Create an Audit Trail for CSC Events

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

Create Tasks from the Consolidated Services Claim Report

Work log Tasks can be manually created and assigned to users in batch mode from the Consolidated Services Claim report. A task is created for each encounter listed on the report that does not already have an existing open task. Note: Tasks to be created from the report must be set up in the Tasks Types master file with Source Type = Encounter. Open NextGen® Enterprise PM. Run the Consolidated Services Claim process for one or more encounters. The Consolidated Services Claim report opens. Select the Assign Tasks button on the report toolbar. The Add Tasks from Report window opens. Select the Task Type and Assigned To users for the new tasks. Enter additional information for the tasks as needed. To save changes and close the window, select OK. One of the following prompt appears: The following prompt displays for encounters on the report that do not have an existing open task: n source(s) on this report do not have an open task of this type assigned. Confirm mass creation of n task(s). T

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 Consolidated Services Claim Library Setup Create a CSC Library Access a Consolidated Services Cla

Help Guide for NextGen® Enterprise PM 8

X12 EDI Format of CSC Claims

Consolidated Service Claims are sent in an EDI file in the X12 837 standard format and includes the following criteria: The header data is populated from the header claim. A header claim can be automatically or manually identified to consolidate all claim details by doing the following: Manually identify a header claim - In NextGen® Enterprise PM access the Encounter Maintenance window, and then select Claims > Consolidated Service Claim tab. In the Primary Responsible Attending field select Responsible Attending. Automatically identify a header claim - In File Maintenance access the Consolidated Services Claim library. On the Attending Specialty Hierarchy window, you can identify the Attending Specialty Hierarchy. Claims in the status of Copy of, Hold, and Consolidated are viewable. Charges are in the same order as in the original claim. Non-covered services are not included in the claim data. Parent topic: Consolidated Service Claims

Help Guide for NextGen® Enterprise PM 8

Significant Events Administration

The following table shows the significant events that you should select while creating a audit trail for CSC events. Encounter Level Significant Events Message is issued when: Message displays on the Clinical History Chart Notes window > Encounter CSC Claim Created A CSC claim is created CSC Claim Created – Encounter Nbr (list all encounter numbers) CSC Encounter Exempt Status Changed During Billing During billing when one of the following check boxes is selected or cleared on the Consolidated Services Claim sub tab: Exempt from Primary Consolidated Services Claim Exempt from Secondary Consolidated Services Claim Exempt from Tertiary Consolidated Services Claim When one of the check boxes is selected the encounter will not be included in the consolidated claim. ( Consolidated Services Claim sub tab on the Claims tab of the Encounter Maintenance window) CSC Primary Exempt Indicator Automatically Changed during Billing – Encounter XXX CSC Secondary Exempt Indicator Automatically Changed

File Maintenance Help for NextGen® Enterprise 8

Significant Events Preferences

The application tracks selected significant events for logging and auditing purposes. Selections made for significant events at the Enterprise level take effect across all practices. Selections for events at the Practice level must be made for each practice. All significant events are enabled by default. Significant events can be viewed in NextGen® Enterprise PM in the Significant Events report and at the account, chart, and encounter levels. Activate Significant Events You can select and track the significant events through the Enterprise, System, or individual practices. Significant Events Security Rights You can control access to the Significant Events Preferences by modifying the users group security rights. Significant Events Reference List You can set up the significant events in NextGen® Enterprise PM and System Administrator. Add a Significant Events Message to the Significant Events Report You can add or remove messages that display in the message box of the sig events msg tab

Create an Audit Trail for CSC Events

Recommendations

Significant Events for Consolidated Claims

Create Tasks from the Consolidated Services Claim Report

Consolidated Services Claim Library

X12 EDI Format of CSC Claims

Significant Events Administration

Significant Events Preferences

Significant Events for Consolidated Claims

Create Tasks from the Consolidated Services Claim Report

Consolidated Services Claim Library

X12 EDI Format of CSC Claims

Significant Events Administration

Significant Events Preferences