NextGen Training PM Manual Revenue Cycle

NextGen Training PM Manual

Revenue Cycle For Coastal Health & Wellness Use Only. Rights Reserved.

TABLE OF CONTENTS

• GETTING STARTED WITH PM

A. How to Access, Login and Exit the NextGen Application Pg

I. Accessing NextGen 1

II. Logging In 2

III. Logging Out/Closing the NextGen Application 4

B. Common NextGen PM Elements Pg

I. Shortcuts 5

II. PM Buttons and Fields 6

III. PM Toolbar and Icons 7

IV. PM Desktop 9

V. Patient Information Toolbar 10

C. Changing Your Password in PM Pg

I. Changing your Password 11

D. PM Advisor Pg

I. Accessing the Advisor screen 12

II. Using the Advisor 13

• APPOINTMENTS

Confirming an Appointment Pg

I. Appointment Lookup 14

II. Person not listed 15

III. Person is listed 15

IV. Appointment Reminders 16

• REVENUE CYCLE PROCESSES

A. Basic Revenue Cycle Processes – Things to Know

I. Encounters and Charge Statuses 17

II. Charge Posting Screen Icons

18

III. Self-Pay Patients with Sliding Fee Schedules 19

• Deposit Table 19

• Managing Charges After Insurance Pays and Patient is also on a Slide 20

B. Determining Coverage

I. Person Lookup 21

• Person is Not Listed 22

• Person is Listed 22

II. Person with Healthcare Coverage at Chart Level 23

• Insurance 23

o Benefits Tab 24

• Employer Tab (Contract) 25

TABLE OF CONTENTS

o Mini-registration form from the agency

o

25

II. Person without Healthcare Coverage at Chart Level

26

• Self-Pay Patients with Sliding Fee Schedules 26

• Waiver Form 26

III. Guarantor attached to Encounter 27

• How to update Guranator on Encounter 27

o Employer (Contract) versus Self 28

IV. Insurance or Contract attached to Encounter 31

C. Adding Insurance

• Adding Insurance 32

• Detail tab 35

• Detail 2 36

• Benefits Tab 37

• Authorizations 38

• Employer Contracts 41

D. Chart Management

I. Sliding Fee Alert 44

II. Reviewing Patient Services Documents 44

E. Creating A New Batch and Set as Active

I. Creating a Batch 45

II. Batch Description 46

III. Securing the Batch 46

IV. Set as Active 47

F. Core Revenue Cycle Process

I. Accessing the Unbilled Encounters Report 49

• Memorized Reports 49

II. Accessing the Unbilled Encounter 52

III. Charge Entry

53

IV. Required Verifications Prior to Billing 54

• Encounter Rendering/ Referring/Location Verification 54

• Encounter Insurance 55

o Self pay 55

o Medicaid 55

o Medicare 56

o Contracts Agency 57

o Contracts Dental 57

o Private Insurance 57

• Charges Review 57

o Medical Encounter 57

o Dental Encounter 60

o Hygienist Encounter 61

o Counseling Encounter 61

TABLE OF CONTENTS

o Nurse Only Encounter 62

o Lab/X Ray Encounter 62

o Medical/Dental Records Request Encounter 63

• Charges – Manual Entry

•

63

V Billing Charges 64

• Self Pay 64

• Medicaid 65

o Claim Production Status Report 66

• Medicare 67


• Contracts 69


• Private Insurance 73


• Exclude Service Charges from Claims 74

IV Confirming or Viewing a Claim 75

• Confirming a claim has been created, clean and pending processing

•

75

• Viewing a claim 76

▪ 1500 Form 76

▪ UB Form 77

▪ ADA Form 78

G. Exporting Claims

I. Creating the Exporting Claim Files 79

II. Exporting Claim Files 81

• Accessing the Clearing House 81

• Selecting the Claim Files 81

H. Claim Requests

I. Searching for Claims 85

II. Changing Media Types 86

III. Printing Claims 87

• Printing Options 87

IV. Archived Claims 88

• Flag Encounters for Rebill 88

• Regenerate Claim Request 89

I. Patient and EOB Payments

I. Accessing the Active Batch 90

II. Accessing the Account/Encounter 91

▪ Dental Contract Services Payments 91

o Person is not listed 92

o Person is listed 92

o Account Source 93

o Encounter Source 93

III. Entering the Payment 94

TABLE OF CONTENTS

• Account/Encounter Payment Entry – Patient Only 94

o Unapplied Payments 94

• Payment Posting Outstanding to Line Items 95

• Encounter Payment Entry – EOB Payments 95

• Encounter Payment Entry – EOB Adjustments 96

IV. Printing the Receipt 96

J. Voiding Charges, Reversing Adjustments and Payments

I. Searching for Encounters by Patient Name 99

II. Searching for Encounters by Encounter Number 99

III. Voiding Charges 101

• Confirmation Screens 102

o Charges without Transactions 102

o Charges with Transactions 103

IV. Reversals 103

• Adjustments 103

• Payments 106

V. Reentering a Revered Payment 107

K. Pre-Listing and Managing Pre-Listed Encounters for Collection

I. Accessing the Encounter 108

II. Documenting the Encounters as Pre-Listed 110

III. Documenting the Encounters with Follow-up Dates 112

IV. Assigning the Correct Collection Letter to the Account 114

V. Printing Pre-Listed Letters 115

VI. Running the Collections Follow-up Report 117

L. Creating and Managing Budget Plans

I. Accessing the Account 120

II. Creating a Budget Plan 121

• Adding Additional Encounters at a Later Date to the Same Budget Plan 124

III. Printing Budget Letters 126

IV. Running the Budget Plan Report 127

M. Dental Contract Services Agreement Process

I. Patient Appointment 130

II. Dental Provider 130

• Pre-Dental Contract Services Assessment Form 131

III. Business Representative/Designee 132

• Add the Appropriate Denture Contract % Plan to the Patient’s PM Chart

Contract Alert

133

• Creating a DenConServ Encounter 134

• Creating a DenConServ Alert 136

IV. CHW Billing 137

V. Dental Receptionist/Contact Center 137

VI. Patient Services 137

VII Check Out 138

TABLE OF CONTENTS

VIII. Dental Contract Services Agreement 139

N. Posting the Batch and End of Day Balancing

I. Accessing the Active Batch 140

II. Accessing the Batch Listing Report 141

III. Printing the Batch Listing Report 142

IV. Balancing the Batch to the Cash Drawer 142

• Ledger 142

o Modifying Unposted Incorrect Transactions 143

• Header 143

V. Posting the Batch 145

O. Statements

I. Exporting Patient Statements 146

• Processing Statement Files in Bulk 146

• Uploading Statement File to EDI 147

II Statements by Individual Patient 149

• Accessing Individual Patient Statements 151

III. Previewing and Printing Statements on Demand 152

• Previewing Statements 152

• Printing Statements 152

IV. Sample Statement 154

1. ClaimRemedi

I. Accessing ClaimRemedi 155

II. Logging In 155

III. Change Password 156

IV. New Eligibility 157

V. Coverage 162

VI. Financial 163

VII. Exclusions 163

VIII. Documenting Eligibility Data 163

IX. Eligibility Search Results 163

X Signing Out 164

2. ClaimRemedi Reporting

I. Accessing ClaimRemedi Reports 165

II. Report Date Ranges 165

3. Internal Contracts

I. Contracts 167

Getting Started With NEXTGEN

HOW TO ACCESS, LOGIN AND EXIT THE NEXTGEN APPLICATION

For Coastal Health & Wellness use only. Rights Reserved. Return to table of contents

1

I. ACCESSING NEXTGEN

1. Double left click on the NextGen 5 icon located on either the desktop or through RDS.

The NextGen Application Launcher will display.

2. Left click once on either Practice management (PM), Electronic Health Record (EHR), or

Electronic Dental Record (EDR), depending on the database the user must access. The

NextGen login window will display. The database name will display on the top banner based

on which database the user is accessing.




2

II. LOGGING IN

3. Left click once in the User field and enter your user name.

(First time logging in, user name will be provided by IT)

4. Left click once in the Password field and enter your password

(First time logging in, a password will be provided by IT)

5. Confirm the following fields display “Coastal Health & Wellness”

• Enterprise

• Practice

6. Left click once on Logon, the appropriate database desktop will display

• PM




3

• EHR

• EDR




4

III. LOGGING OUT/CLOSING THE NEXTGEN APPLICATION

7. Left click once on File, then Logout or Exit or the Down arrow in EDR, then Log Off or Exit

PM

A NextGen alert will display,

Are you sure you want to

logout of NextGen? All open

screens will be closed.

Left click once on Yes

EHR

A NextGen alert will display,

Are you sure you want to Exit?

• Left click once on Yes

EDR

The application closes

Common NextGen PM Elements SHORTCUT MENUS, BUTTONS AND FIELDS, TOOLBAR AND ICONS, DESKTOP


5

The Practice Management (PM) database is used to conduct all business aspects of CHW. Users

will be able to perform/access the following:

➢ Maintain and schedule appointments

➢ Maintain patient demographic charts

➢ Create and maintain billing encounters

➢ Bill for services provided

➢ Generate paper and electronic claims

➢ Generate standard and customized reports

➢ Generate customized letters to send to patients

I. SHORT CUT MENUS

Mouse and Keyboard

• Throughout the Nextgen application there are short-cut menus. Users can access short-

cut menus by right-clicking in the appropriate area.

• Users can usually complete a task by clicking on an icon from the toolbar menu located

across each desktop or by right clicking on an item and selecting the option from the

shortcut menu.

Mouse Usage:

• Use the left mouse button to select and click items.

• Use the right mouse button to display a shortcut menu of options.

Minimize:

• Click on the Minimize button on the title bar of the active window. The program

window will minimize to the Windows taskbar.

Maximize/Restore:

• On the Windows taskbar, click the Icon of the database to restore.

NextGen Application Launcher

PM

• On the PM title bar, select the Maximize button to change the sizing of the user

screen or restore to normal size



6

II. PM BUTTONS AND FIELDS



7

III. PM TOOLBAR AND ICONS



8

PM TOOLBAR AND ICONS (CONTINUED)

Click the EHR button to launch the EHR application.

Click the Doc Mgmt button to launch the Document Management application.



9

IV. PM DESKTOP

• When a user logs into the PM application, the PM’s main desktop window will display.

All PM functions are performed within this window.

Toolbar: Contains a row of icons that give access to functions and modules.

Menu Bar: Contains several shortcut menus. When clicking on an item in the menu bar, the short cut menu displays

Title Bar: Displays the “NextGen” the name of the practice: Coastal Health & Wellness

Current User Status Bar: Displays the current status of PM. (i.e.) When generating a report, the status bar displays “Generating Report”…

Current Version, Date, and Time

Current DB



10

V. PATIENT INFORMATION TOOLBAR

Users can easily identify patient information when switching between the patient chart, charges

and payment entry

A. Patient Demographic Row – Contains the patient’s name, sex, DOB, person number,

medical record number and other ID

B. Patient Picture

C. Alerts Button – allows users to access patient chart alerts

D. Contact information & Contact Preference – displays perfered contact number. Hovering

over “contact” displays all contact numbers

E. Patient Status - displays patients if in collection or budget statuses

F. Preferred Language - helps identify the language patients prefer to speak

G. Patient Portal - indicates if patient is registered with the patient portal – if patient is

registered with the patient portal, the patient portal icon is blue . if patient is not

registered with the patient portal, the patient portal icon is greyed-out

H. Email address – displays current email address.

▪ This field will now be required. If a patient does not have an email account or does not

want to share – enter “no email available” in the email field. And continue to enter comments

I. Encounter Information – displays when the encounter tab is active and an encounter is

selected. Displays encounter primary insurance, if patient is self pay, self pay will display.

Rendering and Guarantor infomation of the current encounter displays

J. Patient Information Badges – provides quick access to patient appointments, insurance,

patient balance, & recall plans

K. Hyperlinks – Appointment search ahead & UDS

A

B

C

D

E

F

G

H I

J

K

Getting Started With PM

CHANGING YOUR PASSWORD IN PM


11

1. Complete “Getting Started with NextGen - How to Access, Login and Exit the

NextGen Application” process

2. Left click once on Tasks from the menu bar

3. Left click once on Change Password, the Change Password screen displays

4. Left click once on the Old Password field and enter your current password

5. Left click once on the New Password field and enter your new password

6. Left click once on the Confirm New Password field and re-enter your new password

7. Left click once on OK

NEXTGEN

ADVISOR


12

Definition:

• The Advisor is a dashboard built in utility containing data sections that supply users with a

quick, at-a-glance summary information about the status about Coastal Health and Wellness

as a practice or per location.

