About Eligibility Verification

NextGen® Eligibility Verification is an electronic method of verifying a patient's eligibility and benefit coverage online. EV allows you to check for authorization and prior authorization, make a referral request, check referral history, and check a claim status. The rules governing eligibility and referrals are based on a patient's managed care coverage plan. The following are NextGen® Eligibility Verification features:

• Eligibility verification enables you to verify a patient's insurance coverage in real-time or in a batch using Background Business Processor. The results of the verification can flow directly into the patient's chart.
• Referral requests are made to generate a referral number, so that a primary care physician (PCP) can send a patient to an authorized specialist.
• Referral history enables you to view a patient's referral history. This history lists all previous referrals made for a patient.
• Claim status check enables you to find out the status of a claim and where it is in the adjudication process.
• Eligibility Verification Manager allows you to track eligibility transactions and the status using a user-friendly visual graph and a detailed grid.
• Prior Authorization is an option available to Eligibility Verification clients hosted on Amazon Web Services (AWS), requesting authorization for future visits and procedures is automated with prior authorization. The authorization request processes and records response information from the payer source. Historical tracking and reporting of the responses is done in NextGen® Enterprise PM.