HI Qualifiers in the EDI file change for ICD-10 codes within the NextGen Inpatient Financials application TEST regions

NextGen Healthcare has identified an issue in which the EDI 837 claim files are not reflecting the correct HI Qualifiers when ICD-10 codes are contained within the application’s TEST files. Please alert your billing staff, or any personnel responsible for creating and submitting claims, to follow the procedure outlined below.

Until this issue is resolved, users should follow the ICD-10 workaround. This process should occur for each TEST file claim that is created.

1. Follow the traditional steps for generating a Bill Run in your facility’s NextGen® Inpatient Financials TEST region, to create the ICD-10 Test Files. These files will then be saved to the normal location, as outlined in Step 2.
2. Locate 837 TEST File(s) in Shared Drive > F > 01 > TMP > Billing.
3. For clients with access to Microsoft® Office¹, open the TEST 837 File using Microsoft® Notepad².  Uncheck the box stating “Always use the selected program to open this kind of file” This will allow the file to remain in the correct 837 format.
4. Once the file is opened in Microsoft® Notepad², select the Edit drop down menu > Replace. Enter the first ICD-9 indicator with the correct corresponding ICD-10 indicator. Then select Replace All.  
5. Use the list of ICD-10 Indicators, shown below, and to Find, and then Replace each segment indicator to update the file from ICD-9 qualifiers to ICD-10 qualifiers, prior to submitting to the payer or clearinghouse. 
6. Once the 837 TEST File is corrected, click File > Save. The file name can be changed if you wish to keep the original file intact.
7. Upload the corrected 837 TEST File(s) to the Clearinghouse or Payer Direct.
8. Repeat this process for each 837 TEST File claim that is created.

The issue is expected to be resolved in NextGen Inpatient Financials version 116.3.6.0, with an estimated release date of mid-July, 2015. Additional client communications may be sent, if needed. Please review the NextGen Healthcare bi-weekly newsletter, Whats Next, for any follow-up or further information.

Please call us at 866-837-2341 or email ASKICD10-Hospital@NextGen.com if you have any questions.