1. Complete “Getting Started with NextGen - How to Access, Login and Exit the NextGen

Application” process

I. ACCESSING THE ADVISOR SCREEN

• Users can access the Advisor by accessing Tasks from the menu bar and selecting Advisor

A message can display from the CHW here

A tally of appointments is tracked here

A tally of encounters is tracked here

A tally of all accounts receivable

A tally of all statements/invoices

A tally of claims is tracked here

All tasks are accessible here

Letters available to send out if applicable

NEXTGEN

ADVISOR


13

• Most users will only access Messages, Appointments, and Tasks

II. USING THE ADVISOR

2. Left click once on the down arrow next to Location to view one location at a time

3. Left click one on the down arrow next to Rendering to view one provider at a time,

specific to appointments

4. Left click once on the print icon, to print a face sheet of the advisor

5. Left click once on the refresh icon, to manually refresh the advisor screen

6. Left click once on the close icon, to close the advisor

7. Left click once on Tasks on the menu bar, then Advisor to re-access the Advisor at anytime

NEXTGEN PM

CONFIRMING AN APPOINTMENT


14

Purpose:

• To inform the patient when, where, and what type of an appointment they have

scheduled



2. Understand “Getting Started with PM - Common NextGen PM Elements”

a. APPOINTMENT LOOKUP

2. Left click once on the Appointment Lookup icon, the Appointment Lookup

screen displays

3. Left click once in the Last (name) field and enter the person’s last name

4. Left click once in the Birth Date field and enter the person’s date of birth

5. Left click once on the Find button to display a search result of Matching Records of all

persons with the same last name and date of birth

• NOTE: The less search criteria the user enters, the more person search result

will display

NEXTGEN PM



15

• Review each result in the matching records list and determine if the person is

listed

• PM distinguishes between a person and patients. A Person does not have

a chart and a Patient has a chart;.

• Person (displayed with a globe next to the name): A person is an

individual who has or will not receive medical/dental services. Users may

enter them in the system as the parent of a child or as the insurance

guarantor. A person may also be an individual who has made an

appointment to be seen for the first time and has not yet been seen.

• Patient (displayed with a chart next to the name): A patient with a

chart receives medical/dental services. A patient is considered a “person”

before the chart is created.

II. PERSON NOT LISTED IN APPOINTMENT LIST FIELD

• If users determine the person is not listed in Appointment List field, this means -

there are no past or future appointments for this patient. Inform patient there is no

appointment, but an appointment can be made today by following the “Scheduling

An Appointment” process

III. PERSON IS LISTED IN APPOINTMENT LIST FIELD

• If user determines the person is listed in the Appointment List field

6. Confirm the searched person is the correct person, by verifying the last name, first name, and

date of birth

NEXTGEN PM



16

7. Confirm the Date/Time

8. Confirm Patient

9. Confirm Event

10. Confirm Resource

11. Confirm Location

• APPOINTMENT REMINDERS

o CHW has systems in place to send appointment reminders 48 hours prior to an

appointment based on the patient’s preference. (keep in mind, an appointment

must be pre-scheduled 48 hours prior to the reminder sent)

o NOTE: A reminder tab within the Add or Edit Appointment window is available

to review all patient reminders after the latest 5.9 version upgrade

12. Left click once on Open to access the Edit Appointment window

13. Left click once on the Reminder tab located on the bottom right of the Edit Appointment

window

NEXTGEN PM

BASIC REVENUE CYCLCE - THINGS TO KNOW


17

• Encounter and Charge Statuses

Unbilled

Encounter

Encounter containing charges or no charges, that has not

been billed

Charges

Individual charge not billed

Billed

Encounter

Encounter with charges and processed for payment

Charges

Individual charge billed and processed from unbilled status

Rebill

Encounter

Encounter once billed. Changes occurred, such as, newly

added charges, insurance or balance controlled rearranged

for rebill. Encounter should never stay in rebilled status

Charges

Individual charge selected for rebill, usually charges

attached to an insurance

History

Encounter

Encounters with no balance due, credits or unapplied

credits. Encounter is closed

Charges

Individual charge without a balance due or credits

Bad Debt

Encounter

Encounter with unable to collect balances and system

automatically changes status, based on current billing and

collection policy.

Charges

Individual charges in bad debt. If encounter status

Budget

Encounter

Encounter included in a budget plan, also known as, a

payment plan

Charges

Individual charges stall in billed status

NEXTGEN PM



18

• Charge Posting Screen Icons

View Chart

access the patient PM chart, such as, patient information, financial, clinical

history/notes, listing of encounters

Encounter

Maintenance

access the encounter to make appropriate changes as needed, such as,

encounter rendering and referring providers

Encounter Insurance

ability to view or add insurance to current encounter

Balance Control

ability to manage money amounts to different buckets, Ins1, Ins2, Ins3 &

patient and which CPTs are added to a claim

Patient Balance

ability to view a total of guarantor balance due

Claim Edits

ability manually run claim edits

Bill Encounter

ability to bill an encounter and process charges

Print Menu

ability to print encounter bill, patient receipts

Add Transaction

ability to add transactions to specific encounter

NDC Charges

ability to update or verify NDC numbers per charge

Exit

close out the charge posting window

NEXTGEN PM



19

• Self Pay Patients with Sliding Fee Schedules

▪ How to identify a patient’s slide & discount; utilizing the Alert and at encounter

level

▪ Alerts are real time based. If patient Sliding Fee Schedule is active and is eligible

for a discount for services rendered on the same day and alert will display within

the patient’s chart.

▪ The patient responsibility is opposite of the discount % displayed on the alert.

▪ Example – alert states discount = 40% - patient is responsible for 60% of charges

rendered on same day.

▪ Encounter is also identified with patient responsibility percentage. Individually

identified on each encounter

o Deposit Table – self pay patients with a sliding fee schedule

% of Pay 0%

20%

40%

60%

80%

100%

Waiver

Minimum Fee (Nominal Fee Charge) $15

Deposit requested at check-in

$20 $25 $30 $40

Required to be paid prior to check-in $50 $50

▪ Patient with a discount of 100% is charged a nominal fee of $15.00 and asked to

collect the nominal fee of $15.00, but if unable to collect, patient cannot be

refused service

▪ Patient with a discount of 80% to 20% is asked for a deposit, based on the

deposit table, but if unable to collecte deposit, patient cannot be refused service.

No nominal fee charge is entered.

▪ Patient who has no healthcare coverage and who decline financial screening,

may sign a Waiver. Waiver patients are responsible for 100% of all charges and

are Required to pay a deposit of $50. If deposit is not collected, services can be

refused. No nominal fee charge is entered.

NEXTGEN PM



20

▪ Patient who has no healthcare coverage and who are financially screened, but

deemed not eligible for a discount, are responsible for 100% of all charges and

are Required to pay a deposit of $50. If deposit is not collected, services can be

refused. No nominal fee charge is entered.

o Managing charges after insurance pays and patient is also on a slide

▪ charges have to be managed as the monies are moved from bucket to bucket.

Example: patient is on Medicare – Medicare pays covered services and 20% is

moved to patient bucket, users must apply slide manually

▪ Perform the following:

o Access chart, encounter tab, right click on encounter, select Sliding fee

(if charges window is open, users will not see a change, close charges

window and reopen to see slide)

NEXTGEN PM Revenue Cycle

DETERMINING COVERAGE


21

Purpose:

• Users will able to determine patient’s current coverage and coverage attached to

patient encounter




3. Understand “Basic Revenue Cycle Processes, Things to Know”

I. PERSON LOOKUP

4. Left click once on , to search for a person in the system, the People Lookup screen

displays






will display


listed

• PM distinguishes between a person and patients. A Person does not have

a chart and a Patient has a chart;.

• Person (displayed with a globe next to the name): A person is an

individual who has or will not receive medical/dental services. Users may

enter them in the system as the parent of a child or as the insurance

guarantor. A person may also be an individual who has made an

appointment to be seen for the first time and has not yet been seen.

• Patient (displayed with a chart next to the name): A patient with a

chart receives medical/dental services. A patient is considered a “person”

before the chart is created.




22

• PERSON NOT LISTED IN MATCHING RECORDS

▪ If the user determines the person is not listed in matching records list, this means – the

person does not exist in the database.

• PERSON IS LISTED IN MATCHING RECORDS

▪ If user determines the person is listed in Matching Records list

▪ Confirm the searched person, is the correct person, by verifying the last name, first name,

and date of birth

8. Left click once on the person’s last name to highlight the person selected in the Matching

Records result list

Frito, Chips 123 my avenue 6/11/1971 Frito, Corn 123 my avenue 6/11/1971 Frito, Lays 123 my avenue 6/11/1971




23

9. Left click once on Open, the Update Patient Information screen displays

II. PERSON WITH HEALTHCARE COVERAGE

10. Verify Available Insurances, located at the bottom of the Update Patient Information

screen.

• Use the scroll button of the Available Insurance screen, to view all

insurance/contracts listed




24

• Double click on the insurance to view the Benefits Info Tab for more

eligibility information, the Insurance Maintenance screen will display

• Left click once on the Benefits Info tab to view detail verification

information




25

• EMPLOYER TAB

o Contract should be also entered as available insurance

11. Left click once on the Employer section of the Update Patient Information screen, to access

the list of Contracts

• Mini-registration form from the agency

12. Access patient’s chart , left click once on Clinical History/Notes Tab

13. Left click once on the Document Management folder in the Chart Notes section.




26

14. Access the Financial Screening document with the same date of services as the encounter,

this should be the mini-registration form from the agency (ex: below)

• Not all mini registration forms are the same

III. PERSON WITHOUT HEALTHCARE COVERAGE

15. Left click once on the UDS section, to access Sliding Fee Schedule Verification and Family

Information (SFSV & FI)

16. Confirm the Sliding Fee Schedule Verification and Family Information expiration date and

compare to DOS to determine if patient was covered by a slide on DOS

• WAIVER – patients can sign a waiver and be responsible for 100% of charges




27

17. Access patient’s chart , left click once on Clinical History/Notes Tab

18. Left click once on the Notes folder in the Chart Notes section.

19. Access the WAIVER Form, the Waiver checkbox should be selected and a patient signature

should be obtained

IV. GUARANTOR ATTACHED TO ENCOUNTER

• How to update Guarantor on Encounter

O Employer (Contract) versus Self

20. Access the patient’s chart, left click once on the Encounter Tab

• The Guarantor attached to the specific encounter is located to the right in the Guarantor

section




28

21. Left click once on the manila file folder, the modify Encounter

22. Left click once on the Change button, the change guarantor to? screen displays

23. Left click on either Employer or Person,

• Employer identifies a contract is responsible for the payment of the encounter, the

Guarantor Search screen will display




29

• Double left click on the contract responsible for payment of the encounter, the employee

maintenance screen with the selected contract will display ** DO NOT CHANGE ANY

INFORMATION IN THIS SCREEN**

• Left click once on OK to attach contract to encounter as guarantor

• Person can be self or a parent who is responsible for the payment of the encounter




30

• Left click once on Self, if patient is self-guarantor or

• Left click once in the Last/First name/DOB fields to search for a person who is

responsible for the payment of the encounter.

• Left click once on find, a list of patients will display, double click to select

• Left click once on Ok on the Modify Encounter Guarantor Information screen, the patient

will display in the Guarantor section




31

V. INSURANCE OR CONTRACT ATTACHED TO ENCOUNTER

24. Access the patient’s chart, left click once on the Encounter Tab

25. Left click once on the Insurance subtab, the encounter insurance informaiton will display




32

• This is the area in which users will change insurance informaiton, if needed.

• Insurance (Contract) can be updated or removed from this screen to the attached

encounter

26. Left click once on the Norton button, the shortcut menu will display

27. Left click once on Open, the Insurance Maintenance screen will display




33

• Follow the Adding Insurance process to update insurance, if needed

NEXTGEN PM Billing

ADDING INSURANCE


34

I. INSURANCE

• ONLY for person's with Commercial Insurance, Medicare, Medicaid and Contracts

• Follow ClaimRemedi process

• ADDING AN INSURANCE

1. Left click once on Norton, of the Available Insurance grid located at the bottom of

the Add Patient Information screen, to access the shortcut menu

2. Left click once on New Insurance, the Payer Lookup screen displays

3. . Left click once in the Payer Name field, type in the first letter of the insurance or the whole

name of the insurance and click once on Find

• A Payer List will display with insurance names that start with the first letter that

was typed in the Payer Name field

▪ If the insurance presented by the patient is not available, send email with all

pertinent information by email to the insurance verification department.

4. Double left click on the name of the insurance to select the insurance, the Insurance

Maintenance screen displays

NEXTGEN PM Billing

ADDING INSURANCE


35

• INSURANCE MAINTENANCE

o DETAIL TAB

5. Confirm the Insurance selected is correct in the Plan Name field

6. Left click once in the HIC/Policy Nbr field and enter a policy number

• If the policy number is a social security number user can use the, Ctrl S command

and it will copy the person's social security number from the PM chart

7. Left click once in the Group Number field to enter a group number, if applicable

8. Left click once in the checkbox next to Active to activate the insurance, it will indicate active

with a check mark

9. Left click once in the Effective Date field and enter the date the insurance will be effective

10. Left click once in the Expiration Date field and enter the date the insurance verification will

expire

11. Left click once in the Note and enter pertinent information related to the verification of the

insurance

12. Left click once on the Amount radio button next to indicate the Co-Payment

NEXTGEN PM Billing

ADDING INSURANCE


36

13. Left click once in the Co-Payment field to enter a co-pay amount that is indicated on the

person's insurance card

14. Left click once in the Deductible field, during the ClaimRemedi process, a deductible amount

should display in the report, enter this amount here

O DETAIL – 2 (Patient name clarification on insurance card)

15. Left click once on the Detail - 2 Tab next to the Detail Tab

• This tab is designed to enter a different name, DOB or sex listed on the patient

insurance card.

• Left click once in any of the fields and document any different information listed on

the patients’ insurance card.

