Attach the Eligibility Profile Library
In
NextGen® Background Business Processor
, create an eligibility responses job to receive a response.
In File Maintenance, set up an eligibility profiles library defining the rules for submitting eligibility inquiries in batch mode.
In file maintenance, select
Master Files
>
System
>
Payers
>
Practice
tab, and then select the
Libraries
sub-tab.
The
Modify Payer Information
opens.
Attach the Eligibility Profile Library to the payer and select
OK
.
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Help Guide for NextGen® Enterprise PM 8
Eligibility Verification Library
Processing inquiries in batch mode requires creating a library. Once created, Eligibility Verification libraries automatically complete required fields and additional data in batch mode that would otherwise require the fields to be entered manually. Two libraries are used to process inquiries in batch mode: Eligibility Profiles Claim Status Profile Your Eligibility Verification Analyst assists in creating the libraries. Attach the Eligibility Profile Library Parent topic: Referral Inquiries and Histories
Help Guide for NextGen® Enterprise PM 8
Submit Eligibility in Batch Mode Using Background Business Processor
Before you can run eligibility inquiries in batch mode, the eligibility profiles library must be defined. This library enables you to set up rules to automatically complete the required fields and additional data in batch mode that you would manually enter in NextGen® Eligibility Verification in real time. These libraries are set up during implementation by your administrator with the help of an analyst. Prior to submitting eligibility inquiries in batch mode using NextGen® Background Business Processor, two jobs must be created: NextGen® Eligibility Verification request and NextGen® Eligibility Verification response. The request job queries the appointments and submits the data to NextGen for processing while your response job later takes the results from the NextGen server and delivers the response to your database. For information on creating a job in NextGen® Background Business Processor for eligibility requests and responses, go to NextGen Healthcare Success Community and downloa
Help Guide for NextGen® Enterprise PM 8
Set Claim Status Request to Run Automatically
You can schedule claim status inquiries to run automatically in batch mode at a set schedule in NextGen® Background Business Processor. In NextGen® Background Business Processor, create a claim status request job. Note: For more information on creating a job in BBP for a claim status check, go to NextGen Healthcare Success Community and download the User Guide for NextGen® Background Business Processor. In File Maintenance, set up a Claim Status Profile library defining the rules for submitting claim status inquiries. For example, specify the type of Service Provider in the Provider Name (2100C Loop NM1 Segments) section. For more information on setting up the Claim Status Profile library, go to NextGen Healthcare Success Community and download the File Maintenance Libraries Guide for NextGen Enterprise. In File Maintenance, select Master Files > System > Payers > Practice > Libraries. The Modify Payer Information window opens. Attach the Claim Status Profile library to the payer and s
Help Guide for NextGen® Enterprise PM 8
Eligibility Requests
When a NextGen® Eligibility Verification is submitted from the NextGen® Enterprise PM application, it is electronically sent to the transaction server, and then the inquiry is sent to a designated trading partner. The trading partner sends the response back through NextGen® Eligibility Verification where the inquiry results are saved in the patient's chart on the Clinical History/Notes tab under Chart Notes and in the patient’s insurance maintenance on the Elig/Ref tab. If a chart does not exist, the results are saved until a chart is created. Once the chart is created, the results are automatically attached to the patient's chart. Note: Only users who have security rights for this function can submit inquiries. Submit Eligibility Requests You can submit inquires regarding a patient's eligibility and benefit coverage. NextGen Eligibility Verification Submission You can access NextGen® Eligibility Verification from multiple points within NextGen® Enterprise PM. Submit Eligibility in Bat
Help Guide for NextGen® Enterprise PM 8
Submit Eligibility From Appointment Scheduling
When enabled from File Maintenance, the NextGen® Eligibility Verification appears when users create an appointment and the following conditions are met: The user has security rights to submit eligibility inquiries. The patient has at least one eligibility-enabled payer attached. The appointment creation date is within the number of days specified in Practice Preferences. An NextGen® Eligibility Verification for the first payer listed for the patient, that is eligibility-enabled, has not successfully processed an inquiry within the time-frame specified in the payer’s Eligibility Profile Library. Event chosen on appointment is selected in Practice Preferences to submit eligibility during appointment scheduling. The standard NextGen® Eligibility Verification window appears when all conditions are met. Parent topic: Eligibility Requests
File Maintenance Help for NextGen® Enterprise 8
Create an Eligibility Profiles Library
In File Maintenance, select Libraries > Eligibility Profiles. Select open menu button and select New. The RTS Eligibility Profile window opens. Select one or more types of service in the Type of Service field. Select a search option in the Patient Search Option field. Refer to Appendix A to select the options and settings as described in the tables and then select OK. To default the eligibility profile to payers by financial class, select Default to Payers. Select a financial class in the Financial Class field. Select Default to All or Default if Blank. A NextGen message opens. Select Yes. Parent topic: Eligibility Profiles Library
