System Tab

Provider Secondary Reference	Qualifier / Data Element
Billing Tab	Employer ID Number (EI) / Tax ID
Referring Tab	<none> / <none>
Rendering Tab	<none> / <none>
Service Facility Tab	<none> / <none>
Payer Billing Tab	<none> / <none>

Help Guide for NextGen® Enterprise PM 8

Practice Tab

To set up electronic dental claims, use the ADA Claims tab on the Practice tab on the Claims tab of the Modify Payer Information window. Field Description Submitter Profile Select the submitter profile that you want to apply to ADA claims. Electronic Transmitter ID Enter the payer-assigned electronic transmitter ID to generate a claim with an electronic transmitter ID. Note: This field only displays when you select a submitter profile. Practice Payer Opt Val Enter the practice/payer-specific value. Payer Alias Enter an alternative payer name when a name that differs from the name that appears in the payer's Payer master file is required. Primary, Secondary, and Tertiary Media Types Enter the primary media type accepted by the clearinghouse as being electronic or paper. If you set it as electronic, then you can also set how the secondary and tertiary claims should be submitted. When Primary, force Secondary claims to paper Select this check box if you want the claim being sent to the se

Help Guide for NextGen® Enterprise PM 8

Payers Master File for Dental Billing

Three areas in the Payers master file must be set up for dental claims. These setup requirements are on the following tabs of the Payers master file: Payer Defaults - 2: Used to set up a payer for dental billing and ADA claims. System: Used to set up provider secondary references. Practice: Used to set up electronic claims. Defaults-2 Tab System Tab Practice Tab Parent topic: Dental Billing

Help Guide for NextGen® Enterprise PM 8

Secondary References Sub-Tab

The Secondary References tab contains additional tabs for 1500 Claims, UB Claims, and ADA Claims qualifiers and data elements. The sub-tab names, and the qualifier and data element options vary depending on whether you have selected the 1500 Claims, UB Claims, or ADA Claims tab. Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs Note: TheUB Claimstab only displays when you have set up theUB Claim Formoptions in theEncountersPractice Preferences. Field Description Qualifier Select the Reference Qualifier, according to the payer, to use in REF01 of the 837 electronic file. Data Element Select the provider ID Data Type to use in REF02 of the 837 electronic file. Options for this field include the following: FL51– This option only displays on theUB Claimstab. The default for the Billing Provider references from Field Locator 51 on the UB claims from the Payers master file. Phys Billing ID– If the provider is attached to a billing group, the Physician Billing ID is t

File Maintenance Help for NextGen® Enterprise 8

Secondary References Sub-Tab

The Secondary References tab contains additional tabs for 1500 Claims, UB Claims, and ADA Claims qualifiers and data elements. The sub-tab names, and the qualifier and data element options vary depending on whether you have selected the 1500 Claims, UB Claims, or ADA Claims tab. Provider Secondary References: 1500 Claims, UB Claims, and ADA Claims Tabs Note: TheUB Claimstab only displays when you have set up theUB Claim Formoptions in theEncountersPractice Preferences. Field Description Qualifier Select the Reference Qualifier, according to the payer, to use in REF01 of the 837 electronic file. Data Element Select the provider ID Data Type to use in REF02 of the 837 electronic file. Options for this field include the following: FL51– This option only displays on theUB Claimstab. The default for the Billing Provider references from Field Locator 51 on the UB claims from the Payers master file. Phys Billing ID– If the provider is attached to a billing group, the Physician Billing ID is t

Help Guide for NextGen® Enterprise PM 8

Attach a Submitter Profile to the Payer Master

A submitter profile must be attached to each Payer master file. Note: 837 electronic files cannot be created for payers that do not have a submitter profile set up in their payer master file. In addition, to maintain HIPAA compliance when submitting electronic claims, a provider secondary reference qualifier must be set up at the Payer master file level as well. The provider secondary reference qualifier identifies, based on the claim type, the type of provider in the 837. In File Maintenance, select Master Files > System > Payers. The Add/Modify Payer Information window opens. Select the payer, and then select the Practice tab and then Claims tab and then click either the 1500 Claims, UB Claims, or ADA Claims sub-tab. Select the applicable Submitter Profile from the Submitter Profile drop-down menu (If applicable, attach a Submitter Profile for 1500 Claims, UB Claims, or ADA Claims). Select OK. Parent topic: Payers Master File

Help Guide for NextGen® Enterprise PM 8

Dental Billing

This section provides information on dental billing for Health Centers that perform dental services. Specific setup in File Maintenance is required so that dental charges can be entered on encounters and then billed to dental payers on either 1500, ADA or UB claim forms. The type of claim form generated is determined by the setup for each dental payer. The following claim formats are supported in NextGen® Enterprise PM: 1500: Electronic 837PPaper CMS 1500 Form (2012) ADA: Electronic 837D Paper ADA Form (2024) UB: Electronic 837IPaper UB04 Form (2004) Dental billing in NextGen® Enterprise PM involves the following setup in File Maintenance: Practice Preferences Code Tables CPT4 Codes SIM library Claim Edits library Claim Printing library Transaction Codes Payers Set Up Practice Preferences for Dental Billing View Code Tables for Dental Billing Service Items Library for Dental Billing Claim Edits for Dental Billing Claim Printing Library for ADA Claims Payers Master File for Dental Billi

System Tab

Recommendations

Practice Tab

Payers Master File for Dental Billing

Secondary References Sub-Tab

Secondary References Sub-Tab

Attach a Submitter Profile to the Payer Master

Dental Billing