Eligibility Verification Library

File Maintenance Help for NextGen® Enterprise 8

Eligibility Profiles Library

The Eligibility Profiles library is required for submitting eligibility inquiries in batch mode. This library enables you to set up rules to automatically complete the required fields and additional data for batch mode that you would manually enter when running an eligibility status check in real-time mode. Create an Eligibility Profiles Library

Help Guide for NextGen® Enterprise PM 8

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. Parent topic: Eligibility Verification Library

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

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

Run an Eligibility Batch Manually

This type of select-and-submit batch submission is a NextGen® Eligibility Verification Batch. (Long-time RTS users may know this as a pseudo-batch.) In NextGen® Enterprise PM, select Tasks > Lookup, > Appointments. The Appointment Lookup window opens depending on whether you are submitting the inquiry from an appointment. Enter the search criteria and select Find. Select the appointments for the patients that you want to include in your batch submission. You must select more than one appointment from the list for batch processing. Right-click a patient and select Eligibility Verification and then select Submit. The Eligibility Verification Batch Request window opens. Uncheck the Submit in Batch Mode to queue and process one at a time. You get your result in real time. The amount of time it takes to complete is based on the number of appointments. Note: If you leave the Submit in batch mode box checked, the inquiries are queued and sent to NextGen® Background Business Processor. The res

File Maintenance Help for NextGen® Enterprise 8

Claim Status Profile Library

The Claim Status Profile library is required for submitting claim status inquiries. This library enables you to set up rules to automatically complete the required fields and additional data for batch mode processing. Create a Claim Status Profile Library Creating a Claim Status Profile Library You can create a claim status profile library using the field's description.

Eligibility Verification Library

Recommendations

Eligibility Profiles Library

Attach the Eligibility Profile Library

Submit Eligibility in Batch Mode Using Background Business Processor

Submit Eligibility Requests

Run an Eligibility Batch Manually

Claim Status Profile Library

Eligibility Verification Library

Eligibility Profiles Library

Attach the Eligibility Profile Library

Submit Eligibility in Batch Mode Using Background Business Processor

Submit Eligibility Requests

Run an Eligibility Batch Manually

Claim Status Profile Library