Eligibility for Unattached Payers

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

Help Guide for NextGen® Enterprise PM 8

Submit Eligibility Requests

There are several ways to submit eligibility inquiries: NextGen® Eligibility Verification Submission NextGen® Eligibility Verification Batch Submission Scheduled Batch through NextGen® Background Business Processor NextGen® Eligibility Verification transactions are submitted from different NextGen® Enterprise PM access points. The access points are Patient Lookup Appointment Book Appointment List Encounter Lookup From any of these access points, a NextGen® Eligibility Verification request can be submitted for a single patient by right-clicking on the patient, appointment, or encounter, and then selecting Eligibility Verification. Regardless of the access point, the user interface is the same. Several inquiries can be submitted at one time using batch mode. Manually submitting a batch of eligibility inquiries can be done from the appointment lookup and encounter lookup. This manual batch was referred to as Real Time batch. (Long time RTS users also know this as pseudo-batch.) Finally, b

Help Guide for NextGen® Enterprise PM 8

Submit NextGen® Eligibility Verification While Adding or Editing an Appointment

Perform the following steps to submit eligibility inquiries for a patient from the Edit Appointment window. From the Appointment Book, access the Edit Appointment window. Select the Ins/Diag tab. Right-click in the Insurance Information section, and then select Eligibility Verification > Submit Request. The patient's eligibility response appears. Parent topic: Eligibility Requests

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

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 for an Unattached Payer

Select Other Payer. If available, enter MemberID. If MemberID is not available, use another alternate search option. Select Submit. The Eligibility Response window opens. Select OK when prompted with an eligibility message to confirm submission. If you want to attach the payer to the patient, select Add to Patient. Select OK when prompted that the payer has been successfully added to the patient. The next time you submit an eligibility for this patient, the previous unattached payer automatically displays in the Payer Selection. Parent topic: Eligibility for Unattached Payers

Eligibility for Unattached Payers

Recommendations

Submit Eligibility From Appointment Scheduling

Submit Eligibility Requests

Submit NextGen® Eligibility Verification While Adding or Editing an Appointment

NextGen® Eligibility Verification Submission

Eligibility Requests

Submit Eligibility for an Unattached Payer

Submit Eligibility From Appointment Scheduling

Submit Eligibility Requests

Submit NextGen® Eligibility Verification While Adding or Editing an Appointment

NextGen® Eligibility Verification Submission

Eligibility Requests

Submit Eligibility for an Unattached Payer