Encounter Mode Referrals

Help Guide for NextGen® Enterprise PM 8

Units Mode Referrals

A payer can provide a referral for the patient to have a specific CPT4 code and number of units performed, and those services may be rendered within a date range defined by the payer. This type of referral is entered in NextGen® Enterprise PM using Units Mode. From the Referral Code Tracking window, you can enter a Units Mode referral with the following information: Referral code (required) Effective and expiration dates (required) Rendering provider Location Provider specialty Free-text description Valid ICD codes Valid CPT4 codes and number of units authorized (required) On the Referral Code Tracking window for an existing authorization, you can view Encounters Utilizing This Referral and Appointments Pending This Referral. These sections do not appear when you enter a new referral. Parent topic: About the Referrals Tab in Insurance Maintenance

Help Guide for NextGen® Enterprise PM 8

About the Referrals Tab in Insurance Maintenance

The Referrals tab on the Insurance Maintenance window enables you to enter one or more referrals for the patient's insurance. For example, when a patient's primary care provider refers them to a specialist for a specific procedure, the specialist may need to obtain a referral from the payer prior to performing that procedure. The referral number provided by the payer can be entered in NextGen® Enterprise PM, so it is included on claims sent by the specialist to that payer for the referred procedure. A Push Pin icon on the tab indicates one or more referrals exist for the patient's insurance. Existing referrals are listed with the following information: Effective Date Expiration Date Referral Code Encounters Encounters Left Units Units Left Description Referrals and Encounters When a referral is entered for the insurance before an encounter is created, it automatically attaches to a new encounter that meets all criteria defined within the referral. Note: If the ICD or CPT4 codes have be

Help Guide for NextGen® Enterprise PM 8

Encounter Mode Authorizations

A payer can provide an authorization for the patient to have a specific number of encounters, and those encounters may occur within a date range defined by the payer. This type of authorization is entered in NextGen® Enterprise PM using Encounter Mode. From the Authorization Code Tracking window, you can enter an Encounter Mode authorization with the following information: Authorization code (required) Effective and expiration dates (required) Number of encounters authorized Rendering provider Location Provider specialty Free-text description Valid ICD codes Valid CPT4 codes Additional administration information Additional free-text notes On the Authorization Code Tracking window for an existing authorization, you can view Encounters Utilizing This Authorization and Appointments Pending This Authorization. These sections do not appear when you enter a new authorization. Parent topic: About the Authorizations Tab in Insurance Maintenance

Help Guide for NextGen® Enterprise PM 8

Add Referral Code Tracking in the Encounters tab

Referrals can be created using ICD code ranges, CPT code ranges, encounters, or units. Multiple providers, a single specialty, or a location can be attached to a referral. You can track referrals by encounter use, pending encounters, and the number of encounters remaining on the referral. Open NextGen® Enterprise PM. On the main toolbar, select Chart or Chart Lookup.. The Patient Lookup window opens. In the Search Criteria section, enter the patient's information, and select Find. Patient records that match the search criteria, appear in the Matching Records section. Select the patient, and then select Open. The Patient Chart window opens. Select Encounters, and then select the Insurance tab under it. Right-click the insurance listed on the Encounter Insurance section, and select Referral. The Referrals Listing window opens. Referral Listing window Right-click and select New Referral from the menu. The Referral Code Tracking window opens. Referral Code Tracking Window Enter the desired

Help Guide for NextGen® Enterprise PM 8

Encounters in NextGen® Enterprise PM

An encounter is an interaction between a patient and a provider in the practice on a specific date and time. In NextGen® Enterprise PM, office encounters are typically created from the appointment book when each patient checks in for their appointment. Facility encounters that are not related to an appointment, such as hospital and nursing home visits, can be created from the patient's chart. Clinical information related to a specific encounter is documented by the provider in NextGen® Enterprise EHR. Financial information, such as charges, billing and transactions, is entered on that same encounter by users in NextGen® Enterprise PM. The Encounters tab on Patient Chart lists all encounters for a patient, and the Encounters Detail tab on Account Profile lists all encounters for a guarantor. For more information on encounters in NextGen® Enterprise EHR, go to the NextGen Healthcare Success Community and download the Layout and Preferences Guide for NextGen® Enterprise EHR. Encounter Sta

Help Guide for NextGen® Enterprise PM 8

Units Mode Authorizations

A payer can provide an authorization for the patient to have a specific CPT4 code and number of units performed, and those services may be rendered within a date range defined by the payer. This type of authorization is entered in NextGen® Enterprise PM using Units Mode. From the Authorization Code Tracking window, you can enter a Units Mode authorization with the following information: Authorization code (required) Effective and expiration dates (required) Rendering provider Location Provider specialty Free-text description Valid ICD codes Valid CPT4 codes and number of units authorized (required) Additional administration information Additional free-text notes On the Authorization Code Tracking window for an existing authorization, you can view Encounters Utilizing This Authorization and Appointments Pending This Authorization. These sections do not appear when you enter a new authorization. Parent topic: About the Authorizations Tab in Insurance Maintenance

Encounter Mode Referrals

Recommendations

Units Mode Referrals

About the Referrals Tab in Insurance Maintenance

Encounter Mode Authorizations

Add Referral Code Tracking in the Encounters tab

Encounters in NextGen® Enterprise PM

Units Mode Authorizations

Units Mode Referrals

About the Referrals Tab in Insurance Maintenance

Encounter Mode Authorizations

Add Referral Code Tracking in the Encounters tab

Encounters in NextGen® Enterprise PM

Units Mode Authorizations