Referral History Inquiries

Help Guide for NextGen® Enterprise PM 8

Submit New Referral Inquiry

To submit a New Referral Inquiry: Right-click and select New Referral from one of the defined access paths. The New Referral Entry appears. Complete the following required fields: Replace with table Patient Insurances Requesting Physician Referred To Entity Type Place of Service Complete the optional fields: Requesting Location (leave blank) Code Qualifier (leave blank) ID Code (leave blank) Reference Code Qualifier (leave blank) CPT4 ICD-CM Reference ID Code (leave blank) Number of Encounters Notes (not sent to payer but displays on response - 255-character limit) Select OK. The inquiry is now being processed. The Progress bar appears under Ready to Submit. When the submission is complete, the system displays the response in the Referral Result window. To print a copy of the eligibility response for your records, select the print option. Select Close. Note: Each time an inquiry is submitted and a response is received, a significant event is logged. When a response is received, a chart

Help Guide for NextGen® Enterprise PM 8

Referral Inquiries and Histories

This feature allows you to submit, or request, new referral inquiries and view referral histories. Referral requests are made to generate a referral number so that a primary care physician (PCP) can send a patient to an authorized specialist. Referral history enables you to view a patient's history. This history lists all previous referrals made for a patient. Referral history generally documents the history of a patient treated by a specialist. Submit New Referral Inquiry Referral History Inquiries Referral history inquiries enable providers to view referral submissions. Eligibility Verification Library Attach 277 Claim Status Note to Encounter Parent topic: About Eligibility Verification

Help Guide for NextGen® Enterprise PM 8

Request a Provider Referral Inquiry

After you add an insurer to a person/patient's profile, you can request a history file for all previous patient referrals from the insurer. In the Insurance Listing section of the Demographics tab, select the Open Menu , and then select Referral History. The Provider Referral Inquiry window appears. Enter the Requesting Physician. This field is required. Enter any additional information. Select OK to save the changes. Parent topic: Managing Insurance Information for a Person or Patient Profile

NextGen® Enterprise EHR Help

Request a Provider Referral Inquiry

After you add an insurer to a person/patient's profile, you can request a history file for all previous patient referrals from the insurer. In the Insurance Listing section of the Demographics tab, select the Open Menu , and then select Referral History. The Provider Referral Inquiry window appears. Enter the Requesting Physician. This field is required. Enter any additional information. Select OK to save the changes. Parent topic: Managing Insurance Information for a Person or Patient Profile

NextGen® Enterprise EHR Help

Referrals

The Referrals call type concerns communications that involve referring a physician to a patient. Select the New Call button and select Referrals from the Call Type list. The Panels and Panel Items opens. Select the Call Information and Contact Information panel items from the panels. Select Requested Referral. The Requested Referral option appears. Requested Referral Select the specialty from the Requested Specialty list. Select a physician to refer to the patient from the Physician list. Select Action(s). The Action(s) option appears. Select the Action(s) associated with the call. You can select more than one. Note: Select Sent letter due to inability to contact generates a document that can be sent to the patient. For more information, see Inability to Contact Letter. Select Call Status and select a status for the call. In the Comments section, enter any comments related to the call or attach a phrase. Select Add. The call is saved and logged on to the Communication Component Grid. P

Help Guide for NextGen® Enterprise PM 8

Eligibility Referral Reconciliation Report Columns

The following columns are available on the Eligibility Referral Reconciliation report: Column Name Description Data Populates From Prac Name Practice Name Practice associated with the patient's eligibility/referral Pat Name Patient Full Name Patient Information Per Nbr Person Number Patient Information Insured Name of Insured Guarantor Maintenance Insured Pat Nbr Patient's HIC/Policy Number Insurance Maintenance Rendering Rendering Provider (Requesting Physician) Requesting Physician from Inquiry Payer Name Payer Name associated with transaction Insurance Maintenance associated with the transaction Inq Type Type of Inquiry (Eligibility, New Referral, or Referral History) Type of inquiry selected from the pop-up menu used to access an inquiry SubmitStatus Status of Inquiry System-generated based on results of the transaction Response Status Response Status Received from clearinghouse Rejection Definition Rejection Definition Received from clearinghouse Crt Dt Create Date System-generate

Referral History Inquiries

Recommendations

Submit New Referral Inquiry

Referral Inquiries and Histories

Request a Provider Referral Inquiry

Request a Provider Referral Inquiry

Referrals

Eligibility Referral Reconciliation Report Columns

Submit New Referral Inquiry

Referral Inquiries and Histories

Request a Provider Referral Inquiry

Request a Provider Referral Inquiry

Referrals

Eligibility Referral Reconciliation Report Columns