Allow Encounter Payers to Differ on a Case

Help Guide for NextGen® Enterprise PM 8

Require Case Management for a Payer

You can indicate that a payer requires case management in NextGen® Enterprise PM. The payer can then only be used on encounters that are part of a case. When case management is required, the following occurs: The Case Management Required field displays on the Patient Chart > Encounters tab > Case Management tab. If a user selects insurance for an encounter and a case is not attached to the encounter, then a warning alert displays when a user saves the encounter insurance. To generate a claim edit when the payer is attached and the encounter is not linked to a case, activate claim edit 217. In File Maintenance, select Master Files > System > Payers. Double-click a payer. The Modify Payer Information window opens. Select Practice tab > Other tab. Select Require Case Management, and then select OK. Select Require Case Management, and then select OK. If you want to generate a claim edit when the payer is attached but the encounter is not linked to a case, activate claim edit 217. Parent to

Help Guide for NextGen® Enterprise PM 8

View Alternate Payer Details for an Encounter

If an alternate payer is associated with an encounter insurance, then the alternate payer details appear in the Alternate Payer Details section. Open a patient chart. Select the Encounter tab and then select the Insurance sub-tab. In the Encounters list, select an encounter having an alternate payer associated with a payer. Select an encounter insurance in the Encounter Insurance section. The alternate payer details appear in the Alternate Payer Details section. Parent topic: Encounters in NextGen Enterprise PM

Help Guide for NextGen® Enterprise PM 8

View Alternate Payer Details for an Encounter

If an alternate payer is associated with an encounter insurance, then the alternate payer details appear in the Alternate Payer Details section. Open a patient chart. Select the Encounter tab and then select the Insurance sub-tab. In the Encounters list, select an encounter having an alternate payer associated with a payer. Select an encounter insurance in the Encounter Insurance section. The alternate payer details appear in the Alternate Payer Details section. Parent topic: Encounters in NextGen Enterprise PM

Help Guide for NextGen® Enterprise PM 8

Attach Cases to Appointments

Open NextGen® Enterprise PM. On the main toolbar, select ApptBook. Right-click an appointment, and then select Open. The Edit Appointment window opens. Select the open menu icon next to Case Description and Date, and then select Open Existing Case. The Select Case window opens. Select the case to be attached to the appointment, and then select OK. Note: In Practice Preferences > Case Management, when you clear the Allow encounter payers to differ when case is attached preference: You can attach a case to an appointment marked as Self Pay. You cannot attach a case to an appointment when the appointment insurance differs from the case insurance. Parent topic: Add Appointments

Help Guide for NextGen® Enterprise PM 8

Enable Qualifying Encounter Billing

The Encounter Rate Billing functionality in NextGen® Enterprise PM includes logic that identifies multiple encounters for a patient on the same date of service at the same location with the same encounter rate payer. Qualifying Encounter Billing must be enabled for the practice. When enabled, the Encounter Rate Billing Status fields display on the Billing & Collections tab of the Encounter Maintenance window. These fields are used to determine which encounter to bill when a patient has multiple same-day encounters with more than one provider at the same location with the same encounter rate payer attached. Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Practice. The Practice Preferences window opens. From the Preference List, select Claims. Select the Enable Qualifying Encounter Billing check box. To save changes and close the window, select OK. Parent topic: Practice Preferences for Encounter Rate Billing

NextGen® Enterprise EHR Help

Manage Cases from Encounters

Before you begin Ensure that the View Case Management checkbox is selected in the user-level settings to turn on case management on the Encounters tab. Any changes made to the Patient's Encounter preferences occur only after you reload the Encounters tab. The Encounters tab in NextGen® Enterprise EHR provides access to the cases and encounters available for the selected patient. Open NextGen® Enterprise EHR, and select a patient from Patient Lookup window. On the Encounters tab, select a case, select Case Options, and then select Properties. Note: Some cases can be marked as Private. If you select a case that is marked private, then you must have necessary user rights and permissions to access that case information. The Case Management window opens. Make necessary modifications to the selected case or the related data. Note: For more information on Case Management, go to NextGen Healthcare Success Community, and download the latest Case Management Guide for NextGen® Enterprise. Select

Allow Encounter Payers to Differ on a Case

Recommendations

Require Case Management for a Payer

View Alternate Payer Details for an Encounter

View Alternate Payer Details for an Encounter

Attach Cases to Appointments

Enable Qualifying Encounter Billing

Manage Cases from Encounters

Allow Encounter Payers to Differ on a Case

Require Case Management for a Payer

View Alternate Payer Details for an Encounter

View Alternate Payer Details for an Encounter

Attach Cases to Appointments

Enable Qualifying Encounter Billing

Manage Cases from Encounters