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Create an Eligibility Profiles Library
In File Maintenance, select
Libraries
>
Eligibility Profiles
.
Select open menu button and select
New
.
The
RTS Eligibility Profile
window opens.
Select one or more types of service in the
Type of Service
field.
Select a search option in the
Patient Search Option
field.
Refer to Appendix A to select the options and settings as described in the tables and then select
OK
.
To default the eligibility profile to payers by financial class, select
Default to Payers
.
Select a financial class in the
Financial Class
field.
Select
Default to All
or
Default if Blank
.
A NextGen message opens.
Select
Yes
.
Create an Eligibility Profiles Library
File Maintenance Help for NextGen® Enterprise
Create an Eligibility Profile Library
You can use the Eligibility Profile library to set up rules to automatically fill in data in batch mode and avoid manually data entry when running an eligibility status check in real time. In File Maintenance, select Libraries > Eligibility Profiles. Select Open Menu , and then select New. The RTS Eligibility Profile window opens. RTS Eligibility Profile window sets the rules and automatically enters data in batch mode Select the type of service. Select the details in Option and Setting, and then select OK. To set the eligibility profile as default for payers based on the financial class, select Default to Payers, select a financial class, and then select Default to All or Default if Blank. Select OK. Note: NextGen® Enterprise PM only allows another transaction to be submitted through NextGen® Background Business Processor, when NextGen® Background Business Processor refers to the Eligibility Profile Library setting Do not submit an eligibility if one has been run within and the eligib
Help Guide for NextGen® Enterprise PM 8
Create an Eligibility Profile Library
You can use the Eligibility Profile library to set up rules to automatically fill in data in batch mode and avoid manually data entry when running an eligibility status check in real time. In File Maintenance, select Libraries > Eligibility Profiles. Select Open Menu , and then select New. The RTS Eligibility Profile window opens. RTS Eligibility Profile window sets the rules and automatically enters data in batch mode Select the type of service. Select the details in Option and Setting, and then select OK. To set the eligibility profile as default for payers based on the financial class, select Default to Payers, select a financial class, and then select Default to All or Default if Blank. Select OK. Note: NextGen® Enterprise PM only allows another transaction to be submitted through NextGen® Background Business Processor, when NextGen® Background Business Processor refers to the Eligibility Profile Library setting Do not submit an eligibility if one has been run within and the eligib
File Maintenance Help for NextGen® Enterprise
Attach a Remittance Profile Library to Payers
Open File Maintenance. Under Master Files, select System > Payers. The Payers List window opens. Double-click a payer to open the Modify Payer Information window. Select the Practice tab and then the Libraries sub-tab. To attach a remittance profile library to a single payer, select the library from the Remittance Profile Library list. To attach a remittance profile library to multiple payers, open a Remittance Profile library, and then select Default to Payers. The Remittance Library Default window opens. Select a financial class from the Financial Class list. Do one of the following: To link the Remittance Profile Library to all payers in the selected financial class, overwriting all libraries previously linked to the payers, select Default to All. To link the Remittance Profile Library to all payers in the selected financial class that do not already have a library linked, select Default if Blank. Parent topic: Libraries
Help Guide for NextGen® Enterprise PM 8
Set Up a Remittance Profile Library
The Remittance Profile Library defines various parameters and rules that are used when importing and processing ERA 835 files downloaded from payers into NextGen® Enterprise PM. The Default Remittance Profile library in File Maintenance is pre-installed in the application and includes a few recommended pre-set options. All remaining options are set based on your organizational preferences or in response to the payer’s ERA 835 file configuration. Practice Level vs. Payer Level Libraries A default Remittance Profile Library must be selected in Practice Preferences > Libraries. The default library is used for all ERA payers in the practice that do not have a specific library linked. A different Remittance Profile Library to be used for a specific payer/financial class can be linked on the Payer > Practice > Libraries sub-tab. This library overrides the default library in Practice Preferences for the payer/financial class. Any payers that do not have a Remittance Profile Library attached u
Help Guide for NextGen® Enterprise PM 8
Attach the Eligibility Profile Library
In NextGen® Background Business Processor, create an eligibility responses job to receive a response. In File Maintenance, set up an eligibility profiles library defining the rules for submitting eligibility inquiries in batch mode. In file maintenance, select Master Files > System > Payers > Practice tab, and then select the Libraries sub-tab. The Modify Payer Information opens. Attach the Eligibility Profile Library to the payer and select OK. Parent topic: Eligibility Verification Library
Help Guide for NextGen® Enterprise PM 8
Attach the Eligibility Profile Library
In NextGen® Background Business Processor, create an eligibility responses job to receive a response. In File Maintenance, set up an eligibility profiles library defining the rules for submitting eligibility inquiries in batch mode. In file maintenance, select Master Files > System > Payers > Practice tab, and then select the Libraries sub-tab. The Modify Payer Information opens. Attach the Eligibility Profile Library to the payer and select OK. Parent topic: Eligibility Verification Library
