Add an Isurance Referral

Help Guide for NextGen® Enterprise PM 8

Add an Insurance Authorization

From the Ins/Diag tab, select the insurance for which an authorization is to be added. Right-click and select New Authorization from the menu. The Authorization Code Tracking window opens. In the Authorization Mode section, select one of the following: Encounter Mode: Select this button if the authorization is approved for a specific number of encounters. This button is selected by default. Units Mode: Select this button if the authorization is approved for a specific number of charge units. If the authorization is for tracking proposes only and should not be included on claims, select the Tracking Only - Do not send on claim check box. In the Authorization Code field, enter the authorization number obtained from the insurance company. This field is required. In the Effective Date field, enter the start date for the authorization. This field is required. In the Expiration Date field, enter the end date for the authorization. This field is required. In the Nbr Encounters field enter the

Help Guide for NextGen® Enterprise PM 8

Components of the Referral Code Tracking Window

Field Action 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. Referral Code Enter the referral number obtained from the insurance company. This field is mandatory. Effective Date Enter the start date for the referral. This field is mandatory. Expiration Date Enter the end date for the referral. This field is required Nbr Encounters Enter the number of encounters approved for the referral. Note: This field is not available for Units Mode referrals. Used This field displays 0. The number increments by 1 each time the referral is linked to an encounter. The number cannot exceed the number in the Nbr Encounters field. Pending This field displays 0. The number increments by 1 each time an appointment is scheduled for the patient. The number cannot exceed the number in the Nbr Encounters field. Encounters Left T

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

Components of Authorization Code Tracking window

Field Description Authorization Mode Select one of the following options: Encounter Mode - when the authorization is for the entire encounter. Units Mode - when the authorization is for units (procedures). Tracking Only - do not send on claim Select this check box to track the number of encounters or units on authorizations for internal purposes. The authorization tracking totals are not sent on the claim or the EDI file. Authorization Code Enter the authorization code provided by the insurance company. Effective Date Select the effective date from the pop-up calendar. Expiration Date Select the expiration date from the pop-up calendar. Nbr Encounters Enter the number of encounters allowed for this authorization. Used Displays the number of authorizations utilized. Pending Displays the number of non-billed authorizations linked to an encounter. Encounters Left Displays the number of authorizations remaining for the patient. Rendering Select a single provider or multiple providers to at

Help Guide for NextGen® Enterprise PM 8

Add Authorizations Code Tracking in the Encounter tab

The Authorization Code Tracking window displays encounters which use the authorization, and appointments pending the authorization. When authorization is not required to be attached to the claim,you can track authorizations for internal purposes. Line-level and claim-level authorizations are tracked by the following: A single location A single location and a specialty A single location and one or more providers. 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 on the Insurance tab under it. Right-click the insurance listed on the Encounter Insurance section, and select Authorization. The Authorization Listing window opens. Authorization Listing Win

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

Add an Isurance Referral

Recommendations

Add an Insurance Authorization

Components of the Referral Code Tracking Window

Add Referral Code Tracking in the Encounters tab

Components of Authorization Code Tracking window

Add Authorizations Code Tracking in the Encounter tab

About the Referrals Tab in Insurance Maintenance

Add an Insurance Authorization

Components of the Referral Code Tracking Window

Add Referral Code Tracking in the Encounters tab

Components of Authorization Code Tracking window

Add Authorizations Code Tracking in the Encounter tab

About the Referrals Tab in Insurance Maintenance