Require Case Management for a Payer

Help Guide for NextGen® Enterprise PM 8

Allow Encounter Payers to Differ on a Case

To allow encounters attached to a case to have different payers, you must enable this feature on the General tab of Practice Preferences window. Access the Practice Preferences and select the General tab. Select Allow encounter payers to differ when case is attached to enable users to change the payers that are selected on the Encounter Insurance Selection window in NextGen® Enterprise PM. Select OK. Parent topic: Case Management Setup

Help Guide for NextGen® Enterprise PM 8

Activate a Claim Edit to Require Case Management

You can create claim edits that indicate that a case must be attached to an encounter. In File Maintenance, select Libraries > Claim Edits. The Claim Edits List window opens. Select a claim edit library. In the ID column, locate the row that contains ID number 217 Claim payer requires case management. Select the Active column. A green check mark appears in the cell to indicate that the claim edit is active. Parent topic: Case Management Setup

Help Guide for NextGen® Enterprise PM 8

Case Management Setup

Setting up Case Management involves the following: Grant the necessary user rights and permissions in System Administrator. Enable Case Management in File Maintenance. Set alerts. Add case information to: Fee tickets Form and label templates from the data repository Requires a case on an encounter. Activate claim edits. Set up the Case Type Master. File in the File Maintenance. Set up and populate the Case Category, Case Contact Role, and Case Market in Master Lists in File Maintenance. Restrict user access to case management in System Administrator. If you use template editor, create the appropriate Case Management Templates in Template Editor. This involves setting the following General Options universal preferences in the System Administrator application that enable you to map template field names to case level templates: Case Mgt Case Type Category Field Case Mgt Case Type Category Item Field Case Mgt Market Field Enable consolidation of claims related to a Clinical Episode of care

Help Guide for NextGen® Enterprise PM 8

Create Cases in an Encounter

Before you begin In Practice Preferences, you must turn on Enable Case Management on the Case Management tab in File Maintenance. You can view and group the common patient encounter data in a case. 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, select the Case Management tab, and then select an encounter. The cases associated with the selected encounter appear. Select the open menu icon next to Case Management, and then select New. In the Case Management window, enter the necessary information, and then select OK. Note: You can view and clear the existing cases for the selected encounter. For more information on managing patient cases, go to NextGen Healthcare Success Com

File Maintenance Help for NextGen® Enterprise 8

Case Management Practice Preferences

Case Management enables you to track specific information for work-related accidents, auto accidents, and slip or fall accidents by rolling up encounters on to a case. A patient may have multiple cases running concurrently for different injuries. To enable Case Management in NextGen® Enterprise EHR and NextGen® Enterprise PM, you must enable Case Management in Practice Preferences on the Case Management window. You can access the Case Management tab through Admin > Practice > Preferences > Case Management in NextGen® Enterprise PM. You can view all case related preferences on the Case Management tab. Case Management has the following fields. Enable Case Management Required Fields Case Description Onset Date Onset Time Referring Provider Payers for this Case General Options Allow encounter payers to differ when case is attached Encounter Options Default Patient Type Copy Referring from appt from case related encounters When Enable Case Management is selected, Case Description, Onset Dat

Help Guide for NextGen® Enterprise PM 8

Create a New Case in NextGen Enterprise PM

This procedure provides instructions for creating a case. On the General tab of the patient chart, you can enter related cases, diagnosis and procedures codes, case contacts, and select encounters to include in the case. Each new Case is automatically assigned a numeric Case Number. All Case Numbers are sequential. To access a patient's chart, select the chart icon and search for the applicable patient. Open the patient's chart and then select Case Management. The Cases window opens. To access the Case Management window, select the open menu icon and select New. In the Available Encounters list, select the encounters that you want to add to the case. The Case Management window displays the name of the selected patient and the Case #. Enter the reason for creating the case, in the Case Description field. Enter the date the condition first occurred, in the Onset Date field. Enter all available additional information on the General tab. Select the Financial tab and enter all pertinent Pay

Require Case Management for a Payer

Recommendations

Allow Encounter Payers to Differ on a Case

Activate a Claim Edit to Require Case Management

Case Management Setup

Create Cases in an Encounter

Case Management Practice Preferences

Create a New Case in NextGen Enterprise PM

Require Case Management for a Payer

Allow Encounter Payers to Differ on a Case

Activate a Claim Edit to Require Case Management

Case Management Setup

Create Cases in an Encounter

Case Management Practice Preferences

Create a New Case in NextGen Enterprise PM