Submit New Referral Inquiry

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

NextGen® Enterprise EHR Help

Referrals

The Referrals call type concerns communications that involve referring a physician to a patient. Select the New Call button and select Referrals from the Call Type list. The Panels and Panel Items opens. Select the Call Information and Contact Information panel items from the panels. Select Requested Referral. The Requested Referral option appears. Requested Referral Select the specialty from the Requested Specialty list. Select a physician to refer to the patient from the Physician list. Select Action(s). The Action(s) option appears. Select the Action(s) associated with the call. You can select more than one. Note: Select Sent letter due to inability to contact generates a document that can be sent to the patient. For more information, see Inability to Contact Letter. Select Call Status and select a status for the call. In the Comments section, enter any comments related to the call or attach a phrase. Select Add. The call is saved and logged on to the Communication Component Grid. P

Help Guide for NextGen® Enterprise PM 8

Components of the Referral Code Tracking Window

Field Action Encounter Mode Select this button if the referral is approved for a specific number of encounters. This button is selected by default. Units Mode Select this button if the referral is approved for a specific number of charge units. Referral Code Enter the referral number obtained from the insurance company. This field is mandatory. Effective Date Enter the start date for the referral. This field is mandatory. Expiration Date Enter the end date for the referral. This field is required Nbr Encounters Enter the number of encounters approved for the referral. Note: This field is not available for Units Mode referrals. Used This field displays 0. The number increments by 1 each time the referral is linked to an encounter. The number cannot exceed the number in the Nbr Encounters field. Pending This field displays 0. The number increments by 1 each time an appointment is scheduled for the patient. The number cannot exceed the number in the Nbr Encounters field. Encounters Left T

Help Guide for NextGen® Enterprise PM 8

Add Referral Code Tracking in the Encounters tab

Referrals can be created using ICD code ranges, CPT code ranges, encounters, or units. Multiple providers, a single specialty, or a location can be attached to a referral. You can track referrals by encounter use, pending encounters, and the number of encounters remaining on the referral. Open NextGen® Enterprise PM. On the main toolbar, select Chart or Chart Lookup.. The Patient Lookup window opens. In the Search Criteria section, enter the patient's information, and select Find. Patient records that match the search criteria, appear in the Matching Records section. Select the patient, and then select Open. The Patient Chart window opens. Select Encounters, and then select the Insurance tab under it. Right-click the insurance listed on the Encounter Insurance section, and select Referral. The Referrals Listing window opens. Referral Listing window Right-click and select New Referral from the menu. The Referral Code Tracking window opens. Referral Code Tracking Window Enter the desired

Help Guide for NextGen® Enterprise PM 8

Eligibility Referral Reconciliation Report Columns

The following columns are available on the Eligibility Referral Reconciliation report: Column Name Description Data Populates From Prac Name Practice Name Practice associated with the patient's eligibility/referral Pat Name Patient Full Name Patient Information Per Nbr Person Number Patient Information Insured Name of Insured Guarantor Maintenance Insured Pat Nbr Patient's HIC/Policy Number Insurance Maintenance Rendering Rendering Provider (Requesting Physician) Requesting Physician from Inquiry Payer Name Payer Name associated with transaction Insurance Maintenance associated with the transaction Inq Type Type of Inquiry (Eligibility, New Referral, or Referral History) Type of inquiry selected from the pop-up menu used to access an inquiry SubmitStatus Status of Inquiry System-generated based on results of the transaction Response Status Response Status Received from clearinghouse Rejection Definition Rejection Definition Received from clearinghouse Crt Dt Create Date System-generate

NextGen® Adaptive Content Engine Help Enterprise 8

Create an Obstetrics Referral

You can select the Medications or Immunizations links at any time during the encounter to open the associated module. Open NextGen® Enterprise EHR. To select an insurance provider from the resulting list, on the Referrals tab, select the Insurance name field. To learn more about documenting on the Referrals Order template, select any of the informational icons. Referrals Order Enter the insurance policy number in the Policy # field. In the To section, select Obstetrics. In the Provider name field, select to select a name from the Physician list. Select the Location field and do one of the following: Select a value from the list. Select the top blank row to enter a location in the field. To indicate if authorization is required, select No or Yes. To document related details, select the Additional Information link. In the Diagnosis section, do the following: Select the Description field. If an assessment has not been documented for the patient encounter, select Add Assessment or Add Comm

Submit New Referral Inquiry

Recommendations

Referral History Inquiries

Referrals

Components of the Referral Code Tracking Window

Add Referral Code Tracking in the Encounters tab

Eligibility Referral Reconciliation Report Columns

Create an Obstetrics Referral

Referral History Inquiries

Referrals

Components of the Referral Code Tracking Window

Add Referral Code Tracking in the Encounters tab

Eligibility Referral Reconciliation Report Columns

Create an Obstetrics Referral