Submit Eligibility for an Unattached Payer
Select
Other Payer
.
If available, enter MemberID. If MemberID is not available, use another alternate search option.
Select
Submit
.
The
Eligibility Response
window opens.
Select
OK
when prompted with an eligibility message to confirm submission.
If you want to attach the payer to the patient, select
Add to Patient
.
Select
OK
when prompted that the payer has been successfully added to the patient.
The next time you submit an eligibility for this patient, the previous unattached payer automatically displays in the Payer Selection.
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Help Guide for NextGen® Enterprise PM 8
Enable Eligibility Preferences in Practice Preferences
In NextGen® Enterprise PM select Admin, select Preferences, and then select Practice. The Practice Preferences window opens. Check Enable eligibility submission for unattached payers. Select OK. Parent topic: Eligibility for Unattached Payers
Help Guide for NextGen® Enterprise PM 8
Eligibility for Unattached Payers
Eligibility inquiries can be submitted for a payer without first attaching it to a patient’s chart. In the case of Medicare or Medicaid replacements, this process can occur multiple times per patient. This feature enables you to submit NextGen® Eligibility Verification for a payer that is not attached to a patient’s chart. If active coverage is obtained, then the payer can be attached to the patient with a single selection. This feature is optional and enabled in Practice Preferences. Enable Eligibility Preferences in Practice Preferences You must enable eligibility submission for unattached payers in Practice Preferences to be able to submit eligibility inquiries. Submit Eligibility for an Unattached Payer You can submit eligibility inquiries for a payer that is not attached to a patient's chart. Parent topic: Eligibility Requests
Help Guide for NextGen® Enterprise PM 8
Submit NextGen® Eligibility Verification While Adding or Editing an Appointment
Perform the following steps to submit eligibility inquiries for a patient from the Edit Appointment window. From the Appointment Book, access the Edit Appointment window. Select the Ins/Diag tab. Right-click in the Insurance Information section, and then select Eligibility Verification > Submit Request. The patient's eligibility response appears. Parent topic: Eligibility Requests
Help Guide for NextGen® Enterprise PM 8
Eligibility Requests
When a NextGen® Eligibility Verification is submitted from the NextGen® Enterprise PM application, it is electronically sent to the transaction server, and then the inquiry is sent to a designated trading partner. The trading partner sends the response back through NextGen® Eligibility Verification where the inquiry results are saved in the patient's chart on the Clinical History/Notes tab under Chart Notes and in the patient’s insurance maintenance on the Elig/Ref tab. If a chart does not exist, the results are saved until a chart is created. Once the chart is created, the results are automatically attached to the patient's chart. Note: Only users who have security rights for this function can submit inquiries. Submit Eligibility Requests You can submit inquires regarding a patient's eligibility and benefit coverage. NextGen Eligibility Verification Submission You can access NextGen® Eligibility Verification from multiple points within NextGen® Enterprise PM. Submit Eligibility in Bat
Help Guide for NextGen® Enterprise PM 8
Eligibility Responses
The following sections explain the NextGen® Eligibility Verification Response received from the payer. The user interface for Real-Time Eligibility Response is informative and easy to navigate. Color codes and symbols make the data easy to understand and to confirm successful responses like Active, Inactive, and Limited. When a payer returns a Limited response, the message is advising providers to contact the payer with further verification. An example is an eligibility response record with a type 'V' (Cannot Process) is handled like type 'U' (Contact for Verification). You can view the latest successful eligibility response from the payer irrespective of having a pending status transaction for the specified time period (in days) as per user preference . To specify the number of days in the user preferences, go to NextGen Healthcare Success Community and download the latest Layout and User Preferences Guide for NextGen Enterprise PM, and refer to the Set General Preferences section. Yo
Help Guide for NextGen® Enterprise PM 8
View Latest Successful Eligibility Response from Appointment Lookup
Before you begin Submit NextGen® Eligibility Verification request for a patient. See Submit Eligibility Requests. To view the latest NextGen® Eligibility Verification response from an appointment in the appointment lookup, do the following: In NextGen® Enterprise PM, select ApptList. The Appointment Lookup window opens. Using the search criteria, find the appointment with the NextGen® Eligibility Verification request and yet to receive the response. Right-click the appointment and select Eligibility Verification > View Latest Successful Response. The system searches for the eligibility response for the latest successful transaction during the time period specified in the user preferences. If the eligibility response is available, the Real-Time Eligibility Response page opens displaying the response for the latest successful transaction. If the eligibility response is not available, a message appears stating that the successful eligibility response for the specified period is not found.