▪ Example:

• Frito-Pie Chips is what is displayed on the Medicare card, but the clinic is

financially screening Frito Chips because that is what is on the ID

NEXTGEN PM Billing

ADDING INSURANCE


37

o BENEFITS INFO TAB

14. Left click once on the Norton button and select New to enter Eligibility and Benefits

information

• It is expected that staff enter all pertinent insurance information in the following fields

o Spoke with:

▪ Enter a specific person’s name as the person who you received the information

from

o Eligible for DOS

▪ Select Yes or No

• If “No” is selected enter a note in the “Reason NOT Eligible on DOS”

field. Example – adult who has Medicaid but today’s visit is for dental

services and this patient’s coverage does not cover dental services. Also

select Type of Benefit as Medical Only

• NOTE: Insurance should not be attached to the encounter if the insurance

does not cover the type of service.

NEXTGEN PM Billing

ADDING INSURANCE


38

o PCP Name

▪ Enter the patient’s “PCP” Primary Care Provider’s name if not CHW

o Type of Benefit

▪ Dental Only

▪ Medical & Dental

▪ Medical Only

o Specific Note Regarding COPAY and Deductible Information

▪ Enter specific information regarding co-pay and/or deductible for the patient’s

coverage. Example – patient has met all co-pays for this calendar year or no need

to collect co-pay for today’s type of service.

o Pre-Authorization Required

▪ Select Yes or No

• If “Yes” is selected – save the Eligibility and Benefit Information

window and access the Authorizations tab

o AUTHORIZATIONS

15. Left click once on the Norton button and select New Authorization

NEXTGEN PM Billing

ADDING INSURANCE


39

16. Left click once in the Authorization Code field and enter authorization number

17. Left click once in the Effective and Expiration Date fields and enter the appropriate dates

18. Left click once in the Nbr Encounters field and enter a total encounter numbers covered by the

authorization code

19. Left click once on OK on any open tab to return to the Insurance Maintenance screen.

20. Left click once on OK on the Insurance Maintenance screen to return to the Modify Patient

Information screen to view the newly entered insurance.

NEXTGEN PM Billing

ADDING INSURANCE


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• Once an insurance has been added to a person’s chart , the insurance will become

available to attach to an encounter at Encounter Creation and a green check mark

will display to indicate that it is available

• An insurance can be deactivated in this screen as well, by left clicking once on the

green arrow, the green arrow will disappear and the insurance is no longer available

• when linking patients through relations, all insurance information is listed for all

patients linked.

▪ For example, Patient58 (Child) (Patient) is covered by Aetna and Patient0516

(Parent) (Father) is not covered by Aetna, users will see Patient58 (Child)

(Patient) insurance(s) display in Patient0516 (Parent) (Father) insurance listings

when linked through relations

• Users will need to remove the green check mark under the "Available" column from

the non-covered patient/parent/child insurance listing. This will unlink the insurance

and not be available for selection. Only patients covered by the insurance should

have the green check mark attached.

NEXTGEN PM Billing

ADDING INSURANCE


41

• An expired insurance will display with a red X on the file folder

II. EMPLOYER (CONTRACTS COVERAGE ONLY)

21. Left click once on the Employer category, the category is ONLY for patients who are

covered by a contract.

• See current list of contracts

• Ask the person for a copy of the mini registration form on the contracted agency's

letter head, exception - Title V

▪ If the person does not have the form contact the agency for a fax copy

• This form will be scanned into the person's PM chart

• If no contract needs to be added, continue to

Relations/Roles/Contact/Guarantor/Head of Household section

22. Left click once on Norton, to access the shortcut menu

NEXTGEN PM Billing

ADDING INSURANCE


42

23. Left click once on New, the Employer Lookup screen displays

24. Left click once on Find, a list of current available contracts will display in the Matching

Records

NEXTGEN PM Billing

ADDING INSURANCE


43

25. Double left click on the contract the person is covered under, this action is only to add the

contract to the PM chart. At Encounter Creation, this contract will also need to be added as as

a Guarantor to invoice the contracted agency

26. Confirm that at least an address is listed and left click once on OK, the contract will display in

the PM chart for selection at Encounter Creation

NEXTGEN Billing

CHART MANAGEMENT


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• SLIDING FEE ALERT

o Sliding Fee alerts are real time, if the alert displays, the patient has a current Sliding Fee,

if the alert does not display, the Sliding Fee Schedule Verification and Family Income

has expired

o All sliding fee patient responsibility percentages will also display per encounter when an

encounter is created

• REVIEWING PATIENT SERVICES DOCUMENTS

o filed under the App For Disc Serv & Supp Docs document type will display in PM, in

the document management manila folder, in the Clinical History/Notes Tab of the

patient’s chart

NEXTGEN PM Revenue Cycle CREATING A NEW BATCH AND SET AS ACTIVE


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Purpose:

• A required process to collect and process payments. This action is required prior to

entering any payments in the payment transaction window.

Definition:

• A batch is the total accumulation of captured transactions that is stored in the system.

Each batch must be posted at the end of each business day by any user collecting

payments.




I. CREATING A BATCH

3. Left click once on , the Batch Posting screen displays

4. Left click once on Norton to open the shortcut menu

5. Left click once on New - Batch… , the Batch Maintenance screen displays



46

II. BATCH DESCRIPTION

6. Left click once in Batch Desc field and type in, your first initial of your first name, full

last name and today’s date

• SWilliams 07/06/2010

o If a coworker happens to have the same initials add a middle initial or the

second letter of your first name

o SBWilliams 07/06/2010

7. Utilize the Default Tracking field if user needs the tracking field in the payment entry to

be the same with this each payment transaction in this batch

• Deposit number for all transactions in this batch

8. Utilize the Default Date field if user needs the transaction date to be the same for all

posted transactions of the batch, if not changed, the default date will be the created date

• Deposit date is 07/12/2015

III. SECURING THE BATCH

9. Left click once on the down arrow, next to the Secured to User field to select your name

• This is a very IMPORTANT STEP, if the batch is not secured to a user, the batch is

opened to any other user access.

• It is very important for user to secure each daily batch to you only this will eliminate

from someone else to access and/or modify your batch.

10. Left click once on a user name, this will secure this batch posting to that specific user



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11. Left click once on OK, the Batch Maintenance screen closes and the Batch Posting

screen re-opens.

IV. SET AS ACTIVE BATCH

12. Right click once on the batch to pull up the shortcut menu

13. Left click once on Set as Active Batch



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• A green check mark will confirm your batch is active

14. Left click once on the red located in the upper right hand corner of the Batch Posting

window.

15. Your batch is now complete for use when checking in a patient and collecting payments

16. Anytime a user logs out of NextGen, the user must “Set Batch as Active,” by following

steps # 11-12

NEXTGEN PM Revenue Cycle CORE REVENUE CYCLE PROCESS


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Purpose:

• End users to understand how to properly and in a timely manner process and bill encounters

Definition:

• A standardization of how to process and bill encounters



2. Understand “Getting Started with PM - Common NextGen PM Elements” process

3. Complete “Creating a New Batch and Set as Active” process

I. ACCESSING THE UNBILLED ENCOUNTERS REPORT

4. Left click once on Reports from the menu toolbar

5. Left click once on Accounts Receivable, Unbilled Encounters

• MEMORIZED REPORTS

o Any report from the Reports menu can be saved as memorized. These

memorized reports are only saved based on any filter changes

▪ Left click once on the Reports icon from the toolbar, the

Memorized Reports screen displays

• Based where the report is saved, select the Report Type

▪ Left click once on the down arrow on the Report Type field to see the

drop down list – follow example below



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▪ Left click once on United Solution, a list of available reports will

display

▪ Double left click on the report with the “Unbilled Encounters”

description, the Report Filter screen displays with the Columns tab

defaulted open

▪ Left click once on the “Filter 1” tab in the settings list to enter a date

range by encounter date



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▪ Left click once on “OK”, a list of “unbilled encounters” will display

based on the encounter dates entered

▪ Users are able to drill down directly from this report and access the

patient’s chart to bill or rebill the encounters listed



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II. ACCESSING THE UNBILLED ENOCUNTER

6. Double left click on an “Unbilled Encounter” directly from the report, the patient’s chart will

display, with the Encounters tab defaulted open and the encounter accessed highlighted as

active.

• Alerts may display – read all alerts carefully and take any action as applicable

• Encounters tab will display

o Encounter Information:

▪ Encounter Number

▪ Encounter Date

▪ Encounter Status

▪ Slide %

▪ Denture Contract

▪ Etc…

o Providers:

▪ Rendering,

▪ Referring

▪ Supervisor

▪ Location

o Diagnosis – attached to this encounter

o Guarantor

▪ Self as gurantor :

• 18 and older

• Emancipated minors

• STD contacted minors

▪ Empoyers (Contracts)

• Contracts who pay for services covered under specific

encounter, such as, BayArea Recovery or Title V

Patient Info

Guarantor



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III. CHARGE ENTRY

7. Left click once on the Charges icon on the toolbar, the charge posting screen will

display

• If charges are pending in the “holding tank”, a NextGen alert will display stating how many

pre-loaded charges need to be processed.

o Charges could also be processed by check-out staff as patients checkout for each visit.

If these charges have already been processed, no alert will display

8. Left click once on Process- to accept the charges, charges will display by line item

• Never select Reject. NEVER REJECT A PRE-LOADED CHARGE

• Close leaves the charges in the holding tank

• Once charges are accepted, based on the patient encounter coverage, users may see

adjustments.

o Selfpay patients with a discounted rate, will display a “Sliding Fee Discount

Adjustment”

o Covered patients may display an adjustment based on the coverage

▪ Example - Medicare – Medicare Rate Adjustment – Medicaid – Medicaid

Rate Adjustment

Patient Info



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IV. REQUIRED VERIFICATIONS PRIOR TO BILLING

These requirements are based on current billing processes and may be subject to change.

• Encounter Rendering/Referring/Location Verification

9. Left click once on the Encounter icon located on the charge posting screen toolbar,

the Encounter Maintenance screen will display

o Confirm the following fields match each line item charge

▪ Rendering

▪ Referring

▪ Supervisor (Encounter Only)

▪ Service Location

o Make appropriate changes to encounter or line item charge

▪ Example – encounter Rendering displays Walk-in Only, but charge rendering

displays Berkley and or service location



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• Encounter Insurance

o Billing users should have an understanding on how insurance company claims should

be billed. Based on charges processed and if patient has coverage, confirm if

insurance/coverage is attached to the encounter

10. Left click once on the Encounter Insurance Selection icon to verify the insurance

attached to the encounter

o Self-Pay patients will not have an insurance/coverage attached. The Selected

Insurance field should be blank

o Medicaid (MCOs and most payers identified as financial class “Medicaid”)

▪ All line item charges will adjust off with a “Medicaid Enc Rate

Adjustment”

▪ If required, a T1015 line item charge will be added as a new charge, after

the encounter/charges are billed. The T1015 charge will display with the

current encounter rate dollar amount.

▪ If required, the T1015 along with other procedure codes (charges) will

generate on the claim



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o Medicare – (National Government Services, Novartis, other payers identified as

financial class “Medicare”)

▪ All outside lab charges will display a “0.00” line item charge

o All in-house labs, x-rays, supplies, etc... (any charge not billable to national

government) charges will display at whole dollar in the Insurance 1 bucket and carve

out to Novartis on a secondary 1500 claim.

o All office visit charges will adjust off with a “Medicare Enc Rate Adjustment”



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o Contracts (AGENCY)

▪ See Agency Contract Guide

▪ See Contract List (describes when a contract is covered in full or what is owed

by the patient)

▪ Contract Adjustment (Specific) adjustment will display for any service

covered by the contract

o Contracts (DENTURE)

▪ See Dental Contract Services Agreement Process

▪ See Dental Contract Services Updates Memo

▪ Dental Contract Services Adjustment code will display for any dental

service covered by the contract

o Private Insurance

▪ Third Party Adjustment code will display for any service covered by the

private insurance

▪ Any patient responsibility remaining balances will display in the patient self-

pay bucket

• This usually occurs after the EOB is received when adjustments and

payments are entered

• Charges Review

o All charges per encounter MUST BE REVEIWED. Each encounter, based on the type of

visit, display specific visit charges

o Medical Encounters (verify by rendingering provider on encounter)

▪ Medical encounters will display Medical CPT Office Visit Codes to confirm

charting is complete, including but not limited to, addional CPTs, such as, lab,

xray, in-house, suppies, etc..

• To confirm a completed chart – a Medical CPT Office Visit code will be

included with each medical encounter. such as, New & Established Office

Visit, New & Established Patient Preventive Visits, CPTs

▪ If the Medical CPT Office Visit Code is missing, users must confirm the visit type

with the appointment listing, see “Confirming an Appointment” process and with

the encoutner within the EHR database. This is a confirmation that either the

patient was seen under other circumstances, (Lab/Xray Only, Dental, Counseling,



58

etc…) other than, a Medical Office Visit or the medical provider has not

completed charting

o Access the EHR database, complete “Getting Started with NextGen -

How to Access, Login and Exit the NextGen Application”

o Access the patient’s EHR chart, see “Getting Started with EHR - How to

Access Patient Charts in HER”

o Review the encounter by:

▪ Patient History Toolbar - Based on the date of service, medical

provider, and location; left click once on the expand button, to

the left of the manila folder, to expand the medical encounter

▪ Review templates – GCHD Finalized is the template utilized by

the Medical Provider to process the Medical Office Visit Codes.

