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

NextGen® Eligibility Verification Submission

The user interface of NextGen® Eligibility Verification is the same irrespective of where it is accessed from. The following table lists the access points for Eligibility. 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, the

Help Guide for NextGen® Enterprise PM 8

New Authorization Access Points

From the… Use this access path People Lookup or Patient Lookup Click Tasks menu, then click Lookup, and then click People. Enter search criteria and then click Find. Right-click the applicable person and then select New Authorization. Note: There are two distinct views of Person Lookup. Both support authorization transactions. By default, the new look is used by NextGen® Enterprise PM; this can be overridden with the NGConfig.INI file. Contact your NextGen® Eligibility Verification analyst before editing any NGConfig.ini file. Encounter Lookup Click Tasks menu, then click Lookup, and then click Encounters. Enter search criteria and then click Find. Right-click the applicable encounter and click New Authorization. Appointment List Click the appointment list icon. Enter search criteria and then click Find. Right-click the applicable appointment and click New Authorization. Patient Chart From a patient's chart, click the Encounters tab and then right-click the applicable encounter and cli

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 Insurance and Financial Information to Patient Encounters

Open NextGen® Enterprise PM. On the main toolbar, select Chart, and then in Patient Lookup, enter your search criteria, and then select Find. Matching people and patient records appear in the search results. In Matching Records, select a patient record , and then select Open. The Patient Information tab opens in the Patient Chart window. Select the Encounters tab, and then select the Insurance tab. In Encounters, select an encounter, and then in Encounter Insurance, right-click a listed insurance, and then select Open. You can also open the Insurance Maintenance window by right-clicking the added payer. Note: To add manual referrals on Insurance Maintenance, you must configure the practice preferences to view Referral Required checkbox on Insurance Maintenance. You can also scan the patient insurance card in Insurance 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

NextGen® Eligibility Verification Submission

Recommendations

NextGen® Eligibility Verification Submission

New Authorization Access Points

NextGen® Eligibility Verification People Lookup

Run an Eligibility Batch Manually

Managing Insurance Information for a Person or Patient Profile

Add Insurance and Financial Information to Patient Encounters

NextGen® Eligibility Verification Submission

NextGen® Eligibility Verification Submission

New Authorization Access Points

NextGen® Eligibility Verification People Lookup

Run an Eligibility Batch Manually

Managing Insurance Information for a Person or Patient Profile

Add Insurance and Financial Information to Patient Encounters