Units Mode Referrals

Help Guide for NextGen® Enterprise PM 8

Encounter Mode Referrals

A payer can provide a referral 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 referral is entered in NextGen® Enterprise PM using Encounter Mode. From the Referral Code Tracking window, you can enter an Encounter Mode referral with the following information: Referral 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 On the Referral Code Tracking window for an existing referral, you can view Encounters Utilizing This Referral and Appointments Pending This Referral. These sections do not appear when you enter a new referral. Parent topic: About the Referrals Tab in Insurance Maintenance

Help Guide for NextGen® Enterprise PM 8

About the Referrals Tab in Insurance Maintenance

The Referrals tab on the Insurance Maintenance window enables you to enter one or more referrals for the patient's insurance. For example, when a patient's primary care provider refers them to a specialist for a specific procedure, the specialist may need to obtain a referral from the payer prior to performing that procedure. The referral number provided by the payer can be entered in NextGen® Enterprise PM, so it is included on claims sent by the specialist to that payer for the referred procedure. A Push Pin icon on the tab indicates one or more referrals exist for the patient's insurance. Existing referrals are listed with the following information: Effective Date Expiration Date Referral Code Encounters Encounters Left Units Units Left Description Referrals and Encounters When a referral is entered for the insurance before an encounter is created, it automatically attaches to a new encounter that meets all criteria defined within the referral. Note: If the ICD or CPT4 codes have be

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

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

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

Units Mode Referrals

Recommendations

Encounter Mode Referrals

About the Referrals Tab in Insurance Maintenance

Units Mode Authorizations

Encounter Mode Authorizations

Add Referral Code Tracking in the Encounters tab

Components of the Referral Code Tracking Window

Encounter Mode Referrals

About the Referrals Tab in Insurance Maintenance

Units Mode Authorizations

Encounter Mode Authorizations

Add Referral Code Tracking in the Encounters tab

Components of the Referral Code Tracking Window