• If the GCHD Finalized template does not display (meaning,

it does not exist) under the medical encounter, billing users

will determine the medical encounter is incomplete. Follow

current follow-up processes for completion of Medical

Encounter.

• If the GCHD Finalized template does display (meaning, the

template is visible) under the medical encounter, billing

users will access the templete by double left clicking to open

• The GCHD Finalized template is used by Medical staff to

submit Medical Office Visit CPTs. Even if the template

diplays under the encounter, billing users must open the

GCHD Finalized template to confirm a CPT was submitted.



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• Opened GCHD Finanlized template – no CPT calculated or

submitted – INCOMPLETE. Follow current follow-up

processes for completion of Medical Encounter.

• Opened GCHD Finanlized template – CPT calculated, but

not submitted – INCOMPLETE. Follow current follow-up

processes for completion of Medical Encounter.

• Opened GCHD Finanlized template – Calculated and

Submitted – COMPLETE

o This occurs when a PM user Rejects charges in the

charge posting screen from the “holding tank”

o If charges were once submitted, billing users will

have to enter charges manually – see Charges –

Manual Entry of this document. (note Diagnosis

codes associated to charges)



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o Dental Encounter (verify by rendingering provider on encounter)

▪ Dental ecounters will display Dental CDTs, such as, Diagnostic Exams,

Restorative, Endodontics, Periodontics, & Oral Surgery, including, but not limited

to, addional CDTs, such as, xrays etc.. A Dental Encounter should never only

include XRay CDTs

▪ If Dental CDT codes are missing, users must confirm the visit type with the

appointment listing, see “Confirming an Appointment” process and review

documentation in EDR to confirm if the dental provider has not completed

charting or the patient left without being seen

o Access the EDR database, complete “Getting Started with NextGen - How to

Access, Login and Exit the NextGen Application”

o Access the patient’s EDR chart, complete “Accessing a Chart in EDR”

o Review the EDR chart:

▪ Based on the date of service, review completed CDTs in the EDR database,

within the Completed and Planned chart item section

▪ If CDT is not listed in the Completed items section, this means charting is

– INCOMPLETE. Follow current follow-up processes for completion of

Dental Encounter.

▪ If CDT is not listed in the Completed items section and only in the

Planned items section, this means charting is– INCOMPLETE. Follow

current follow-up processes for completion of Dental Encounter.

▪ If CDT is listed in the Completed items section, this means charting is–

COMPLETE.

o This occurs when a PM user Rejects charges in the charge

posting screen from the “holding tank”

COMPLETED ITEMS

PLANNED ITEMS



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o Hygienist Encounter (verify by rendingering provider on encounter)

▪ Hygienist ecounters will display Dental Hygienist CDT codes, such as, Preventive

& Periodontal to confirm charting is complete

▪ Follow Dental Encounter process listed above

o Counseling Encounter (verify by rendingering provider on encounter)

▪ Counseling ecounters will display Counseling CPT codes to confirm charting is

complete




Access Patient Charts in EHR”


▪ Patient History Toolbar - Based on the date of service, counseling


the left of the manila folder, to expand the counseling encounter

▪ Review template – BH – Indvidual Counsel/Psych Prog Note is

the template utilized by the Counselor to process the Counseling

Visit Codes.

o If the BH – Indvidual Counsel/Psych Prog Note template

does not display (meaning, it does not exist) under the

medical encounter, users will determine the counseling

encounter is incomplete. Follow current follow-up processes

for completion of Counseling Encounter.

o If the BH – Indvidual Counsel/Psych Prog Note template

does display (meaning, the template is visible) under the

counseling encounter, users will access the templete by

double left clicking to open

o The BH – Indvidual Counsel/Psych Prog Note template is

used by the Counseling staff to submit Counseling Visit

CPTs. Even if the template diplays under the encounter,

billing users must open the BH – Indvidual Counsel/Psych

Prog Note template to confirm a CPT was submitted.

o Opened BH – Indvidual Counsel/Psych Prog Note

template – scroll to the very bottom of the template, if the

“Submit to Superbill” button is not selected and missing the

green check, no CPT has been submitted –



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INCOMPLETE. Follow current follow-up processes for

completion of Counseling Encounter.

o Opened BH – Indvidual Counsel/Psych Prog Note

template – scroll to the very bottom of the template, if the

“Submitted to Superbill is checked green, the CPT has been

submitted – COMPLETE.

o This occurs when a PM user Rejects charges in the

charge posting screen from the “holding tank”

o If charges were once submitted, billing users will

have to enter charges manually – see Charges –

Manual Entry of this document. (note Diagnosis

codes associated to charges)

o Nurse Only Encounter (usually displaying the 99211 Medical Office Visit CPT code)

▪ Nurse Only encounters will display a 99211 Medical Office Visit CPT code,

including, but not limited to, addional CPTs, such as, Depo, Wound Care. A Nurse

Only encounter can also ONLY display immunizations, in-house medications

injections, patient education dummy codes, & TB Skin Test & Readings without

the Medical Office Visit CPT included.

▪ If the required 99211 Medical Office Visit CPT code is missing, follow the

Medical Encounter process listed above

o Lab/Xray Only Encounter (usually ONLY displaying lab/xray CPT codes)

▪ Lab/Xray Only visits will only display lab/xray charges

▪ Users must confirm the visit type with the appointment listing, see “Confirming

an Appointment” process and the encoutner documentation in EHR must be

reviewed to confirm lab/xray only visit




Access Patient Charts in EHR”


o Patient History Toolbar - Based on the date of service, medical


the left of the manila folder, to expand the medical encounter



63

o Review templates – If the Lab Master is the ONLY template

utilized by the medical staff, then billing users can determine this

visit is a lab/xray only visit.

o Medical/Dental Record Request Encounter (Only displays dummy MedRec charge)

• Charges – Manual Entry

o For any charges discovered “Submitted or Completed” based on the processes listed

above, but are NOT displaying in the Charge Posted screen, billers must manually

enter missing charges with associated diagnosis codes.

▪ Access the Charge Posting screen as indicated in the charge entry section listed

above.

▪ Left click once on the New button

▪ Left click once in the Svc Item (Service Item) field and type in the missing CPT or

CDT code

o If modifiers are requried, enter modifiers in the CPT4 fields, there are 4

fields available for modifiers

▪ Left click once in the Diag (Diagnosis) field and type in the diagnosis assiciated to

the charge

o Left click once on the Next button if there are more than one

missed code

▪ Left click once on Save

o All other required fields will filter based on service item code or from the

encounter



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V. BILLING CHARGES

▪ This step should only be completed once all charges have been reviewed.

11. Left click once on the Bill Encounter icon, the Encounter Bill screen will display

• Self Pay

12. Confirm checkboxes to the left of each service charge being billed are checked

13. Left click once on OK, a Nextgen alert will display “Do you want to bill this self-pay

encounter”



65

14. Left click once on Yes, encounter is now billed as self-pay to patient

• Medicaid

15. Confirm checkboxes to the left of each service charge are checked, action to bill service

charge

▪ For all service charges needed to display on a claim, confirm a green check mark is

displaying to the right of the service charge

▪ Based on current Medicaid billing - all service charges are billed to Medicaid.

16. Left click once on OK, the claim will go through an initial claim scrub. The system will create

a Claim Production Report for the encounter, a Claim Process screen will display indicating a

claim is being processed.



66

o Claim Production Status Report

▪ Users must read the Message column and if errors occurr during the claim

process, take action as indicated.

▪ Medicaid claims will produce and service charges will display on a 1500 claim

form for Medical service charges and a ADA for Dental service charges

17. Left click once on the Exit icon to close the Claim Production Status Report, a

Nextgen alert will display “No errors were encountered. Create claim?

18. Left click once on OK, the Charge Posting screen will display

a. This example is addressing Medicaid, Medicaid utilizes Encounter Rate Billing – a

required additional line item, what is called a “T1015” code will display on the 1500

claim form.



67

• Medicare


charge

20. For all service charges needed to display on a claim, confirm a green check mark is


a. Because most of service charges to Medicare either adjust off or $0.00 out, the only

green check mark that will display, are carved out service charges. Users must use

Balance Ctl to manage service charges to display on claims

o Left click once on the Balance Ctl button to access the Balance

Control screen

o Left click once in the “R” column to the Right of Ins1 Amt, this will display a

green check mark and include the service charge on the claim.



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b. Based on current Medicare billing - all service charges are billed to Medicare.




o If a NextGen alert displays stating “This request will produce a total of 2 claims. Do

you want to proceed”?

o Left click once on Yes.

▪ Most Medicare claims allow in-house labs, medications, supplies,

etc…to be carved out on a 1500 claim form.



69




▪ Medicare claims will produce and service charges will display on a UB92 claim

form for Medical service charges. And if, any inhouse labs, medications, supplies,

etc… are services charges on the same encounter, these charges are carved out

and sent out on a 1500 cliam form

22. Left click once on the Exit icon to close the Claim Production Status Report, the

Charge Posting screen will display.

a. This example is addressing Medicare, Medicare utilizes Encounter Rate Billing – a

required additional line item, what is called a “G” code will display on the UB92 claim

form.

• Contracts

o Refer to Agency Contract Guide and Contract List

▪ Based on the Agency Contract Guide and Contract List – varies billing

processes can occur

▪ A contract can be billed as self pay if the patient under contract is

responsible for the bill

▪ Internal invoicing through the accounting department is conducted to

bill agencies

▪ No claims are produced, if a claim is produced - delete

▪ If applicable – the guarantor must be the contracted agency and not self



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charge

24. Left click once on OK, a Nextgen alert will display “Do you want to bill this self-pay

encounter”

25. Left click once on Yes, encounter is now billed as self-pay to patient

o If a NextGen alert displays “No charges are selected for proceeding. Go to Balance

Control and select at least one charge before continuing”

o Left click once on OK, to return to the Encounter Bill screen

o Left click once on the Balance Ctl button to access the Balance

Control screen

o Left click once in the “R” column to the Right of Ins1 Amt, this will display a

green check mark and include the service charge on the claim.



71







72



▪ Contract claims will always produce errors.

▪ Contract claims will be created but deleted immediately.

• The system will not bill service charges unless a claim is created.


Nextgen alert will display “The claim contains errors which may cause it to be rejected by the

claim payer. Do you want to create it anyway”?

28. Left click once on Yes, the Charge Posting screen will display

29. Left click once on the Claims icon from the PM toolbar to open the Encounter

Claim Requests screen, to delete the dirty claim.

30. Right click once on the dirty claim to display the shortcut menu

31. Left click once on Delete

32. Left click once on Close, on the Encounter Claim Request screen, to return to the Charge

Posting screen.



73

• Private Insurance


charge

▪ For all service charges needed to display on a claim, confirm a green check mark is








▪ Private Insurance claims will produce and service charges will display on a 1500

claim form for Medical service charges and a ADA for Dental service charges



74


Nextgen alert will display “No errors were encountered. Create claim?

36. Left click once on OK, the Charge Posting screen will display

• Exclude Service Charges from Claims

o If at any time a service charge should not be included on a claim and not be

billed to this insurance, users must remove the green check mark and remove

the dollar amount from the insurance bucket.

37. Left click once on any green check mark in the “R” column to the Right of Ins1 Amt, to

remove service charges from a specific insurance amt buckets and or secondary/teritary

insurances.

o Enter dollar amounts in the appropriate Ins Amt fields when choosing other

than the Ins1 bucket.

o Removing any dollar amount from the insurance amt buckets will autopopulate

in the Patient Amt field and the total becomes patient responsibility



75

VI. CONFIRMING OR VIEWING A CLAIM

• Confirming a claim has been created, clean and pending processing

o To view individual claims, the charges window or an encounter must be selected to view a

certain claim form for a specific encounter

38. Left click once on the Claims icon from the PM toolbar, the Encounter Claim

Requests screen

o All claims associated with the specific encounter will be listed

o A status of “Clean” “Pending” is standard



76

o A status of “Dirty” should NEVER be kept, but deleted and billing must be corrected to

display a “Clean” claim. (NEVER DELETE ARCHIVED CLAIMS)

o A green check mark indicates the claim is pending processing.

o See “How to Process Claims”

• Viewing a Claim

39. Right click once on the claim line, to display the shortcut menu and select open, the Claim

will display

o 1500



77

o UB92



78

o ADA

NEXTGEN PM Revenue Cycle EXPORTING CLAIMS


79

Purpose:

• Process pending claims created from billed encounters to receive payment

Definition:

• To accurately export billable claims to payers through the clearing house




3. Understand “Basic Billing – Things to Know”

I. CREATING THE EXPORTING CLAIM FILES

4. Left click once on the EDI File icon, the 837 Electronic File Creation screen

displays

5. Left click once on the down arrow of the Submitter Profile Library field. Users will select

each individual library listed below and process individually:

a. ClaimRemedi 5010

b. ClaimRemedi 5010 TMHP

c. ClaimRemedi 5010 UB

d. ClaimRemedi FP 5010

• Each payer is linked to a specific library based on requirements.



80

6. Left click once on the down arrow of the Claim Form field and select the type of claim that

needs to be exported

• 1500

• ADA

• UB92

7. Left click once on the down arrow of the Claim Type field and select the correct claim type

such as Commercial or Medicaid

8. Left click once on the find, button to list all claims needing to be uploaded to the

clearing house.



