Eligibility Verification Manager

Help Guide for NextGen® Enterprise PM 8

Eligibility Responses

The following sections explain the NextGen® Eligibility Verification Response received from the payer. The user interface for Real-Time Eligibility Response is informative and easy to navigate. Color codes and symbols make the data easy to understand and to confirm successful responses like Active, Inactive, and Limited. When a payer returns a Limited response, the message is advising providers to contact the payer with further verification. An example is an eligibility response record with a type 'V' (Cannot Process) is handled like type 'U' (Contact for Verification). You can view the latest successful eligibility response from the payer irrespective of having a pending status transaction for the specified time period (in days) as per user preference . To specify the number of days in the user preferences, go to NextGen Healthcare Success Community and download the latest Layout and User Preferences Guide for NextGen Enterprise PM, and refer to the Set General Preferences section. Yo

Help Guide for NextGen® Enterprise PM 8

Eligibility Verification from Eligibility Manager

To perform an Eligibility Verification from Eligibility Verification Manager, select a patient from the Eligibility Verification Manager grid. With the patient row highlighted, right-click and then select Eligibility Verification. The Eligibility Verification window appears with the patient's name highlighted in the title bar. Parent topic: Eligibility Verification Manager

Help Guide for NextGen® Enterprise PM 8

Generate Eligibility Report from Eligibility Manager

To perform an eligibility referral report from the eligibility verification dashboard, right-click anywhere in the dashboard grid and select Eligibility Referral Report. The NextGen Report Filter appears. Use the Settings List and the available columns to create your Eligibility Referral Report. Parent topic: Eligibility Verification Manager

Help Guide for NextGen® Enterprise PM 8

Eligibility Manager Eligibility Graph

The transaction chart displays on the dashboard of the Eligibility Verification Manager window. The bar graph is a display of transactions grouped by request date. The Chart Transaction Volume allows you to chart transactions for the last 62 days. You can also select the Date Range fields to enable them. A legend in the right of the chart explains the meaning of each color in the chart. Parent topic: Eligibility Verification Manager

Help Guide for NextGen® Enterprise PM 8

View Eligibility Response

To return to the dashboard, select the dashboard tab next to the patient's name in Eligibility Response. Double-clicking another patient's name from the dashboard grid displays that patient's eligibility response. You can open eligibility response information for multiple patients, and tab through each by selecting the patient's tab. Parent topic: Eligibility Verification Manager

Help Guide for NextGen® Enterprise PM 8

About Eligibility Verification

NextGen® Eligibility Verification is an electronic method of verifying a patient's eligibility and benefit coverage online. EV allows you to check for authorization and prior authorization, make a referral request, check referral history, and check a claim status. The rules governing eligibility and referrals are based on a patient's managed care coverage plan. The following are NextGen® Eligibility Verification features: Eligibility verification enables you to verify a patient's insurance coverage in real-time or in a batch using Background Business Processor. The results of the verification can flow directly into the patient's chart. Referral requests are made to generate a referral number, so that a primary care physician (PCP) can send a patient to an authorized specialist. Referral history enables you to view a patient's referral history. This history lists all previous referrals made for a patient. Claim status check enables you to find out the status of a claim and where it is i

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Eligibility Verification Manager

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Eligibility Responses

Eligibility Verification from Eligibility Manager

Generate Eligibility Report from Eligibility Manager

Eligibility Manager Eligibility Graph

View Eligibility Response

About Eligibility Verification