Insurance Maintenance Window

Help Guide for NextGen® Enterprise PM 8

Encounter Insurance Selection Window

The window also provides you with a pushpin icon to indicate that data exists for a category and provides you with easy access to the Insurance Maintenance window. Also, you can perform the following actions: Access a right-click menu with options for sizing columns and selecting columns to display on the window. Select the pushpin icon to access the Insurance Maintenance window and view, add, or modify information to the category. Hover over the column header to view information such as patient name, DOB, effective date, expiration date, encounters remaining, and status. Select on a column to access the corresponding tab on the Insurance Maintenance window. For example, if a pushpin icon is not present in the Card column, a select in the column will take you directly to the Ins Cards tab of the Insurance Maintenance window. Resize, move, and remove columns from the window Add Insurance to Encounters You can add one or more insurances to an encounter for billing purposes. Add Insurance

Help Guide for NextGen® Enterprise PM 8

About the Eligibility/Referral Tab in Insurance Maintenance

The Elig/Referral tab on the Insurance Maintenance window can be used with NextGen Eligibility Verification. The following real-time transactions can be submitted from this tab: Eligibility Verification requests New Referral requests Referral History requests A Push Pin icon on the tab indicates one or more real-time transactions exist for the payer. Note: This tab is available only if the Enable Eligibility/Referral option has been selected in Practice Preferences > General. Parent topic: Insurance Maintenance Window

Help Guide for NextGen® Enterprise PM 8

About the Authorizations Tab in Insurance Maintenance

The Authorizations tab on the Insurance Maintenance window enables you to enter one or more authorizations for the patient's insurance. For example, a provider may need to obtain an authorization from the payer prior to performing a specific procedure for the patient. The authorization number provided by the payer can be entered in NextGen® Enterprise PM, so it is included in the claims sent by the provider to that payer for the authorized procedure. A pushpin icon on the tab indicates one or more authorizations exist for the patient's insurance. Existing authorizations are listed with the following information: Effective Date Expiration Date Authorization Code Description Encounters Encounters Left Units Units Left If you have selected a service package library in Libraries > Service Package Library field on the Practice Preferences window, the existing authorizations are sorted by Effective Date in the descending order, so newer authorizations are at the top of the list and older aut

Help Guide for NextGen® Enterprise PM 8

Viewing Insurance Information in Encounters

You can view a patient's insurance information in the Insurance tab You can view insurance information for an encounter in the Insurance tab under Encounters. The Encounters section displays the list of patient encounters. The Insurance Information section displays information for the selected insurance based on the setup for the payer in the payers master file in File Maintenance. For more information on setting up payers, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise PM. You can do the following on the Insurance tab under Encounters: Open the Encounter Insurance Selection window for the selected encounter. Open the Insurance Maintenance window for the encounter. Remove the selected insurance from the encounter. Open the Balance Control window for the selected encounter. Open the Authorization Listing window for the selected insurance. Open the Referral Listing window for the selected insurance. Open the

Help Guide for NextGen® Enterprise PM 8

About the Detail-2 Tab in Insurance Maintenance

The Detail-2 tab on the Insurance Maintenance window allows you to enter additional information about the patient's insurance. Insurance Card Name Override Information entered in the First, Middle, Last, Suffix and Sex fields can be used to override the same information entered in demographics for the subscriber of the insurance. This information is used for claims. For example, the subscriber's name in demographics is different than the name on their insurance card. Other information for claims includes Plan Code and TPL Code. A TPL (Third-Party Liability) code may be needed for secondary Medicaid claims. Eligibility Verification Override The Date of Birth field can be used to override the birth date entered in demographics for the subscriber of the insurance. If a date is entered and the Eligibility Verification check box is selected, the date will be sent on Eligibility Verification, New Referral and Referral History transactions submitted to the payer using NextGen Eligibility Veri

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

Insurance Maintenance Window

Recommendations

Encounter Insurance Selection Window

About the Eligibility/Referral Tab in Insurance Maintenance

About the Authorizations Tab in Insurance Maintenance

Viewing Insurance Information in Encounters

About the Detail-2 Tab in Insurance Maintenance

About the Referrals Tab in Insurance Maintenance

Insurance Maintenance Window

Encounter Insurance Selection Window

About the Eligibility/Referral Tab in Insurance Maintenance

About the Authorizations Tab in Insurance Maintenance

Viewing Insurance Information in Encounters

About the Detail-2 Tab in Insurance Maintenance

About the Referrals Tab in Insurance Maintenance