About the Referrals Tab in Insurance Maintenance

Help Guide for NextGen® Enterprise PM 8

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 aut

Help Guide for NextGen® Enterprise PM 8

Encounter Mode Referrals

A payer can provide a referral for the patient to have a specific number of encounters, and those encounters may occur within a date range defined by the payer. This type of referral is entered in NextGen® Enterprise PM using Encounter Mode. From the Referral Code Tracking window, you can enter an Encounter Mode referral with the following information: Referral code (required) Effective and expiration dates (required) Number of encounters authorized Rendering provider Location Provider specialty Free-text description Valid ICD codes Valid CPT4 codes On the Referral Code Tracking window for an existing referral, you can view Encounters Utilizing This Referral and Appointments Pending This Referral. These sections do not appear when you enter a new referral. Parent topic: About the Referrals Tab in Insurance Maintenance

Help Guide for NextGen® Enterprise PM 8

Units Mode Referrals

A payer can provide a referral 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. This type of referral is entered in NextGen® Enterprise PM using Units Mode. From the Referral Code Tracking window, you can enter a Units Mode referral with the following information: Referral code (required) Effective and expiration dates (required) Rendering provider Location Provider specialty Free-text description Valid ICD codes Valid CPT4 codes and number of units authorized (required) On the Referral Code Tracking window for an existing authorization, you can view Encounters Utilizing This Referral and Appointments Pending This Referral. These sections do not appear when you enter a new referral. Parent topic: About the Referrals Tab in Insurance Maintenance

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

Add Referral Code Tracking in the Encounters tab

Referrals can be created using ICD code ranges, CPT code ranges, encounters, or units. Multiple providers, a single specialty, or a location can be attached to a referral. You can track referrals by encounter use, pending encounters, and the number of encounters remaining on the referral. Open NextGen® Enterprise PM. On the main toolbar, select Chart or Chart Lookup.. The Patient Lookup window opens. In the Search Criteria section, enter the patient's information, and select Find. Patient records that match the search criteria, appear in the Matching Records section. Select the patient, and then select Open. The Patient Chart window opens. Select Encounters, and then select the Insurance tab under it. Right-click the insurance listed on the Encounter Insurance section, and select Referral. The Referrals Listing window opens. Referral Listing window Right-click and select New Referral from the menu. The Referral Code Tracking window opens. Referral Code Tracking Window Enter the desired

Help Guide for NextGen® Enterprise PM 8

Add an Isurance Referral

From the Ins/Diag tab, select the insurance for which a referral is to be added. Right-click and select New Referral from the menu. The Referral Code Tracking window opens. In the Referral Mode section, select one of the following: Encounter Mode: Select this button if the referral is approved for a specific number of encounters. This button is selected by default. Units Mode: Select this button if the referral is approved for a specific number of charge units. In the Referral Code field, enter the referral number obtained from the insurance company. This field is required. In the Effective Date field, enter the start date for the referral. This field is required. In the Expiration Date field, enter the end date for the referral. This field is required. In the Nbr Encounters field enter the number of encounters approved for the referral. This field is not available for Units Mode referrals. The Used field displays 0. The number increments by 1 each time the referral is linked to an enc

About the Referrals Tab in Insurance Maintenance

Referrals and Encounters

Recommendations

About the Authorizations Tab in Insurance Maintenance

Encounter Mode Referrals

Units Mode Referrals

Insurance Maintenance Window

Add Referral Code Tracking in the Encounters tab

Add an Isurance Referral

About the Authorizations Tab in Insurance Maintenance

Encounter Mode Referrals

Units Mode Referrals

Insurance Maintenance Window

Add Referral Code Tracking in the Encounters tab

Add an Isurance Referral