Processing Electronic Claims - 837 Files
This section explains how electronic claims (837 files) are processed.
The basic steps include:
Select the
EDI
file
button.
The
837 Electronic File Creation
window opens.
Select a
Submitter Profile
library.
Select options applicable to the types of claims that you want to send electronically.
Select the
Process
button.
Electronic Claims File Structure
Control Segments
Application Setup for the 837 File
837 Electronic File Creation Window
Electronic Send Report
Set Up Automatic Task Completion for Clean Claims
Recommendations
Explore
Help Guide for NextGen® Enterprise PM 8
837 Electronic File Creation Window
Use the 837 Electronic File Creation window to identify search criteria for claims that you want to send in an electronic file. This window has the following tabs: General, Advanced, and Practices. Each tab contains the File Options and Electronic Claims sections. File Options and Pending Electronic Claims Sections These sections display on each of the tabs for the 837 Electronic File Creation window. File Options - you can select the file for data transfer, identify the batch type, create a report, update claim requests, and send a test file. Pending Electronic Claims - displays the claims that match the search criteria on the active tab. General, Advanced, Practices, File Options, and Pending Electronic Claims Refer to the following topics for information about the fields on this window: 837 Electronic File Creation - General Tab 837 Electronic File Creation - Advanced Tab 837 Electronic File Creation Window Practices Tab 837 Electronic File Creation - File Options and Pending Electr
Help Guide for NextGen® Enterprise PM 8
Electronic Send Report
When pending claims are processed and the 837 electronic file is created, the Electronic Send report automatically displays if the Report results check box on the 837 Electronic File Creation window is enabled. The report separates claims that were accepted from those that were rejected. In addition, you can use the drill-down arrow to double-click on information in the report, and the editable claim view displays. After the Electronic Send report displays you can click the filter button and further filter the report. Electronic Send Report Columns The claims related data is available on the Electronic Send report. Electronic Send Report - Filter 2 Parent topic: Processing Electronic Claims - 837 Files
Help Guide for NextGen® Enterprise PM 8
Claims Processing
Claims can be processed on demand or in batch mode. This section explains: Paper claims Electronic claims - 837 files 997 files 277 files ERA - 835 files COB - manual posting Processing Paper Claims Claim Production Status Report Processing Electronic Claims - 837 Files Process Claim Requests for Multiple Encounters 997/999 File 277 File Coordination of Benefits Electronic and Manual Processing You can view information on all the payers for EDI claims in the Coordination of Benefits Information window. Parent topic: Claims
Help Guide for NextGen® Enterprise PM 8
Application Setup for the 837 File
The structure of the 837 electronic file is important to understand because much of the information that is required in the 837 file must be set up in File Maintenance. The following areas of the application must be set up to support the creation of 837 electronic files: In File Maintenance Access... For more information refer to... Libraries Submitter Profiles File Maintenance Libraries Guide for NextGen® Enterprise PM Master Files Locations Payers Providers File Maintenance Master Files Guide for NextGen® Enterprise PM Practice Preferences File Maintenance Preferences Guide for NextGen® Enterprise PM Parent topic: Processing Electronic Claims - 837 Files
Help Guide for NextGen® Enterprise PM 8
Create an EDI File by Claim Type, CPT4 Code or Date
To create an EDI file by claim form, claim type, CPT4 code, or begin and end date, use this procedure. Select the EDI File toolbar button. The 837 Electronic File Creation window opens. Complete the following required fields: Submitter Profile Library Claim Form Send File Name Batch Type To further refine your search, enter data in the applicable fields. Enable any of the following check boxes to update claims, create a report, or send a test file: Update claim requests as processed Report results - to display the report after it is processed. Use test code in REF02 trans type segment Select Find. In the Pending Electronic Claims section select the claims to include in the EDI file. Select Process. The Electronic Send report generates and automatically displays when the Report Results check box is enabled. Parent topic: 837 Electronic File Creation Window
Help Guide for NextGen® Enterprise PM 8
Create an EDI File by Practice
Select the EDI File toolbar button. The 837 Electronic File Creation window opens. Complete the following required fields: Submitter Profile Library Claim Form Send File Name Batch Type Select the Practices tab. You can search for claims by a single practice, multiple practices, or all practices within your enterprise. To search for claims by single or multiple practices go to Step 5. To search for claims for All Practices in your enterprise go to Step 7. To search for pending claims associated with a single or multiple practices, select the open record icon. The Practices window opens. Select the Flashlight icon to search for practices. Move the applicable practices to the Included section. Select OK. To search for pending claims across all practices, enable the All Practices check box. Enable any of the following check boxes to update claims, create a report, or send a test file. Update claim requests as processed Report results - to display the report after it is processed. Use test
button.
The 837 Electronic File Creation window opens.