Eligibility Profiles Library

File Maintenance Help for NextGen® Enterprise 8

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. Parent topic: Eligibility Profiles Library

Help Guide for NextGen® Enterprise PM 8

Eligibility Verification Library

Processing inquiries in batch mode requires creating a library. Once created, Eligibility Verification libraries automatically complete required fields and additional data in batch mode that would otherwise require the fields to be entered manually. Two libraries are used to process inquiries in batch mode: Eligibility Profiles Claim Status Profile Your Eligibility Verification Analyst assists in creating the libraries. Attach the Eligibility Profile Library Parent topic: Referral Inquiries and Histories

File Maintenance Help for NextGen® Enterprise 8

Claim Status Profile Library

The Claim Status Profile library is required for submitting claim status inquiries. This library enables you to set up rules to automatically complete the required fields and additional data for batch mode processing. Create a Claim Status Profile Library Creating a Claim Status Profile Library You can create a claim status profile library using the field's description.

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

Submit Eligibility in Batch Mode Using Background Business Processor

Before you can run eligibility inquiries in batch mode, the eligibility profiles library must be defined. This library enables you to set up rules to automatically complete the required fields and additional data in batch mode that you would manually enter in NextGen® Eligibility Verification in real time. These libraries are set up during implementation by your administrator with the help of an analyst. Prior to submitting eligibility inquiries in batch mode using NextGen® Background Business Processor, two jobs must be created: NextGen® Eligibility Verification request and NextGen® Eligibility Verification response. The request job queries the appointments and submits the data to NextGen for processing while your response job later takes the results from the NextGen server and delivers the response to your database. For information on creating a job in NextGen® Background Business Processor for eligibility requests and responses, go to NextGen Healthcare Success Community and downloa

Help Guide for NextGen® Enterprise PM 8

Submit Eligibility Requests

There are several ways to submit eligibility inquiries: NextGen® Eligibility Verification Submission NextGen® Eligibility Verification Batch Submission Scheduled Batch through NextGen® Background Business Processor NextGen® Eligibility Verification transactions are submitted from different NextGen® Enterprise PM access points. The access points are Patient Lookup Appointment Book Appointment List Encounter Lookup From any of these access points, a NextGen® Eligibility Verification request can be submitted for a single patient by right-clicking on the patient, appointment, or encounter, and then selecting Eligibility Verification. Regardless of the access point, the user interface is the same. Several inquiries can be submitted at one time using batch mode. Manually submitting a batch of eligibility inquiries can be done from the appointment lookup and encounter lookup. This manual batch was referred to as Real Time batch. (Long time RTS users also know this as pseudo-batch.) Finally, b

Eligibility Profiles Library

Recommendations

Create an Eligibility Profiles Library

Eligibility Verification Library

Claim Status Profile Library

Attach the Eligibility Profile Library

Submit Eligibility in Batch Mode Using Background Business Processor

Submit Eligibility Requests

Eligibility Profiles Library

Create an Eligibility Profiles Library

Eligibility Verification Library

Claim Status Profile Library

Attach the Eligibility Profile Library

Submit Eligibility in Batch Mode Using Background Business Processor

Submit Eligibility Requests