Submit Eligibility in Batch Mode Using Background Business Processor

Help Guide for NextGen® Enterprise PM 8

Submit Eligibility Requests

There are several ways to submit eligibility inquiries: NextGen® Eligibility Verification Submission NextGen® Eligibility Verification Batch Submission Scheduled Batch through NextGen® Background Business Processor NextGen® Eligibility Verification transactions are submitted from different NextGen® Enterprise PM access points. The access points are Patient Lookup Appointment Book Appointment List Encounter Lookup From any of these access points, a NextGen® Eligibility Verification request can be submitted for a single patient by right-clicking on the patient, appointment, or encounter, and then selecting Eligibility Verification. Regardless of the access point, the user interface is the same. Several inquiries can be submitted at one time using batch mode. Manually submitting a batch of eligibility inquiries can be done from the appointment lookup and encounter lookup. This manual batch was referred to as Real Time batch. (Long time RTS users also know this as pseudo-batch.) Finally, b

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

Batch NextGen® Eligibility Verification When NPI is Missing

The following are examples of how NextGen® Eligibility Verification manages eligibility when specific information is missing or not defined: If the resources physician link does not contain an NPI, NextGen® Eligibility Verification batch eligibility sends the appointment rendering physician NPI as the provider if the resources physician link record does not contain an NPI. If the appointment resources physician link is fille but an NPI does not exist, the appointment rendering physician NPI is used. If the appointment rendering physician is not filled, then the Eligibility Profile Library (2100B Loop NM1 Segments Identification Code (NM109) is used. If the appointment rendering physician is filled but an NPI does not exist, then the Eligibility Profile Library (2100B Loop NM1 Segments Identification Code (NM109) is used. The following two images are in sequence and provide an example of editing a response from scheduling administration. The first image shows an open edit resource acces

Help Guide for NextGen® Enterprise PM 8

Run an Eligibility Batch Manually

This type of select-and-submit batch submission is a NextGen® Eligibility Verification Batch. (Long-time RTS users may know this as a pseudo-batch.) In NextGen® Enterprise PM, select Tasks > Lookup, > Appointments. The Appointment Lookup window opens depending on whether you are submitting the inquiry from an appointment. Enter the search criteria and select Find. Select the appointments for the patients that you want to include in your batch submission. You must select more than one appointment from the list for batch processing. Right-click a patient and select Eligibility Verification and then select Submit. The Eligibility Verification Batch Request window opens. Uncheck the Submit in Batch Mode to queue and process one at a time. You get your result in real time. The amount of time it takes to complete is based on the number of appointments. Note: If you leave the Submit in batch mode box checked, the inquiries are queued and sent to NextGen® Background Business Processor. The res

Help Guide for NextGen® Enterprise PM 8

Set Claim Status Request to Run Automatically

You can schedule claim status inquiries to run automatically in batch mode at a set schedule in NextGen® Background Business Processor. In NextGen® Background Business Processor, create a claim status request job. Note: For more information on creating a job in BBP for a claim status check, go to NextGen Healthcare Success Community and download the User Guide for NextGen® Background Business Processor. In File Maintenance, set up a Claim Status Profile library defining the rules for submitting claim status inquiries. For example, specify the type of Service Provider in the Provider Name (2100C Loop NM1 Segments) section. For more information on setting up the Claim Status Profile library, go to NextGen Healthcare Success Community and download the File Maintenance Libraries Guide for NextGen Enterprise. In File Maintenance, select Master Files > System > Payers > Practice > Libraries. The Modify Payer Information window opens. Attach the Claim Status Profile library to the payer and s

Help Guide for NextGen® Enterprise PM 8

Attach the Eligibility Profile Library

In NextGen® Background Business Processor, create an eligibility responses job to receive a response. In File Maintenance, set up an eligibility profiles library defining the rules for submitting eligibility inquiries in batch mode. In file maintenance, select Master Files > System > Payers > Practice tab, and then select the Libraries sub-tab. The Modify Payer Information opens. Attach the Eligibility Profile Library to the payer and select OK. Parent topic: Eligibility Verification Library

Submit Eligibility in Batch Mode Using Background Business Processor

Recommendations

Submit Eligibility Requests

Eligibility Requests

Batch NextGen® Eligibility Verification When NPI is Missing

Run an Eligibility Batch Manually

Set Claim Status Request to Run Automatically

Attach the Eligibility Profile Library

Submit Eligibility Requests

Eligibility Requests

Batch NextGen® Eligibility Verification When NPI is Missing

Run an Eligibility Batch Manually

Set Claim Status Request to Run Automatically

Attach the Eligibility Profile Library