NextGen Knowledge Center

About the Authorizations Tab in Insurance Maintenance

The Authorizations tab on the Insurance Maintenance window enables you to enter one or more authorizations for the patient's insurance. For example, a provider may need to obtain an authorization from the payer prior to performing a specific procedure for the patient. The authorization number provided by the payer can be entered in NextGen® Enterprise PM, so it is included in the claims sent by the provider to that payer for the authorized procedure.

A pushpin icon on the tab indicates one or more authorizations exist for the patient's insurance.

Existing authorizations are listed with the following information:

  • Effective Date
  • Expiration Date
  • Authorization Code
  • Description
  • Encounters
  • Encounters Left
  • Units
  • Units Left

If you have selected a service package library in Libraries > Service Package Library field on the Practice Preferences window, the existing authorizations are sorted by Effective Date in the descending order, so newer authorizations are at the top of the list and older authorizations are at the bottom. However, the authorizations continue to appear in ascending order if you have not selected the service package library. This same sort is also used on the Authorization Listing window.

Selecting the Show Active Only check box enables you to view only those authorizations where the current system date (today) falls within the Effective and Expiration Date range. This same check box option is also available on the Authorization Listing window.

Authorizations and Encounters

When an authorization is entered for the insurance before an encounter is created, it automatically attaches to a new encounter that meets all criteria defined within the authorization.

When an authorization is entered for the insurance after an encounter is created, you can manually attach it to an existing encounter that meets all criteria defined within the authorization. This is done from the Patient Chart, Encounters tab, Insurance sub-tab, Verification section.

  • Encounter Mode Authorizations A payer can provide an authorization for the patient to have a specific number of encounters, and those encounters may occur within a date range defined by the payer.
  • Units Mode Authorizations A payer can provide an authorization for the patient to have a specific CPT4 code and number of units performed, and those services may be rendered within a date range defined by the payer.
  • Service Unit Authorizations A payer can provide an authorization for the patient to have a specific service package with unit limitations, and those packaged services may be rendered within a date range defined by the payer.