Updating Location Specific Authorizations and Referrals

Help Guide for NextGen® Enterprise PM 8

Updating a Location for Encounter Specific Line Items

This topic only refers to clients who activate the Encounter Advanced Restrictions option in System Administrator. The path is System Administrator > Rights > Encounters - Advanced Restrictions. When a location is changed for encounter specific line-items, the following occurs: Task approval is not required. The original location is replaced with the new location. Authorizations or referrals attached to the original payer are unlinked from the encounter. When the change is processed, the system issues an alert to update the authorizations or referrals if required. 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

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 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

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

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

Updating Location Specific Authorizations and Referrals

Recommendations

Updating a Location for Encounter Specific Line Items

Components of Authorization Code Tracking window

Components of the Referral Code Tracking Window

Add Authorizations Code Tracking in the Encounter tab

Add Referral Code Tracking in the Encounters tab

Authorizations and Referrals - Line-level and Claim-level

Updating a Location for Encounter Specific Line Items

Components of Authorization Code Tracking window

Components of the Referral Code Tracking Window

Add Authorizations Code Tracking in the Encounter tab

Add Referral Code Tracking in the Encounters tab

Authorizations and Referrals - Line-level and Claim-level