81

9. Left click once in the File Options field, select where to send the file and create a file name

convention for each type of Claim form/Type

• It is preferred all claim files are saved and stored on shared drives for future access if

needed

o Keep from saving claim files on personal desktops.

• Ex: Y:\claims\Nov 2017\11212017commercial

o Y is a shared drive, claims is a file folder, Nov 2017 is a file folder,

11212017commerical is the file name

o This helps identify the type of claims contained in this file

10. Left click once on the process, button to export the files to the shared drive, an

Electronic Send Report will display.

• This confirms a file was created

11. Repeat these steps for each Submitter Profile Library, Claim Form and Claim Type

II. EXPORTING CLAIM FILES

• Access the Clearing House

12. Complete ClaimRemedi process, https://claimremedi.providersportal.com/ and log in.

• Selecting the Claim Files

13. Left click once on Submit – Claims, the Claim Submission page will display

https://claimremedi.providersportal.com/



82

14. Left click once on the Select button, a search file screen will display. Search for the processed

claim file needing to be uploaded to the clearing house.

15. Left click once on Open, the file will display in the Click Select Files to get started section

• Claims will auto populate in the Uploaded Claim Files section



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16. Repeat these steps for each claim file

17. Follow ClaimRemedi process to complete the Claim Edits within ClaimRemedi process

NEXTGEN PM Revenue Cycle CLAIM REQUESTS


84

Purpose:

• To verify the request status(pending or archived), change media type (paper or electronic) of a

claim. This process is usually performed if a payer is requesting changes to a claim.

Definition:

• The act of viewing pending or archived claims within Nextgen





I. SEARCHING FOR CLAIMS

4. Left click once on , the Claims Request Lookup screen displays

5. Left click once on the down arrow of the Request Status field, to select Archived or Pending

claims

• Archived claims are not available for processing, but can be flagged for re-bill or

regenerate a claim request



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• Pending claims are still available for processing.

• Complete Exporting Claims process to archive claims

6. Left click once on the down arrow of the Media Type field, to select either electronic or paper

7. Left click once on the down arrow of the Claim Form field to select the type of form

8. Left click once on the down arrow of the Claim Type field to narrow down the search

9. Left click once on the Find button, all claims filtered will display in the Claim Requests field

• A pending list can help determine how many claims are still needing to be uploaded to

the clearing house

II. CHANGING MEDIA TYPES

10. Right click once on any one claim to display the shortcut menu

11. Left click once on the Electronic Claim option, a NextGen alert will display, Change Claim’s

media type from electronic or paper?



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a. The nextgen alert will display, Change Claim’s media type from paper to electronic?

For paper claim changes to electronic, adding a check mark on the Electronic Claim

option, indicating the claim will be processed as an electronic claim

• This process is usually required from the payer when a claim needs changes

• The Medial Type will change from E (Electronic) to P (Paper) or vice versa

• Adding the check mark to the Electronic Claim option changes the from Paper to

Electronic



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III. PRINTING CLAIMS

12. Right click once on any paper media claim to display the shortcut menu

• this option is not available for electronic media type claims

13. Left click once on Print - Claims, the claims printing screen displays

• The Update “Pending” to “Archived” status on paper claim is checked

14. Left click once on OK, all selected paper claims will print to the defaulted printer

15. Did all claims print correctly? Left click once on Yes or No

a. Yes – system will change status of claim from pending to archived

• Printing Options

b. No – system will keep status of pending on claim

o If claim did not print correctly – adjustments can be made through the Options

button



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o Enter offset from top and left margins

o Left click Ok, to try printing

IV. ARCHIVED CLAIMS

• Archived claims are not available for processing, but can be flagged for re-billing or

regenerate a claim request

• Flag Encounter for Rebill

16. Left click once on Flag Encounter for Rebill, the rebill screen displays, this will allow the

user to run the encounter through the billing process to create a new claim request

17. Left click once on OK, the Claim Request Rebill reason screen displays

18. Left click once in the field and type in a reason, (i.e., policy number corrected, added gender

of the patient), the status on the encounter should change to rebill



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• The encounter is considered rebilled in the system, but the new claim has been

exported to the clearing house

• Follow Exporting Claims process

• Regenerate Claim Request

19. Left click once on Regenerate Claim Request, if the user does not want to make any changes

to the claim, this request will not go through the bill process again, but will create a new claim

with the exact same information submitted before and place it in a pending status ready to

process

20. Left click on OK

NEXTGEN PM Revenue Cycle PATIENT OR EOB PAYMENTS


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Purpose:

• To collect any outstanding balances on patient accounts

Definition:

• To accurately collect and apply patient payments for outstanding balances





I. ACCESSING THE ACTIVE BATCH

4. Left click once on , the Batch Posting screen and the users secured batch

displays

5. Double left click once the user secured batch to access the Payment Entry screen



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II. ACCESSING THE ACCOUNT/ENCOUNTER

• ACCOUNT SOURCE

▪ Most patient payments must be posted to the Account source, with the

exception of payments made to Dental Contract Service encounters, the

source will be Encounter not Account

• ENCOUNTER SOURCE

▪ Payer payments and Dental Contract Service payments will be applied to an

encounter source. See both current “Dental Contract Service Agreement

Process” and “Dental Contract Service Updates Memo” procedures to

probably apply payments

6. Left click once on the down arrow of the Source field, select Account/Encounter



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7. Left click once on the Search icon, to search for the account name, the

Account/Encounter List screen displays





o PERSON IS NOT LISTED IN ACCOUNT/ENCOUNTER LIST

• If user determines the person is not listed in Account/Encounter List, this

person does not have an account and the account may be in someone else’s name

• Access the patient’s chart, relations/role category or communicate with person to

whom the account holder may be, then proceed with person is listed process

below

O PERSON IS LISTED IN ACCOUNT/ENCOUNTER LIST

• If user determines the person is listed in Account/Encounter List

11. Confirm the searched person is the correct person by verifying the last name, first name,

and DOB

12. Double left click on the person’s last name to select the patient and apply payments to

their account, the Payment Entry screen displays with patient’s account displaying



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• Alerts may display, read carefully, take any action as applicable and close

• ACCOUNT SOURCE (used for patient payments only)

• Any charge not paid will display with a balance

• ENCOUNER SOURCE (used for patient and specific payer payments)

• Encounter source is encounter specific, the most recent encounter with a balance will

display first

o Left click once on the down arrow of the Enc/Clam# field and select the

appropriate encounter to enter the payment



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o ENTERING THE PAYMENT

• ACCOUNT/ENCOUNTER PAYMENT ENTRY - PATIENT ONLY

• ONLY if payments are collect should a user access the Payment Entry screen

13. Left click once on the down arrow of the Pay Code field and select the appropriate

payment method.

14. Left click once in the Tracking field, for Credit Card/Debit Card and Check payments

ONLY

a. Enter an authorization number for all Credit Card/Debit Card payments

b. Enter a check number only for all Check payments

15. Left click once in the Pay Amt field and enter the total amount user is collecting

o UNAPPLIED PAYMENTS

• If user is collecting more than the balance is displaying, an Unapplied

Payment screen will display

▪ Account Source

▪ Encounter Source

• Left click once on OK

▪ Account Source

o An unapplied amount will display in the Acct Credit field

▪ Encounter Source

o An unapplied amount will display in the Enc Credit field



95

o PAYMENTS POSTED TO OUTSTANDING LINE ITEMS

• Payments will post to the oldest line item with a balance first, as account

payments are collected

• Left click once on Save

• ENCOUNTER PAYMENT ENTRY – EOB PAYMENTS

(can only be applied through the encounter)

• ONLY if payments are collect should a user access the Payment Entry screen

16. Left click once in the Payer field and select the payer name/patient name option

17. Left click once on the down arrow of the Pay Code field and select Third Party

Payment method.

18. Left click once in the Tracking field, enter deposit information

19. Left click once in each line item within the Third Party Payment column and enter

each total for each line items listed on the EOB



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• ENCOUNTER ADJUSTMENT ENTRY – EOB ADJUSTMENTS

(can only be applied through the encounter)

20. Left click once on the down arrow of the Adj Code field and select the correct

adjustment code based on the adjustment per payer

21. Left click once in each line item within the “name of adjustment” Adjustment column

and enter each total for each line items listed on the EOB

22. Left click once on the Recalc button, the system will auto produce totals in the Pay Amt

and Adj Amt fields

23. Left click once on Save

o PRINTING THE RECEIPT (if patient requests one to be mailed)

24. Left click once on the printing icon, to print the patient’s receipt, the shortcut

menu will display

25. Left click once on Account Receipt, the Print Account Receipt screen will display



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26. Left click once on Print, the Account Receipt will print to the defaulted printer, make

sure the default printer is where Receipts print, this copy is for patient

27. Left click once on Print again, the Account Receipt will print to the defaulted printer,

make sure the default printer is where Receipts print, this copy is for the user to

reconcile with End of Day Balancing.

28. Left click once on Close, continue to follow patient services procedures



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29. Left click once on icon, to close the Print Account Receipt screen, the Payment

Entry screen displays

Patient Info

Account holder

List of Encounters

payment posted to Total Payment

NEXTGEN PM Revenue Cycle VOIDING CHARGES

REVERSING ADJUSTMENTS AND PAYMENTS


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Purpose:

• Voiding charges, adjustments and payments reversals are performed to correct billing

records as needed. Billing users must document reasons to why a charge was voided, an

adjustment was added or a payment was reversed.

Definition:

• The act of voiding and/or adjusting charges or apayments from a patient’s

encounter





4. Left click once on , the Charge Posting screen displays

I. SEARCHING FOR ENCOUNTERS BY PATIENT NAME

5. Left click once on the search icon the Patient Lookup dialog box displays, to

search by patient name




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6. Left click once in the Last name field and enter the person’s last name




• NOTE: The less search criteria the user enters, the more person search result will

display. If person is not listed based on search ALWAYS perform a double

search by removing data from a field. Ex: Only enter a last name without a DOB

or enter a DOB without a last name.

9. Left click once on the patent name to highlight the patient

10. Left click once on open, the patient’s information will populate on the Charge Posting

screen

11. Left click once on the down arrow of the Encounter field to select the correct encounter

number in which charges need to be voided




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II. SEARCHING FOR ENCOUNTERS BY ENCOUNTER NUMBER

12. Left click once on the search icon the Patient Lookup screen displays, to search

by encounter number (Enc Nbr)

13. Enter the encounter number in the Enc Nbr field to search by encounter number and left

click once on find, the patient name and encounter will display




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III. VOIDING CHARGES

• Once a charge is voided it cannot be reversed and a new charge will need to be entered, if

applicable

• $0 SIM items cannot be voided unless other charges exist on the same encounter

14. Left click once on the Line Item needed to be voided, this action will highlight the charge

• NOTE: if charge has not been processed through nightly processing, the charge

can be deleted. A delete button will display, not a void button

15. Left click once on VOID, located in the middle of the screen.

• Confirmation Screens

a. Charges without transactions

▪ Will display a line through the line item and no line item credit will

display in any insurance or patient buckets




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b. Charges with transactions

▪ Will display a line through the line item and line item credit will

display in patient bucket

▪ Line item credits must be reversed – see Reversals: Adjustments or

Payments

IV. REVERSALS

• ADJUSTMENTS

• All adjustments must be reversed using the same exact adjustment code

a. Example, a charge is displaying a private insurance adjustment, when

reversing the adjustment, the private insurance adjustment code must be

used

16. Left click once on the black arrow to the left of the voided date/svc item charge to expand

the line item and display all adjustments (and/or payments) to the line item

17. Double left click once on either the adjustment code, the posted transaction Payment

Entry window with detailed information will display




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▪ Make note of the transaction payer, tracking, date, adjustment code, transaction

notes, and adjustment amount

▪ Example:

o Payer: Aetna/Test4, Patient4

o Tracking: Blank

o Date: 10/02/17 (same as original date)

o Adjustment Code: Private Insurance Adjustment

o Adjustment Amount (Column):-$21.00

o Transaction Note: Blank

18. Left click once on the X to close the posted transaction Payment Entry screen, the

Charge Posting screen will display

19. Left click once on the Add Transaction icon, a blank Payment Entry screen will

display (same window as if user is adding a patient payment)

▪ User must enter all data noted within the posted transaction payment entry screen

review

▪ Example: Left click once in each of the following fields and select or enter

o Payer: Aetna/Test4, Patient4

o Tracking: Blank

o Date: 10/02/17(same as original date)

o Adjustment Code: Private Insurance Adjustment

o Adjustment Amount (Column):-$21.00 (same exact way the dollar was

posted)




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▪ Dollar amount must be entered directly in the adjustment

column on the line item from which the adjustment is being

reversed from

o Transaction Note: Enter a note as to why the adjustment is being reversed

20. Left click once on the Recalc button to recalculate the dollars entered within the

adjustment column

▪ A total amount dollar amount should display in the Adjustment Amount field

21. Left click once on the Save button to save the transaction, if a Status is required – select

one of the following

• You must also determine the status in which the remaining balance should display

in

• Settled moved to self

• Use if the remaining balance is patient responsibility

• Rebill

• Use if the remaining balance needs to be rebilled

• Appeal Deny

• Use if the remaining balance needs to be appealed

• None

• Use if the remaining balance is $0.00, if the balance is a wrap around

for Medicaid, or none of the above apply




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• PAYMENTS

• This process is similar to reversing adjustments. In most instances payments will

be moved from one encounter to another. Enter the dollar amount in the opposite

manner in which it was entered, using the (-)sign with the same pay code used.

