About the Eligibility/Referral Tab in Insurance Maintenance

Help Guide for NextGen® Enterprise PM 8

About the Benefit Info Tab in Insurance Maintenance

The Benefit Info tab on the Insurance Maintenance window allows you to enter eligibility, benefits, and financial information for the insurance. A pushpin icon on the tab indicates that eligibility, benefits, and financial information exist for the payer. Eligibility and Benefits Information The Eligibility and Benefits tab includes a standardized set of prompts with either a free-text or a pick-list response. Note: You can customize the captions for the two note fields on the right side of the window in Enterprise Preferences > Client Defined. Financial Information Tab The Financial Information tab includes a standardized set of prompts with either a free-text, a dollar amount, or a pick-list response. Parent topic: Insurance Maintenance Window

Help Guide for NextGen® Enterprise PM 8

About the Referrals Tab in Insurance Maintenance

The Referrals tab on the Insurance Maintenance window enables you to enter one or more referrals for the patient's insurance. For example, when a patient's primary care provider refers them to a specialist for a specific procedure, the specialist may need to obtain a referral from the payer prior to performing that procedure. The referral number provided by the payer can be entered in NextGen® Enterprise PM, so it is included on claims sent by the specialist to that payer for the referred procedure. A Push Pin icon on the tab indicates one or more referrals exist for the patient's insurance. Existing referrals are listed with the following information: Effective Date Expiration Date Referral Code Encounters Encounters Left Units Units Left Description Referrals and Encounters When a referral is entered for the insurance before an encounter is created, it automatically attaches to a new encounter that meets all criteria defined within the referral. Note: If the ICD or CPT4 codes have be

Help Guide for NextGen® Enterprise PM 8

About the Detail-2 Tab in Insurance Maintenance

The Detail-2 tab on the Insurance Maintenance window allows you to enter additional information about the patient's insurance. Insurance Card Name Override Information entered in the First, Middle, Last, Suffix and Sex fields can be used to override the same information entered in demographics for the subscriber of the insurance. This information is used for claims. For example, the subscriber's name in demographics is different than the name on their insurance card. Other information for claims includes Plan Code and TPL Code. A TPL (Third-Party Liability) code may be needed for secondary Medicaid claims. Eligibility Verification Override The Date of Birth field can be used to override the birth date entered in demographics for the subscriber of the insurance. If a date is entered and the Eligibility Verification check box is selected, the date will be sent on Eligibility Verification, New Referral and Referral History transactions submitted to the payer using NextGen Eligibility Veri

Help Guide for NextGen® Enterprise PM 8

About the External Tab in Insurance Maintenance

The External tab on the Insurance Maintenance window enables you to add an External System that interfaces with the NextGen Enterprise applications and to associate an External ID for the insurance. Note: If the External ID and External System have been defined in the Payers > External tab in File Maintenance, they will default to the Insurance Maintenance > External tab for all patients with that insurance. Parent topic: Insurance Maintenance Window

Help Guide for NextGen® Enterprise PM 8

Insurance Maintenance Window

The Insurance Maintenance window is used to add or update a patient's insurance information. The subscriber of the insurance may be the patient, or another person to which the patient has a relationship, such as a spouse or a parent. The Insurance Maintenance window includes the following tabs: Detail Detail-2 Insurance Cards Benefit Information Authorizations Referrals Eligibility/Referral Website External About the Detail Tab in Insurance Maintenance You can find basic information about the patient's insurance. About the Detail-2 Tab in Insurance Maintenance You can find additional information about the patient's insurance in this tab. About the Ins Cards Tab in Insurance Maintenance You can capture images of the front and back of the insurance card using a scanner or a digital camera. About the Benefit Info Tab in Insurance Maintenance You can enter eligibility and benefits information for the insurance. About the Authorizations Tab in Insurance Maintenance You to enter one or more

Help Guide for NextGen® Enterprise PM 8

NextGen® Eligibility Verification Submission

The user interface of NextGen® Eligibility Verification is the same irrespective of where it is accessed from. The following table lists the access points for Eligibility. From the… Use this access path People or Patient Lookup Tasks > Lookup > People. After you enter the search criteria, select Find and right-click on the applicable person. Encounter Lookup Select Tasks menu, then select Lookup, and then select Encounters. Enter search criteria and then select Find. Right-click the applicable encounter Appointment List Select the appointment list icon. Enter search criteria and then select Find. Right-click the applicable appointment Patient Chart From a patient's chart, select the Encounters tab and then right-click on the applicable encounter From a patient's chart, select the Financial tab. Right-click the applicable encounter. Appointment Book ( Daily, Weekly List, Weekly Schedule, or Multi-View view) Right-click the applicable appointment. Insurance Listing Select Tasks menu, the

About the Eligibility/Referral Tab in Insurance Maintenance

Recommendations

About the Benefit Info Tab in Insurance Maintenance

About the Referrals Tab in Insurance Maintenance

About the Detail-2 Tab in Insurance Maintenance

About the External Tab in Insurance Maintenance

Insurance Maintenance Window

NextGen® Eligibility Verification Submission

About the Benefit Info Tab in Insurance Maintenance

About the Referrals Tab in Insurance Maintenance

About the Detail-2 Tab in Insurance Maintenance

About the External Tab in Insurance Maintenance

Insurance Maintenance Window

NextGen® Eligibility Verification Submission