The following example uses the People Lookup window to run a on a specific person.
Select the lookup icon.
The People Lookup window opens.
Select a record, right-click and then select Eligibility Verification.
The Eligibility Verification window opens.
Complete the required fields that appear in red:
Payer Selection field lists all the active payers that are attached to the patients and are marked available in the insurance maintenance.
Requesting Physician field lists all providers with NextGen® Eligibility Verification license and valid NPI.
Benefit Search Options field lists all available types of services. This is a required field when you use NextGen® Eligibility Verification for the first time. On subsequent searches, the field is populated with your previous search criteria. You must select at least one type of service to obtain successful response from the payer.
Optional fields
Other Payer is an optional feature that allows you to send transaction to an unattached payer. For more information, see Submit Eligibility for Unattached Payers.
Date Range (allows back date to 1 year) is an optional way to allow you to use date range instead of specific date as a date of service. It defaults to today’s date as many payers only provide benefits information for the current date. It allows you to back date up to one calendar year to get historical information.
Deactivate Inactive Insurance is an optional way to mark the insurance inactive in the event the insurance response status received from the payer is inactive.
Note: Deactivate also marks the payer as inactive in Insurance Maintenance.
Patient Search Options is defaulted to Name, DOB, MID because most payers require you to provide this information for your patient. However, you can change this and use alternate search options. The payer is responsible to provide your information to submit successful transactions. The search options you select can result in a rejected transaction.
Benefit Search Options
Type of Services - you have many types of services to choose from and you need to select at least one service type.
CPT4 - an optional field to send transaction by CPT code.
ICD-CM (based on payer availability) – an optional field to send transaction by ICD codes.
Note: CPT4 and ICD codes are not mandated by the industry, therefore all payers may not respond to the request.
Place of Service - this is an optional field that allows you to send place of service with the request.
Notes (not sent to payer but displays on response - 255-character limit)
Other Payer
The other payer option allows you to submit eligibility on an unattached payer for the patient. The payers list displays the available payers and the included payers. Highlight a payer (or double-click the payer) from the available list and then select the right arrow to place the payer in the included list.
Note: If the option to Submit Other Payer is not displayed, go to Practice Preference to enable.
Select Submit.
Once the enquiry is complete, the NextGen® Eligibility Verification response appears.