❖ Example, a patient paid $15.00 in cash towards a nominal fee, but the

patient left without being seen and the nominal fee is voided. The payment

should be reversed by entering -$15.00 on the nominal fee line item, using

the Cash Payment in the Pay code field.

22. Follow steps in the Reversal section, however user is reviewing payments

▪ Make note of the transaction payer, tracking, date, paytment code, transaction

notes, and pay amount

▪ Example:

a. Payer: Test4, Patient4

b. Tracking: Blank

c. Date: 11/09/17 (same as original date)

d. Payment Code: Cash Payment

e. Payment Amount (Column):$15.00

f. Transaction Note: Blank

23. Left click once on the Add a Transaction icon, on the charge entry screen, the

Payment Entry screen will display

▪ User must enter all data noted within the posted transaction payment entry screen

review

▪ Example: Left click once in each of the following fields and select or enter

a. Payer: Test4, Patient4

b. Tracking: Blank




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c. Date: 11/09/17 (same as original date)

d. Payment Code: Cash Payment

e. Payment Amount (Column):-$15.00

▪ Dollar amount must be entered directly in the payment column on the

line item from which the payment is being reversed from

f. Transaction Note: Enter a note to why the payment is being reversed and

where the payment is being applied.

▪ Example: patient left without being seen and payment moved to encounter

#5555 with outstanding balance

V. RE-ENTERING A REVERSED PAYMENT

• For all payment reversals – the payment must be re-entered, even if re-entered onto a

different encounter or to the patient account. See Patient and EOB Payments. Users

must use all original payment dates and codes when re-entering payment reversals.

NEXTGEN PM Revenue Cycle PRE-LISTING AND MANAGING PRE-LISTED ENCOUNTERS FOR COLLECTIONS


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Purpose:

• To identify encounters for CHW collection process

Definition:

• A pre-listed encounter is eligible for collection process and bad debt

• Encounters can be pre-listed for review before they are turned over for collection and

assigned a Bad Debt status. The following conditions must be before pre-listing an

encounter:

▪ The encounter and all line item charges must have a Billed status.

▪ The Insurance balances must be equal to zero($0.00) dollars.

▪ The Patient balance must be greater than zero($0.00) dollars.

▪ No credit balance can exist on the encounter.

▪ No unposted transactions can exist on the encounter.





I. ACCESSING THE ENCOUNTER

4. Left click once on , to search for a specific encounter to pre-list, the Encounter

Lookup screen displays

▪ If an encounter number is not available, a person lookup can be conducted on this

same screen

▪ Left click once in the Last name field and enter the person’s last name

▪ Left click once in the Birth Date field and enter the person’s date of birth

▪ Left click once on the Find button to display a search result of Matching Records

of all persons with the same last name and date of birth


will display. If person is not listed based on search ALWAYS perform a

double search by removing data from a field. Ex: Only enter a last name

without a DOB or enter a DOB without a last name


listed



109

5. Left click once in the Enc Nbr field and enter the encounter to pre-list

6. Left click once on Find

7. Right click once to display the shortcut menu and select Chart, the patient’s chart will

display defaulted to the Encounter’s tab



110

II. DOCUMENTING THE ENCOUNTERS AS PRE-LISTED

8. Right click once on the encounter in which needs to be Pre-Listed, the shortcut menu

will display



111

9. Left click once on Pre-List

10. Left click once on Open, the Pre-List Multiple Encounters From Chart screen will

display

11. Left click once on the down arrow for the Collection Agency field and select “CHW

Billing and Collections”

12. Left click once on the Calendar icon to select the Effective Date

13. Left click once in the Guar Credit Rating field and select Bad

14. Left click once in the Bad Debt Status and select Letters Only

▪ Multiple encounters can be selected on this screen

15. Left click once on OK, the encounter is now pre-listed



112

III. DOCUMENTING THE ENCOUNTERS WITH FOLLOW UP DATES

16. Right click once on the encounter to enter a follow up date, the shortcut menu will

display

17. Left click once on Open, the Encounter Maintenance screen will display with the general

tab defaulted open

18. Left click once on the Billing and Collections tab



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19. Left click once in the Collection Follow-Up Date field to enter a follow up date in

accordance with the “CHW Billing and Collections” policy for the specific collection

letter time frame

a. Debt Warning Notice, 1st letter at 60 days with at least $100 balance

b. 2nd Debt Warning Notice, 2nd letter sent if no response at 30 days from

the first notice

c. Suspension, 3rd letter sent if no response at 60 days from the 2nd notice

20. Left click once in the Collection Follow-Up Date field to enter a date in which the user

must follow-up if the patient has not taken action.



114

• ALL THESE STEPS WILL NEED TO BE REVERSED IF THE PATIENT

IS PLACED ON A BUDGET PLAN

▪ Select Delete from the Pre-List option

▪ Remove the Follow-up date on the Billing and Collection tab of the

encounter

21. Left click once on OK to save the follow-up changes

IV. ASSIGNING THE CORRECT COLLECTION LETTER TO THE ACCOUNT

22. Right click once on any of the encounter to access the account, the shortcut menu will

display

23. Left click once on Account, the account will display with the properties tab defaulted

open

24. Left click once the down arrow in the Collection Letter field and select one of the

following in accordance with the CHW Billing and Collection Policy for the specific

collection letter time frame

▪ Debt Warning Notice, 1st letter at 60 days with at least $100 balance

▪ 2nd Debt Warning Notice, 2nd letter sent if no response at 30 days from the

first notice

▪ Suspension, 3rd letter sent if no response at 60 days from the 2nd notice



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25. Left click once in the Send Collection Letter check box to display the check mark, the

system will include this patient’s account to the list when letters are generated

26. Left click once on the red “X” to close the chart and save the changes

27. Left click once on Yes to save changes to the account

V. PRINTING PRE-LISTED LETTERS

28. Left click once on File on the PM menu bar, to display the shortcut menu

29. Left click once on Print Forms, Letters, Account Collection Letters, the Batch

Account Collection Letters screen will display



116

30. Left click once on Find, a list of pending letters will display

▪ Confirm a check mark is selected for each letter to print

▪ Confirm the Update Letter Dates check box is selected. This will reset and

indicate no same letter is printed in the next letter run

31. Left click once on Print, letters will print to defaulted printer. A nextgen alert will

display, Did the letter(s) print correctly?

32. Left click once on Yes, letters selected for printing will no longer display on the Batch

Account Collections Letters screen.

▪ Letters should be processed weekly

▪ A Last Letter Print Date will display in the patient’s account

▪ The letter that was once assigned will no longer display in the Collection Letter

field

▪ Repeat all steps by adding additional collection letters at the account level for

each collection letter needed based on the “CHW Billing and Collection Policy”



117

VI. RUNNING THE COLLECTIONS FOLLOW-UP REPORT

• This report will be used to keep track of when the next letter is needed

33. Left click once on Reports on the menu bar to display the shortcut menu

34. Left click once on Memorized to display a report listing

35. Left click once on the down arrow for the Report Type field and select United Solutions

36. Double click on the Collections Board Panel Report, the report filter will display with

the columns tab defaulted open



118

37. Left click once on Filter 1, enter encounter dates. Start date will always be 10/19/2010

through the current end of month.

38. Left click once on the Filter 2 tab and make sure Collection Letter 1 is entered for the Pat

Sts field.

39. Left click once on OK to run the report, the report will display



119

• This report will list all encounters with a patient status of Collection Letter 1

NEXTGEN PM Revenue Cycle CREATING AND MANAGING BUDGET PLANS


120

Purpose:

• Based on the CHW Billing and Collections Policy, patients are allowed the opportunity to

pay outstanding balances in installments

Definition:

▪ An installment plan for patients to be able to pay off outstanding balances

due




3. Understand “Revenue Cycle Processes – Things to Know”

I. ACCESSING THE ACCOUNT

4. Left click once on the Account icon to locate the patient’s account, the Account

Lookup screen will display

5. Left click once in the Employer/Last Name field and enter a patient last name

6. Left click once on Find to located the patient account



121

7. Double left click on the Account to open the account, the patient account will display

with the Properties tab defaulted open

II. CREATING A BUDGET PLAN

8. Left click once on the Budget tab of the patient’s account, any budget plan assigned or

completed will display or no budget plans will display if the patient has never been on a

budget plan



122

9. Left click once on the Norton button to display the shortcut menu, to create a new budget

plan

10. Left click once on New, the Budget Details screen will display

▪ Confirm the Non-Perpetual radio button is selected – this option allows to only

select specific encounters to be included in the plan

11. Left click once on the Norton button to display the shortcut menu, to select encounters to

be included in the budget plan

12. Left click once ALL to add all encounters qualified for a budget plan

• All encounters will display with a patient balance will display



123

13. Left click once to highlight each encounter that should not be included in the Budget

Plan

14. Left click on the Norton button to display the short cut menu and select Delete for each

encounter not included in the Budget Plan

• The Total Patient Balance will display the total Pat Bal of all encounters

selected for the budget plan

15. Left click once in the Budget Due Date and enter when the first payment is due

▪ Based on when the patient wants to make the first payment, but before 30 days

16. Left click once on the Payment Cycle down arrow to select Every 30 days

17. Enter the dollar amount the patient agrees to pay in the Payment Amount field, see

“CHW Billing and Collection Policy” for minimum

18. Hit the Tab key on your keyboard, the system will calculate the Total # Payments.



124

19. Left click once on Apply, the budget plan is now in active

20. Left click once on Close, the budget plan will display in the Budget tab of the patient’s

account

▪ If the patient’s encounter is included in a budget plan, the encounter will not display on

the statement. Budget plan encounters will be managed and included on budget plan

reminder letters

o Adding additional encounters at a later date to the same budget plan

21. Left click once on the current Budget Plan to highlight the plan and add the additional

encounters

22. Left click once on the Norton button to display the short cut menu and select open



125

23. Left click once on Re-Establish, the Budget Plan becomes editable

▪ Follow same steps as listed above when the budget plan was originally created

▪ A newly “Active” budget plan will display and the previously active budget plan will

inactivate



126

III. PRINTING BUDGET LETTERS

24. Left click once on File on the PM menu bar, to display the shortcut menu

25. Left click once on Print Forms, Letters, Budget Letters, the BudgetLetters screen will

display

▪ All check marks for each Include Budget Letters categories will defaulted checked

▪ A total of Letter Count will display to the right of the Budget Letter categories – this total

letters will print

26. Left click onc on Print



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▪ A confirmation if letters printed properly will display – left click once on Yes

IV. RUNNING THE BUDGET PLAN REPORT

• This report will display patients who are on a budget plan

27. Left click once on Reports on the menu bar to display the shortcut menu



128

28. Left click once on Memorized to display a report listing

29. Left click once on the down arrow for the Report Type field and select Collections

30. Double click on the Budget Plans, the report filter will display with the columns tab

defaulted open



129

31. Left on OK, a report will generate listing patients on a budget plan


DENTAL CONTRACT SERVICES AGREEMENT PROCESS


130

Coastal Health & Wellness Clinic

Dental Contract Services Agreement Process

I. Patient Appointment

▪ Patient can request a dental contract services appointment with either the Dental

Receptionist, Contact Center or Check-Out desk. All dental contract services associated

appointments must be identified with the “Dental Contract Services” event. Selecting the

“Dental Contract Services” event informs the Check-In staff when not to collect the

nominal/deposit fee. Also, apply the appointment to the designated Dental Contract

Services category/time slot to schedule dental contract services appointments.

II. Dental Provider

▪ Completes a Comprehensive Exam

▪ Determine patient’s needs and procedures needed to implement a dental contract

services treatment plan, including extractions and all necessary pre-work.

