Service Unit Authorizations

Help Guide for NextGen® Enterprise PM 8

Units Mode Authorizations

A payer can provide an authorization for the patient to have a specific CPT4 code and number of units performed, and those services may be rendered within a date range defined by the payer. This type of authorization is entered in NextGen® Enterprise PM using Units Mode. From the Authorization Code Tracking window, you can enter a Units Mode authorization with the following information: Authorization code (required) Effective and expiration dates (required) Rendering provider Location Provider specialty Free-text description Valid ICD codes Valid CPT4 codes and number of units authorized (required) Additional administration information Additional free-text notes On the Authorization Code Tracking window for an existing authorization, you can view Encounters Utilizing This Authorization and Appointments Pending This Authorization. These sections do not appear when you enter a new authorization. Parent topic: About the Authorizations Tab in Insurance Maintenance

Help Guide for NextGen® Enterprise PM 8

Encounter Mode Authorizations

A payer can provide an authorization for the patient to have a specific number of encounters, and those encounters may occur within a date range defined by the payer. This type of authorization is entered in NextGen® Enterprise PM using Encounter Mode. From the Authorization Code Tracking window, you can enter an Encounter Mode authorization with the following information: Authorization code (required) Effective and expiration dates (required) Number of encounters authorized Rendering provider Location Provider specialty Free-text description Valid ICD codes Valid CPT4 codes Additional administration information Additional free-text notes On the Authorization Code Tracking window for an existing authorization, you can view Encounters Utilizing This Authorization and Appointments Pending This Authorization. These sections do not appear when you enter a new authorization. Parent topic: About the Authorizations Tab in Insurance Maintenance

Help Guide for NextGen® Enterprise PM 8

Service Unit Authorizations

When a payer authorizes a service package with unit limitations for a patient, and those packaged services may be rendered within a date range defined by the payer, you can enter the authorization in NextGen® Enterprise PM as a Service Unit Authorization. Note: Service Unit Authorizations are available only if a Service Package Library is selected in Practice Preferences > Libraries. For more information on Encounter Mode and Units Mode authorizations, refer to the Encounter Maintenance User Guide for NextGen® Enterprise PM. Access Authorizations for a Patient's Insurance Add or Modify Service Unit Authorization You can add or modify a service unit authorization. Delete a Service Unit Authorization Parent topic: Working with Service Packages in NextGen Enterprise PM

Help Guide for NextGen® Enterprise PM 8

About the Authorizations Tab in Insurance Maintenance

The Authorizations tab on the Insurance Maintenance window enables you to enter one or more authorizations for the patient's insurance. For example, a provider may need to obtain an authorization from the payer prior to performing a specific procedure for the patient. The authorization number provided by the payer can be entered in NextGen® Enterprise PM, so it is included in the claims sent by the provider to that payer for the authorized procedure. A pushpin icon on the tab indicates one or more authorizations exist for the patient's insurance. Existing authorizations are listed with the following information: Effective Date Expiration Date Authorization Code Description Encounters Encounters Left Units Units Left If you have selected a service package library in Libraries > Service Package Library field on the Practice Preferences window, the existing authorizations are sorted by Effective Date in the descending order, so newer authorizations are at the top of the list and older aut

Help Guide for NextGen® Enterprise PM 8

Service Unit Authorization Report

The Service Unit Authorization report in NextGen® Enterprise PM enables you to review and monitor patients with service unit authorizations to determine whether they have met or exceeded the maximum number of packaged services authorized by their insurance, and whether those services were provided within the time frame authorized by the payer. You can also use the report to determine if patients with upcoming appointments are nearing their service limit so an authorization for additional units or days can be requested and obtained from their insurance. This encounter-based report is available only if a Service Package Library is selected in Practice Preferences > Libraries. For more information on Service Packages and Service Unit Authorization, go to the NextGen Healthcare Success Community and download the Behavioral Health Billing User Guide for NextGen® Enterprise PM The Service Unit Authorization report includes patients with a service unit authorization that have encounters with

Help Guide for NextGen® Enterprise PM 8

Working with Service Packages in NextGen® Enterprise PM

When Service Package functionality is enabled for a practice, you can utilize the following functionality in NextGen® Enterprise PM: From the Authorizations tab on the Insurance Maintenance window or Authorization Listing window, you can enter service unit authorizations for payers that authorize packaged services for patients with unit and duration limitations. From the Reports > General > Authorizations menu, you can generate a Service Unit Authorization report to review and monitor patients with service unit authorizations and determine whether they have met or exceeded the maximum number of packaged services authorized by their insurance. Service Unit Authorizations Service Unit Authorization Report Parent topic: Service Packages in NextGen Enterprise PM

Service Unit Authorizations

Recommendations

Units Mode Authorizations

Encounter Mode Authorizations

Service Unit Authorizations

About the Authorizations Tab in Insurance Maintenance

Service Unit Authorization Report

Working with Service Packages in NextGen® Enterprise PM

Units Mode Authorizations

Encounter Mode Authorizations

Service Unit Authorizations

About the Authorizations Tab in Insurance Maintenance

Service Unit Authorization Report

Working with Service Packages in NextGen® Enterprise PM