception Claim Rules window > Revenue Code field
Rev Cd Cat	Revenue Code Category	Payer Exception Claim Rules window > Revenue Code Category(s) field
Ovride Rev Cd Qual	Override Rev Code Qualifier	Payer Exception Claim Rules window > Override Rev Code Qualifier field
Sum Claim	Create Summary Claim	Payer Exception Claim Rules window > Create Summary Claim check box Y or N

File Maintenance Help for NextGen® Enterprise 8

Institutional Billing Library Listing Report

The Institutional Billing Library Listing report includes information from the Institutional Billing library in File Maintenance. Information on the report pulls from the Institutional Billing Maintenance window. The report includes the following information: Column Description Data Populates From Lib Name Library Name Institutional Billing Library Name field Eff Dt Effective Date Effective Date field Exp Dt Expiration Date Expiration Date field Desc Description Description field Use as Default Billing Rules Use as default billing rules for Institutional claims Use as default billing rules for Institutional Claims check box Y or N Valid Payers Valid Payers Valid Payers section Multiple entries are separated by semi-colons Crt Dt Created Date Modification Information > Creation Date & Time field Created By Created By Modification Information > Creator field Mod Dt Last Modified Date Modification Information > Modified Date & Time field Modified By Last Modified By Modification Informati

File Maintenance Help for NextGen® Enterprise 8

IB Library with TOB by Rev Code Report

The Institutional Billing Library with TOB by Rev Code report includes information from the Institutional Billing library in File Maintenance. Information on the report pulls from the Institutional Billing Maintenance window > Define TOB by Rev Code tab. The report includes the following information: Column Description Data Populates From Lib Name Library Name Institutional Billing Library Name field Desc Description Description field Default Default Use as default billing rules for Institutional Claims check box Y or N Type of Bill Rules Type of Bill Rules Define Type of Bill by Revenue Code Category window > Description field Payer Name Payer Name Valid Payers section Eff Dt Effective Date Define Type of Bill by Revenue Code Category window > Effective Date field Exp Dt Expiration Date Define Type of Bill by Revenue Code Category window > Expiration Date field Rev Cd Cat Revenue Code Category Define Type of Bill by Revenue Code Category window > Revenue Code Category field Fac Type F

File Maintenance Help for NextGen® Enterprise 8

IB Library with Claim Rules by TOB Report

The Institutional Billing Library with Claim Rules by TOB report includes information from the Institutional Billing library in File Maintenance. Information on the report pulls from the Institutional Billing Maintenance window > Claim Rules by TOB tab. The report includes the following information: Column Description Data Populates From Lib Name Library Name Institutional Billing Library Name field Desc Description Claim Rules By Type of Bill Range window > Description field Eff Dt Effective Date Claim Rules By Type of Bill Range window > Effective Date field Exp Dt Expiration Date Claim Rules By Type of Bill Range window > Expiration Date field Tob From Type of Bill From Claim Rules By Type of Bill Range window > TOB From field Tob To Type of Bill To Claim Rules By Type of Bill Range window > TOB To field Adm Diag Admitting Diagnosis Claim Rules By Type of Bill Range window > Populate Admitting Diagnosis check box Y or N Patient Reason Visit Patient Reason for Visit Claim Rules By Ty

File Maintenance Help for NextGen® Enterprise 8

Institutional Billing Library Reports

The following File Maintenance reports are available for the Institutional Billing library: Institutional Billing Library Listing Report IB Library with TOB by Rev Code Report IB Library with Claim Rules by TOB Report IB Library with Payer Exception Claim Rules Report Institutional Billing Library Listing Report IB Library with TOB by Rev Code Report IB Library with Claim Rules by TOB Report IB Library with Payer Exception Claim Rules Report Parent topic: File Maintenance Library Reports

File Maintenance Help for NextGen® Enterprise 8

EDI Claim Profile Listing Report

The EDI Claim Profile Library Listing report includes information from the EDI Claim Profile library in File Maintenance. Information on the report pulls from the EDI Claim Profile Maintenance window. Note: This report uses enhanced reporting functionality. The report includes the following information: Column Description Data Populates From Lib Name Library Name EDI Claim Profile Name field Eff Dt Effective Date Effective Date field Exp Dt Expiration Date Expiration Date field Desc Description Description field Use as Default EDI Rules Default EDI Rules Use as default EDI rules for all payers check box Y or N Valid Payers Valid Payers Valid Payers section Multiple entries are separated by semi-colons Created By Created By Who/When > Modification Information > Creator field Crt Dt Create Date Who/When > Modification Information > Creation Date & Time field Modified By Last Modified By Who/When > Modification Information > Last Modified By field Mod Dt Last Modified Date Who/When > Modi

File Maintenance Help for NextGen® Enterprise 8

Setup the Payer Exception Claim Rules Tab

The Payer Exception Claim Rules tab on the Institutional Billing Maintenance window allows the Revenue Code to control specific claim override options for the selected payers. From the Institutional Billing Maintenance window, select the Payer Exception Claim Rules tab. In the Payer Exception Claim Rules section, do one of the following: To add a new payer exception claim rule, select open menu button and select New. To modify an existing payer exception claim rule, select the row for the rule in the list, select the open menu button and select Open. The Payer Exception Claim Rules window opens. In the Effective Date and Expiration Date fields, enter an effective date and an expiration date for the rule. These fields are required. Dates cannot overlap between rules for the same payer revenue code or category. If dates overlap, the following prompt displays when OK is selected: Effective/Expiration dates overlap with [Payer Exception Claim Rules Name]. In the Description field, enter a

IB Library with Payer Exception Claim Rules Report

Recommendations

Institutional Billing Library Listing Report

IB Library with TOB by Rev Code Report

IB Library with Claim Rules by TOB Report

Institutional Billing Library Reports

EDI Claim Profile Listing Report

Setup the Payer Exception Claim Rules Tab

IB Library with Payer Exception Claim Rules Report

Institutional Billing Library Listing Report

IB Library with TOB by Rev Code Report

IB Library with Claim Rules by TOB Report

Institutional Billing Library Reports

EDI Claim Profile Listing Report

Setup the Payer Exception Claim Rules Tab