▪ Educate patient on procedures and steps to complete a dental contract service

treatment plan

▪ Electronically complete the Pre- Dental Contract Services Assessment Form, by:

(a) checking the check boxes to the left of the dental contract services CDT

codes

(b) enter a tooth number in the free text field to the right of the extraction CDT

code description

ex:

▪ Elec

tronically sign and date Pre- Dental Contract Services Assessment Form

▪ Print a completed copy of the Pre- Dental Contract Services Assessment Form

for the patient

▪ Explain to the patient if a Dental Contract Services Agreement is not signed within

30 days of issuing the Pre- Dental Contract Services Assessment Form, the

patient must be re-evaluated and a new Pre- Dental Contract Services Assessment

Form must be completed by the dental provider

▪ Explain to the patient to deliver the Pre- Dental Contract Services Assessment

Form to a Business Representative through the Check-out staff. The Business

Representative will assist the patient with executing a Dental Contract Services

Agreement and discuss payment options

▪ Electronically enter all dental contract services appropriate CDTs as “PLANNED”

at the patient’s first dental contract services appointment

▪ Will “COMPLETE” all “PLANNED” dental contract services CDTs when a

procedure is performed, such as, an extraction, impression, wax bite, etc..or the

appropriate appliance is delivered

Coastal Health & Wellness

Pre-Dental Contract Services Assessment Form

CDT Code CDT Description DENTURES

D5110 Complete Denture - Maxillary

D5120 Complete Denture - Mandibular

D5130 Immediate Denture - Maxillary

D5140 Immediate Denture - Mandibular

D5211 Maxillary Partial Denture - Resin Base

D5212 Mandibular Partial Denture - Resin Base

D5213 Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases

D5214 Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases

CDT Description D7140 Extraction, Coronal Remnants Deciduous Tooth 1, 2 ,3, 4




131

D5225 Maxillary Partial Denture – Flexible base (including any clasps, rest, and teeth)

D5226 Mandibular Partial Denture – Flexible base (including any clasps, rest, and teeth)

D5282 Removable Unilateral Partial Denture, Maxillary

D5283 Removable Unilateral Partial Denture, Mandibular

D5410 Adjust Complete Denture - Maxillary

D5411 Adjust Complete Denture - Mandibular

D5421 Adjust Partial Denture - Maxillary

D5422 Adjust Partial Denture - Mandibular

D5511 Repair Broken Complete Denture Base, Mandibular

D5512 Repair Broken Complete Denture Base, Maxillary

D5520 Replace Missing or Broken Teeth

D5611 Replace Resin Denture Base, Mandibular

D5612 Repair Resin Denture Base, Maxillary

D5621 Repair Cast Framework, Mandibular

D5622 Repair Cast Framework, Maxillary

D5630 Repair or Replace Broken Clasp

D5640 Replace Broken Teeth – Per Tooth

D5650 Add Tooth to Existing Partial Denture

D5660 Add Clasp to Existing Partial Denture

D5710 Rebase Complete Maxillary Denture

D5711 Rebase Complete Mandibular Denture

D5730 Reline Complete Maxillary Denture - Chairside

D5731 Reline Complete Mandibular Denture - Chairside

D5740 Reline Partial Maxillary Denture - Chairside

D5741 Reline Partial Mandibular Denture - Chairside

D5750 Reline Complete Maxillary Denture (Lab)

D5751 Reline Complete Mandibular Denture (Lab)

D5820 Interim Partial Denture (Maxillary)

D5821 Interim Partial Denture (Mandibular)

D5899 Gold Denture Crown Per Tooth

CDT Code CDT Description ROOT CANALS AND CROWNS

D1510 Space Maintainer, Fixed, Unilateral

D1515 Space Maintainer, Fixed, Bilateral, Maxillary

D1516 Space Maintainer, Fixed, Bilateral, Mandibular

D2740 Crown – full contour zirconia /E-Max

D2750 Crown – porcelain fused to high noble metal

D2790 Crown – full cast high noble metal

D2791 Crown – full cast base metal

D2792 Crown – full cast noble metal

D2930 Prefabricated Stainless Steel Crown – Primary Tooth

D2931 Prefabricated Stainless Steel Crown – Permanent Tooth

D2934 Prefabricated Esthetic Coasted Stainless Steel Crown – Primary Tooth

D2950 Core Buildup, Including any pins

D2952 Post and Core in Addition to crown, indirectly fabricated

D2954 Prefabricated Post and Core in Addition to Crown

D3221 Pupal Debridement, primary and permanent teeth

D3310 Endodontic therapy, anterior tooth (excluding final restoration)

D3320 Endodontic therapy, premolar tooth (excluding final restoration)

D3330 Endodontic therapy, molar tooth (excluding final restoration)

D6750 Retainer Crown – porcelain fused to high noble metal




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D6240 Pontic – porcelain fused to high noble metal

D6245 Pontic - porcelain/ceramic

D6740 Retainer Crown – porcelain/ceramic

CDT Code CDT Description DEVICES

D9944 Occlusal Guard – Hard appliance, full arch

D9945 Occlusal Guard – Soft appliance, full arch

D9946 Occlusal Guard – Hard appliance, partial arch

NOTE: This assessment is valid for thirty days. In other words, you have 30 days to execute a contract and payment plan with CHW. Any Dental Contract Services must

be paid in full prior to the 90-day expiration date of the contract. Once you have paid in full, personnel from the dental office, will call you to schedule an appointment to start your dental work. For Dentures Contracted Services, the first 3 adjustments of new dentures are at no charge. Any additional adjustments will be charged to you

based on the current dental fee schedule.

__________________________________________________________________________

Provider Signature Date

III. Business Representative/Designee

▪ Based on the Pre-Dental Contract Services Assessment Form completed by the

Dental Provider, discuss with the patient the total dental contract services cost using

the current Dental Contract Services - Fee Schedule form. The Plan is determined

based on the Patient’s Sliding Fee on the day the patient signs the Dental Contract

Services Agreement.

Plan Patient Sliding Fee

Dental Contract Services 0% Pay 100% discount






▪ Follow “Document a Patient’s Dental Contract Services Electronically” training

guide.

▪ Complete the Dental Contract Services Agreement electronically within the

patient’s dental record

▪ Verify IDENTITY OF PARTIES, patient name, DOB, address and phone number

are correct

▪ Enter the patient’s sliding fee percentage

▪ Enter information into the following appropriate fields:

• Line II – TERM OF THE AGREEMENT

- Enter an “Effective date” (today’s date) and an “Expiration date” (90 days

from the Effective date) in a date format MM/DD/YYYY

• Line III – PROFESSIONAL DENTAL SERVICES TO BE RENDERD BY

CHW CLINIC

- Enter the CPT codes documented on the Pre-Dental Contract Services

Assessment Form

➢ Example: – D7111 (1,4,8,20, and 27) - Extraction, Coronal Remnants

Deciduous Tooth

- D5211 – Maxillary Partial Denture - Resin Base

• Line IV – PAYMENT FOR SERVICES

- Enter in the total cost of the dentures based on the current Dental Contract

Services- Fee Schedule and the Plan Chart in numeric format in whole

dollars, such as, 545

▪ Review and explain the entire Dental Contract Services Agreement with the patient.

▪ Ensure the patient clearly understands (repeats back) the following:

▪ Line II – Term of the agreement - the Effective date and Expiration date

▪ Line III – Professional dental services to be rendered by the CHW Clinic

▪ Line IV – Payment for services –




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• (a) the total cost of the Dental Contract Services Agreement

• (b) Full payment must be received prior to dental services begin

• (c) making payments is acceptable

• (d) For certain procedures, missed or cancelled appointments may result

in the potential need for a patient to be seen more than initially projected,

consequently resulting in additional fees charged to the patient.

▪ Line V – Denture Adjustments

▪ Line VI - No Refunds – explain this section very clearly

▪ Line VII – Entire Agreement

▪ Line VIII – Termination of Agreement

▪ Line IX – Amendments

▪ Line X – Governing Law

▪ Line XI – Written Notice

▪ After explaining the Line items to the patient, continue to follow the “Document a

Patient’s Dental Contract Services Electronically” training guide and collect electronic

signatures

IV. ADD THE APPROPRIATE DENTAL CONTRACT SERVICES % PAY PLAN TO THE

PATIENT’S PM CHART

▪ Access patient in PM

▪ Left click once on the Modify Patient file folder, the Modify Patient Information

dialog window will open with access to the insurance button.

▪ Left click once on the Insurance button to access the Insurance Listing dialog box

▪ Left click once on the Norton button of the insurance listing window, select New

Insurance, to add the new Dental Contract Service % Pay Plan

▪ Left click once in the Payer Name field and enter the appropriate Dental Contract

Services % Pay Plan (see chart listed above)




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▪ Double click once on the appropriate Dental Contract Services % Pay Plan

▪ Left click once in both the Effective and Expiration Date fields and enter a 1 year

period. The effective date will be the date the contract was signed and expiration

date will be 1 year from the signed date.

▪ Left click once on OK, the Dental Contract Services % Pay Plan should now

display in the patient’s chart

▪ Close the patient’s PM chart

▪ Offer to make a payment today

V. CREATING A DenConServ ENCOUNTER

▪ Access patient in PM

▪ Left click once on the Encounter tab (located far right of the

patient chart)

▪ Left click once the on the Norton button and select New. A

Create Encounter screen will display

▪ Left click once on the down arrow of the Patient Type and

select Established Patient




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▪ Left click once on the down arrow of the Rendering and

Referring fields and select the dental provider who signed the

Dental Contract Services Assessment Form

▪ Left click once on the down arrow of the Supervisor field and

select the appropriate supervisor.

▪ Left click once on the down arrow of the Service Location and

select the appropriate location in which services were rendered.

▪ Left click once in the Dental Contract Services field and enter

the total dollar of the Dental Contract Services Agreement

▪ Left click once in the DCS Expiration Date field and enter a 1

year expiration date from the time the patient signed the Dental

Contract Services Agreement

▪ Left click once on OK on the create encounter window

▪ Make note of the encounter number located in the Encounter

Information box (667502)

▪ Right click once on the newly created encounter to display the

shortcut menu and select Charges, the charges window will

display




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▪ Left click once on New button of the charges window

▪ Left click once in the Svc Item field and enter the dummy

charge of DenConServ and use the Tab key on your keyboard to

select the charge

▪ Left click once on the Save button, a diagnosis not entered

warning dialog box will display

▪ Left click once on OK of the alert

▪ Close the charges window

VI. CREATING A DenConServ ALERT

▪ Left click once on the Clinical/History/Notes tab located to the

left of the Encounters tab

▪ Left click once on Alerts

▪ Right click once in the details (white field) to the right of the

selected Topics list, to display the shortcut menu and select New

to create a new Alert

▪ Left click once in the Alert field and enter “Dental Contract

Services”




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▪ Left click once in the Expiration Date field and enter an

expiration date ending in 90 days. This expiration date is specific

to the signed 90-day contract.

▪ Left click once in the Alert Entry field and enter the following:

“Please Apply All Dental Contract Services Payments to

Encounter# 123456 With a Total of $364.00. Contract Expires

09/24/2019”

VII. CHW Billing

▪ Will be responsible for notifying the patient in the event full payment has not been paid

in full by letter, at least 30 days prior to the Dental Contract Services Agreement

expiring.

o If only partial payments have been made by the expiration date (not paid in full),

follow the Refund section of the Dental Contract Services Agreement. For any

special requests from patients, in reference to the Refund section of the contract,

consult with management.

▪ Will notify Patient Information Manager, Business Office Manager, and the Dental

Director through email with patient information for those contracts paid in “full”

▪ Will manage all contracts prior to 7/1/19 plan changes with any old methods of using the

Denture Contract process. These encounters should be identified with the “Denture

Contract % Pay” payer.

VIII. Dental Receptionist/Contact Center

▪ Will contact the patient when a confirmation email from CHW Billing is received

indicating the Dental Contract Services Agreement has been paid in “full”

▪ Will schedule the patient for the first dental contract services appointment by using the

“Dental Contract Services” event for all newly paid in “full” Dental Contract Service

Agreement. Also, apply the appointment to the designated Dental Contract Services

category/time slot to schedule dental contract services appointments.

IX. Patient Services

▪ Patient Services staff will use the Dental Contract Services event to confirm a patient’s

Dental Contract Services appointment at the time of check-in

▪ Will add the “Dental Contract Services % Pay” payer to the patient’s encounter at the

time of check-in.

o Keep in mind, CHW will continue to honor denture contract agreements prior to

this change, this means, some patients will continue to have the old “Denture

Contract % Pay” payer




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**NOTE: When a patient checks-in for a dental contract services appointment and a dental contract

services payer is not in the patient's chart, please report this to billing by emailing: the Billing Dept and

the NextGen Trainer. Dental Contract Services payers must be managed by billing. Do not add any Dental

Contact Services payers to patient's chart.** no dental contract services payer attached, will not affect the

patient’s appointment, nor any dental documentation.

▪ Patient Services to apply all Dental Contract Services payments to the Dental Contract

Services encounter indicated by CHW billing within the patient’s chart alert

X. Check Out

▪ Will contact a Business Representative/Designee if a patient presents with the Pre-

Dental Contract Services Assessment form and if the patient is willing to sign a Dental

Contract Services Agreement.

▪ Will assist with scheduling follow up “Dental Contract Services” appointments

▪ Will assist with collecting Dental Contract Services % Pay plan payments

DENTAL CONTRACT SERVICES AGREEMENT

I. IDENTITY OF PARTIES

This Service Agreement is between the Coastal Health & Wellness with clinics located at 9850-C Emmett F Lowry

Expressway, Texas City, TX 77591 and 4700 Broadway, Galveston, Texas 77551 AND

┌ ┐ Patient Information Label

└ ┘

II. TERM OF AGREEMENT

This is a 90 day Service Agreement beginning on ____________ (Effective date) and shall end on ____________

(Expiration date) unless this agreement is terminated according to Section VIII.

III. PROFESSIONAL DENTAL SERVICES TO BE RENDERED BY CHW CLINIC

Completed by Dental Provider on the Pre – Dental Contract Services Assessment Form.

IV. PAYMENT FOR SERVICES

In consideration of Dental Contract Service(s), the Patient agrees to pay CHW the sum of

$ ______ .00 for the dental work to be performed under this Service Agreement.

FULL PAYMENT (stated above) must be received before dental services will be performed.

Making payments through installments is acceptable. However, the balance of dental contract service charges must be

paid prior to the 90-day expiration date of this contract.

For certain procedures, missed or cancelled appointments may result in the potential need for a patient to be seen more

than initially projected, consequently resulting in additional fees charged to the patient.




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V. DENTURE ADJUSTMENTS

Patient is eligible for three adjustments within the first three months. After the three months, Patient will be charged at

the established fee schedule for any additional adjustments including the clinic fee for the visit.

VI. REFUNDS

NO REFUNDS will be issued after denture services begin.

