NextGen® Eligibility Verification Submission

From the…	Use this access path
People or Patient Lookup	Tasks > Lookup > People. After you enter the search criteria, select Find and right-click on the applicable person.
Encounter Lookup	Select Tasks menu, then select Lookup, and then select Encounters. Enter search criteria and then select Find. Right-click the applicable encounter
Appointment List	Select the appointment list icon. Enter search criteria and then select Find. Right-click the applicable appointment
Patient Chart	From a patient's chart, select the Encounters tab and then right-click on the applicable encounter From a patient's chart, select the Financial tab. Right-click the applicable encounter.
Appointment Book ( Daily, Weekly List, Weekly Schedule, or Multi-View view)	Right-click the applicable appointment.
Insurance Listing	Select Tasks menu, then select Lookup, and then select People. Enter search criteria and then select Find. Right-click the applicable patient. Select Open, and then select Insurance on the People Maintenance details. Right-click the applicable Insurance.
Insurance Maintenance	Select a patient's chart and then select the Insurance tab. Double-click the applicable insurance, and then select the Elig/Referral tab. Right-click the window. Note: You can also access the Insurance Maintenance dialog box from the Ins/Diag tab on the appointment book.

Help Guide for NextGen® Enterprise PM 8

Submit Eligibility From Appointment Scheduling

When enabled from File Maintenance, the NextGen® Eligibility Verification appears when users create an appointment and the following conditions are met: The user has security rights to submit eligibility inquiries. The patient has at least one eligibility-enabled payer attached. The appointment creation date is within the number of days specified in Practice Preferences. An NextGen® Eligibility Verification for the first payer listed for the patient, that is eligibility-enabled, has not successfully processed an inquiry within the time-frame specified in the payer’s Eligibility Profile Library. Event chosen on appointment is selected in Practice Preferences to submit eligibility during appointment scheduling. The standard NextGen® Eligibility Verification window appears when all conditions are met. Parent topic: Eligibility Requests

Help Guide for NextGen® Enterprise PM 8

NextGen® Eligibility Verification People Lookup

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 m

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

NextGen® Enterprise EHR Help

Managing Insurance Information for a Person or Patient Profile

You can associate insurance information on the following windows: Add Person Information and Modify Person Information windows for person records Add Patient Information and Modify Patient Information windows for patient records In the Available Insurance section of the Demographics tab, select the Open Menu to perform the following tasks: Add Insurance to a Person or Patient record Hidden Insurance Information Open Insurance Information for a Person or Patient record Hide Insurance Add an Authorization to a Person or Patient record Add an Eligibility Verification to a Person or Patient record Add a Referral to a Person or Patient record Request a Provider Referral Inquiry Promote or Demote Insurance For more information on adding or modifying insurance information, go to the NextGen Healthcare Success Community and download the latest Encounter Maintenance User Guide for NextGen® Enterprise PM. Add Insurance to a Person or Patient You can use the Insurance Maintenance window to add an

Help Guide for NextGen® Enterprise PM 8

Add Benefit Information to Patient Insurance

You can record annual and lifetime benefit information to help determine patient responsibility. 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 then select Find. Patient records that match the search criteriaa ppear in the Matching Records section. Select the patient, and then select Open. The Patient Chart window opens. Select the Encounters tab. The encounters associated with the patient appear in the Encounters section. Select the Insurance tab and then select the encounter from the Encounters section. Right-click the selected insurance, and then select Open. The Insurance Maintenance window opens. Select the Benefits Info tab and then select the Eligibility and Benefits tab. To view existing benefit information, select open menu and then select New or Open. The Eligibility and Benefit Maintenance window opens. Eligibilty and Benefit Information Win

Help Guide for NextGen® Enterprise PM 8

Managing Insurance Information for a Person or Patient Profile

You can associate insurance information on the following windows: Add Person Information and Modify Person Information windows for person records Add Patient Information and Modify Patient Information windows for patient records In the Available Insurance section of the Demographics tab, select the Open Menu to perform the following tasks: Add Insurance to a Person or Patient record Hidden Insurance Information Open Insurance Information for a Person or Patient record Hide Insurance Add an Authorization to a Person or Patient record Add an Eligibility Verification to a Person or Patient record Add a Referral to a Person or Patient record Request a Provider Referral Inquiry Promote or Demote Insurance For more information on adding or modifying insurance information, go to the NextGen Healthcare Success Community and download the latest Encounter Maintenance User Guide for NextGen® Enterprise PM. Add Insurance to a Person or Patient You can use the Insurance Maintenance window to add an

NextGen® Eligibility Verification Submission

Recommendations

Submit Eligibility From Appointment Scheduling

NextGen® Eligibility Verification People Lookup

Run an Eligibility Batch Manually

Managing Insurance Information for a Person or Patient Profile

Add Benefit Information to Patient Insurance

Managing Insurance Information for a Person or Patient Profile

Submit Eligibility From Appointment Scheduling

NextGen® Eligibility Verification People Lookup

Run an Eligibility Batch Manually

Managing Insurance Information for a Person or Patient Profile

Add Benefit Information to Patient Insurance

Managing Insurance Information for a Person or Patient Profile