Updating a Location for Encounter Specific Line Items

Help Guide for NextGen® Enterprise PM 8

Updating Location Specific Authorizations and Referrals

This topic refers to clients who activate the Encounter Advanced Restrictions option in System Administrator. The path is System Administrator > Rights > Encounters - Advanced Restrictions. When line-item referrals and authorizations are location specific and the location is changed, the following occurs: Task approval is required. Authorizations or referrals attached to the original payer are unlinked from the encounter. A notification email is sent to the assigned user stating that an Encounter change was approved. The payer must be reviewed and updated, if needed. Authorizations or referrals attached to the payer must be manually linked to the encounter in the Patient Insurance- Encounter window to confirm that the location is applicable for the authorizations and referrals. Parent topic: Authorizations and Referrals - Line-level and Claim-level

Help Guide for NextGen® Enterprise PM 8

Components of Authorization Code Tracking window

Field Description Authorization Mode Select one of the following options: Encounter Mode - when the authorization is for the entire encounter. Units Mode - when the authorization is for units (procedures). Tracking Only - do not send on claim Select this check box to track the number of encounters or units on authorizations for internal purposes. The authorization tracking totals are not sent on the claim or the EDI file. Authorization Code Enter the authorization code provided by the insurance company. Effective Date Select the effective date from the pop-up calendar. Expiration Date Select the expiration date from the pop-up calendar. Nbr Encounters Enter the number of encounters allowed for this authorization. Used Displays the number of authorizations utilized. Pending Displays the number of non-billed authorizations linked to an encounter. Encounters Left Displays the number of authorizations remaining for the patient. Rendering Select a single provider or multiple providers to at

Help Guide for NextGen® Enterprise PM 8

Add Authorizations Code Tracking in the Encounter tab

The Authorization Code Tracking window displays encounters which use the authorization, and appointments pending the authorization. When authorization is not required to be attached to the claim,you can track authorizations for internal purposes. Line-level and claim-level authorizations are tracked by the following: A single location A single location and a specialty A single location and one or more providers. 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 on the Insurance tab under it. Right-click the insurance listed on the Encounter Insurance section, and select Authorization. The Authorization Listing window opens. Authorization Listing Win

Help Guide for NextGen® Enterprise PM 8

Authorizations and Referrals - Line-level and Claim-level

The eligibility verification functionality in NextGen allows you to verify patient benifit and the benifit coverage. referrals from primary physician to a specialist check on a claim status with a payer submit authorization requests managed patient care involves referrals from a primary care provider to an authorized specialist. Referral history allows you to view all the previous referrals for a given patient authorization involvess requests for approval frm payers for the services to be rendered verify patient benifit and the benifit coverage. Line level and claim level authorizations and referrals for primary, secondary, and tertiary payers can be attached automatically or manually to an encounter. You can manually attach a medical specialty, a location, or one or more rendering providers to authorizations and referrals. Authorizations can be tracked for internal purposes when a payer does not require authorizations to be sent on the claim. Primary, Secondary, and Tertiary Payers fo

System Administrator Help

Encounters - Advanced Restrictions Operation

The Encounters - Advanced Restrictions Operations are used in NextGen® Enterprise PM and NextGen® Enterprise EHR. Subgroup Description Encounter Changes Location Enables users to activate the Encounter Advanced Restrictions option in System Administrator when a location is changed for encounter specific line-items. Encounter Changes Primary Payer Enables users to activate the Encounter Advanced Restrictions option in System Administrator when a primary payer is changed. Encounter Changes Services Dates Enables users to activate the Encounter Advanced Restrictions option in System Administrator when service dates are changed. Void and Enter Charges Enables users to void and enter a charge on an encounter. Parent topic: Subgroups of the Operations Permissions Group

Help Guide for NextGen® Enterprise PM 8

Change Line Item Discounts to Encounter Discounts

When you change from a line item-level discount to an encounter-level discount, the previous discount amounts are cleared out in both the header and on the line items. To change line item-level charge discounts to encounter-level discounts, do the following: Open the Charge Posting window for the desired patient and encounter. Select the Discounts button on the charge posting toolbar. The Discounts window opens. Select Encounter in the Discount Level section. Enter the encounter level discount percentage or amount. The Discount Information grid displays the discounted amount for the selected line items in the Discount Amount column. Select OK. The new discounts are processed according to the status of the encounter. In Progress encounters: The application deletes the original discount adjustments, applies new discounts, and then posts the transaction batch. Tax charges are recalculated. Since the encounter is in an In Progress status, no process dates are defined for the charges or tra

Updating a Location for Encounter Specific Line Items

Recommendations

Updating Location Specific Authorizations and Referrals

Components of Authorization Code Tracking window

Add Authorizations Code Tracking in the Encounter tab

Authorizations and Referrals - Line-level and Claim-level

Encounters - Advanced Restrictions Operation

Change Line Item Discounts to Encounter Discounts

Updating Location Specific Authorizations and Referrals

Components of Authorization Code Tracking window

Add Authorizations Code Tracking in the Encounter tab

Authorizations and Referrals - Line-level and Claim-level

Encounters - Advanced Restrictions Operation

Change Line Item Discounts to Encounter Discounts