REFUNDS will only be issued prior to dental contract services begin. Refunds will be made only after the Patient has

met all other CHW financial obligations, including balances which may have occurred for dental and/or medical

services rendered by the CHW clinics.

VII. ENTIRE AGREEMENT

This Agreement supersedes all previous agreements between the parties, contains the entire understanding between the

parties, and may not be changed, except in writing, duly executed by each of the parties.

VIII. TERMINATION OF AGREEMENT

This Agreement may be terminated by either party by furnishing a written notice to the other party.

This Agreement will terminate if Patient is no longer allowed to receive medical and/or dental services from CHW,

except if Patient’s dental contract services have begun. Patient will receive refunds according to Section VI.

IX. AMENDMENTS

Any changes to this Agreement must be made and adopted as written amendments signed and approved by both

parties.

X. GOVERNING LAW

This interpretation and enforcement of this contract shall be governed by the laws of the State of Texas.

XI. WRITTEN NOTICE

All notices required by this Agreement must be in writing and either mailed by certified or registered mail, return

receipt requested, to the address listed below, or hand delivered.

Coastal Health & Wellness

ATTN: Director of Contracts and Compliance

PO Box 939

La Marque, Texas 77568

For the Patient

Patient’s Address for Service has been provided in Section I of this Service Agreement

By signing this Agreement, the parties have agreed to all the terms and conditions of this Agreement and Patient fully

understands the Dental Provider’s recommendation for treatment on the Pre – Dental Contract Services Assessment Form.

Patient or Patient’s Legal Representative CHW Business Representative

Date Date

NEXTGEN Revenue Cycle POSTING THE BATCH AND END OF DAY BALANCING


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Purpose:

• All transactions collected from prescheduled appointments, medical/dental

records payments or payment only collections. This step must be completed at the

end of each business day

Definition:

• The act of electronically posting a batch and balancing all collection of payments

at the end of each business day by each user documenting transactions. Users

must confirm, total batch dollars match total dollars collected in drawer, prior to

posting the batch.





I. ACCESSING THE ACTIVE BATCH

4. Left click once on , the Batch Posting screen and the users secured batch

displays

5. Right click once on the users batch needing to post, to display the shortcut menu



141

II. ACCESSING THE BATCH LISTING REPORT

6. Left click once on Print, Batch Listing, the batch listing report will display.

• The report will list all transactions associated to the batch. All transactions types

should be listed separately

o All cash payments will be listed with at total dollar of cash collected

o All check payments will be listed with a total dollar of checks collected



142

• PRINTING THE BATCH LISTING REPORT

7. Left click once on the Print Report icon, to print the report

8. Left click once on icon, to close the Batch Listing report

9. Compare each total, by transaction type on the report with the cash drawer, all dollars should

match.

• BALANCING THE BATCH TO THE CASH DRAWER

• LEDGER


11. Left click once on Ledger, the Transaction Ledger will display

• A list of all accounts and encounters payments received will display

• Review the list to confirm the total dollar amounts and transaction codes

(payment type) are correct



143

o MODIFYING AN UNPOSTED INCORRECT TRANSACTION

• If a transaction is incorrect

o Double left click on the incorrect account or encounter transaction, the

payment entry screen will display

o Left click once on Open to access the saved transaction and be able to

make corrections

▪ Make corrections as needed

• Pay Amount

• Pay Code

• Etc..

o Left click once on Save, to save the changes

o Left click once on icon, to close the Payment Entry screen and

return to the Transaction Ledger screen

• HEADER

12. Left click once on the Header button, located on the bottom left hand side of the

Transaction Ledger screen, the Batch Maintenance screen displays



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13. Left click once in the Total Billed field on the Batch Maintenance screen and enter the total

billed displayed in the Billed field on the Transaction Ledger screen

14. Left click once in the Total Allowed field on the Batch Maintenance screen and enter the

total allowed displayed in the Allowed field on the Transaction Ledger screen

15. Left click once in the Total Paid field on the Batch Maintenance screen and enter the total

payment displayed in the Payment field on the Transaction Ledger screen

16. Left click once in the Total Adjusted field on the Batch Maintenance screen and enter the

total adjustment displayed in the Adjustment field on the Transaction Ledger screen

17. Left click once on OK, on the Batch Maintenance screen, the batch maintenance screen

closes and the Transaction Ledger screen displays

18. Left click once on Close on the Transaction Ledger screen, the Batch Posting screen

displays. Users will notice the Status of the existing batch should now indicate “balanced”

• If the status does not indicate “balanced” users must repeat all steps in the Header

section.



145

III. POSTING THE BATCH


20. Left click once on Post, to post the currently selected batch, the NextGen Confirm post of

batch screen displays

21. Left click once on OK, the batch will now post

22. Left click once on OK

NEXTGEN Revenue Cycle STATEMENTS


146

Purpose: To process statements to EDI in bulk and individual statements for payments or

record requests

Definition:

• The act of processing statements and demanding individual statements with detail

charges and payments per patient




3. Understand “Revenue Cycle Processes – Things to Know”

I. EXPORTING PATIENT STATEMENTS TO EDI (NG for mailing)

• Processing Statement Files in Bulk

• THIS PROCESS HAS BEEN AUTOMATED – SKIP TO UPLOADING

STATEMENT FILE TO EDI

• This process must be completed on a weekly basis

4. Left click once on File – Statements from the menu bar, the Statement Options screen

will display



147

5. Left click once on Export, a file open option will display, select where to send the file

and create a file name convention

• It is preferred all statement files are saved and stored on shared drives for future

access if needed

o Keep from saving claim files on personal desktops.

• Ex: Z:\Statements\2017\Nov 2017\11212017

o Z is a shared drive, Statements is a file folder, 2017 is a file folder, Nov

2017 is a file folder 11212017 is the file name

o This helps identify the ending date of statements included in this file

• Once the file is selected, statements process and a file is created

• Uploading Statement File to EDI

6. Access clearing house, https://edi.nextgen.com/index.shtml and log in

7. Left click once Submit New Files option within the clearing

house website, enter username and password provided by billing supervisor username:

MGCH

https://edi.nextgen.com/index.shtml



148

8. Left click once on the Browse…button to select the statement file

o Select the statement file and allow to display in the field to the left of the

Browse button

o Users may select the Multiply Upload link to upload mutiple files with

one upload



149

9. Left click once on the Click Upload Files button, files will upload.

II. STATEMENTS BY INDIVIDUAL PATIENT

10. Left click once on the Encounter Icon, to search for a patient’s encounter in the

system, the Encounter Lookup screen displays

11. Left click once in the Last Name field and enter the patient’s last name



150

12. Left click once in the First Name field and enter the patient’s first name

13. Left click once on Find, a list of the patient’s encounter will display

14. Left click once on the person’s last name to highlight the selection in the Encounters

List field

15. Right click once on any of the patient’s encounter to view the short cut menu, select

Chart



151

• The patient’s chart will display with the encounter selected highlighted

• Accessing Individual Patient Statements

16. Left click once on the Stmts icon, located on the toolbar, the Patient Statement

screen displays



152

• Statement Account Options

• Acct Statement Amt Range

▪ Break down of a statement by dollar amount range

• Statement Encounter Options

▪ Show only Encounters with a Patient Balance

• Statement Charge Options

▪ Show all Charges by Date Range

• Statement Display Options

▪ Display statement by Guarantor or Patient

▪ Print statement by Location

III. PREVIEWING AND PRINTING STATEMENTS

• Previewing Statements

17. Left click once on Preview, based on field changes with the patient statement screen,

review statement.

• Printing Statements

18. Left click once on the Print icon within the preview window, statement will print.

a. Printing statements is usally performed for record release purposes

b. Users may discuss patient balance with patients over phone, only if required

patient informaiton has been verified.



153

Test, Patient 1234 Love Ave Love, Texas 775590



154

NEXTGEN Revenue Cycle CLAIMREMEDI

VERIFYING HEALTHCARE COVERAGE


155

Purpose:

• ClaimRemdi is the electronic system to verify eligibility for Commercial,

Medicare, and Medicaid coverage, to accurately bill patients receiving services.

I. ACCESSING CLAIMREMEDI

1. Left click once on , to search for the following address

https://claimremedi.providersportal.com, the Log window will display

II. LOGGING IN

2. Left click once in the User Name field and enter a username

3. Left click once in the Password field and enter a password

4. Left click once on Log In, the Home and Welcome Galveston County Health District.

https://claimremedi.providersportal.com/




156

III. CHANGE PASSWORD

5. Left click once on the down arrow next to the user name

to access Settings

6. Left click once on Password on the Settings toolbar

7. Left click once in the New Password field and enter a new password




157

8. Left click once on the Confirm New Password field and enter the new password again

9. Left click once on the Save button, a confirmation will display.

IV. NEW ELIGIBILITY

10. Left click once on Submit, located on the left hand side of the screen, the shortcut

menu will display

11. Left click once on Eligibility, the Submit Eligibility screen will display

12. Left click once on the drop down arrow of the Payer field , to display Coastal Health

& Wellness list of available payers to verify healthcare coverage




158

13. Left click once on a payer to verify eligibility, the payer’s required fields will display




159

14. Follow the Search Options, Payer Help and/or Key for each selected payer




160

15. Enter all required information, as applicable

16. Left click once on the Check Eligibility white arrow , located at the right

of the payer selected and top of the Submit Eligibility screen, the verification page

will display.




161




162

Tab Contains Information

Coverage Active or inactive, displays healthcare

coverage. The bottom of the result page

will display the latest HMO/PPO

information. Financial Co-Payment and Deductible information, is

in Professional (Physician) section

Exclusions Information on what services are excluded

on the plan

V. COVERAGE




163

VI. FINANCIAL

VII. EXCLUSIONS

VIII. DOCUMENTING ELIGIBILITY DATA

17. Enter all eligibility status information into the patient’s chart and attach the insurance

to the patient’s encounter as instructed in the checkin process.

IX. ELIGIBILITY SEARCH RESULTS

The eligibility search results display verifications already verified by other staff

members. If an eligibility has already been searched, it is best to re-access the same

eligibility check. Every eligibility check conducted is considered a transaction.

18. Left click once on the down arrow of the Search option to display the shortcut menu




164

19. Left click once on Eligibility, a list of eligibility search results will display

X. SIGNING OUT

20. Left click once on the down arrow next to the user name

to access the Sign Out, left click once and close

out the current window

NEXTGEN Revenue Cycle

CLAIMREMEDI

REPORTS


165

I. ACCESSING CLAIMREMEDI REPORTS

1. Left click once on Reports from the side picklist, the reporting list will display

2. Left click once on any of the reports selection

II. REPORT DATE RANGES

3. Left click once within the date ranges from the report selected and select dates


CLAIMREMEDI

REPORTS


166

4. Left click once on the Run Report, results will display


INTERNAL CONTRACTS


167

Name of Contract

Payer

Charges Encounter Guarantor

Services Agency

Charge

Self Pay

Charge CPT

Agency Contracts ADA Women’s Center

Medical or Dental

Nominal Fee

All other charges

adjust off with

Contract

Adjustment

(Specific)

$15.00 $0.00 Nominal Fee AGENCY

Bay Area Recovery

Center Medical or

Dental

Pathway to Recovery

Center Medical or

Dental

St Vincent's House

Medical or Dental

Our Father's Kingdom

Medical or Dental

Streetscape Ministry

Medical or Dental

College of the

Mainland

Hepatitis B

Surface Antibody

$0.00 $25.00 86706COM90 SELF

Varicella Zoster

Antibody Titer

$0.00 $25.00 86787COM90

MMR Antibody

Titer

$0.00 $75.00 86735COM90,

86762COM90,

86765COM90

TB Chest X-ray

single view)

$0.00 $65.00 71010COMG

Provider

examination (for

TB X-ray)

$0.00 $50.00 Office Visit

Code


INTERNAL CONTRACTS


168

Gulf Coast Center Medical office

visits Only

No nominal fee is

charged.

Office visit code

should adjust up

or down to the

$50.00 to charge.

$50.00 $0.00 Office Visit

Code

SELF, unless patient is a minor

Headstarts

(SEASONAL)

Galveston Headstart

Medical or Dental

Any dental

service - if patient

is covered by

insurance, bill

insurance. If no

coverage, services

are charged to

agency according

to contract

Based on

services

provided

$0.00 Dental Visit

Codes

Headstart agency, unless patient has insurance

coverage, then the adult guarantor

Hitchcock ISD

Headstart Medical or

Dental

Any medical

service - if patient

is covered by

insurance, bill

insurance. If no

coverage, services

are charged to

agency according

to contract

Based on

services

provided

$0.00 Medical Visit

Codes

Texas City Headstart

Medical or Dental

Title V Title V Medical See Chart Based on

services

provided

Based on

services

provided

Medical Visit

Codes

Title V unless some services are not covered

by Title V, CHW billing will change guarantor

after invoicing Titile V

Title V Dental Dental Visit

Codes

STD/HIV Contract STD/HIV Contract Medical office

visits Only

STD/HIV

Contract charge

All charges will

adjustment off

$0.00 $20.00 STD/HIV

Contract

SELF, even if patient is a minor


INTERNAL CONTRACTS


169

Sport Physicals Medical Services Only no nominal fee is

charged. Office

visit code should

adjust up or down

at $50.00. Do not

use any other

adjustments

$0.00 $25.00 Based on

services

provided by

physician

SELF, unless patient is a minor