Referral Inquiries and Histories

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

Help Guide for NextGen® Enterprise PM 8

Referral History Inquiries

Do the following to submit a referral history inquiry: Right-click and select Referral History from one of the defined access paths. The Provider Referral Inquiry appears. Complete the following required fields: Patient Insurances Requesting Physician Complete the optional fields: Requesting Location (leave blank) Referred To Entity Type Code Qualifier (leave blank) ID Code (leave blank) Reference Code Qualifier (leave blank) Reference ID Code (leave blank) Notes (not sent to payer but displays on response - 255-character limit) Select OK. The inquiry is now being processed. The progress bar at the bottom of the dialog box displays under Ready to Submit. When the submission is complete, the system displays the response in the Referral Result window. View the Transaction Details, Service Provider Details, and Subscriber Details. Note: Scroll-down and view additional information; for example, Services Detail and procedure and diagnosis codes, and benefit dates. To print a copy of the eli

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

About Eligibility Verification

NextGen® Eligibility Verification is an electronic method of verifying a patient's eligibility and benefit coverage online. EV allows you to check for authorization and prior authorization, make a referral request, check referral history, and check a claim status. The rules governing eligibility and referrals are based on a patient's managed care coverage plan. The following are NextGen® Eligibility Verification features: Eligibility verification enables you to verify a patient's insurance coverage in real-time or in a batch using Background Business Processor. The results of the verification can flow directly into the patient's chart. 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 referral history. This history lists all previous referrals made for a patient. Claim status check enables you to find out the status of a claim and where it is i

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

Referral Inquiries and Histories

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