Appointment Level Insurance for Cost Estimation

Help Guide for NextGen® Enterprise PM 8

Cost Estimation for an Appointment

You can estimate the patient cost for an appointment with any status such as Expected, Kept, Cancelled, No Show, and Pending. You can also do cost estimation for an appointment with event SIM codes or an appointment with an encounter. Note: Cost estimation can only be completed for one appointment at a time. You can initiate cost estimation from the following: The Appointment Lookup window. You can open the Appointment Lookup window by selecting Appointments on the toolbar or selecting Tasks > Lookup > Appointments. Using the search criteria, you can find the appointment list of a specific person or patient. You can right-click the desired appointment and select Estimate Patient Cost. The appointment book. To open an appointment from the appointment book, you can select ApptBook on the toolbar or select Tasks > Appt Book. In the appointment book that opens, you can right-click the specific appointment and select Estimate Patient Cost. By default, the following details are displayed on

Help Guide for NextGen® Enterprise PM 8

Cost Estimation for a Person

A person in NextGen® Enterprise PM is denoted by and can be any of the following: New patient who has not yet been checked in for the first appointment Guarantor for a patient in the practice Insurance policy holder for a patient in the practice Emergency contact for a patient in the practice Patient in another practice within the same enterprise You can find a person using the People Lookup window and initiate cost estimation for the person. You can open the People Lookup window through one of the following methods. Selecting Lookup or Est Patient Cost on the toolbar. Selecting Tasks > Estimate Patient Cost from the menu. Selecting Tasks > Lookup > People from the menu. You can use the search criteria to find the person. You can open the Estimate Patient Cost window by right-clicking the record of the specific person and selecting Estimate Patient Cost. If you initiate cost estimation for a person or patient using the People Lookup window, the following information is displayed. Demog

Help Guide for NextGen® Enterprise PM 8

Cost Estimation for a Patient

In NextGen® Enterprise PM, a patient is a record that has a chart created in the practice and is denoted by . A chart includes the clinical and financial details related to the patient's encounters in the practice. A person can become a patient in the practice when a chart is created for the person. A patient record that has an account in the practice is denoted by . You can search for and find a patient in the practice on the Patient Lookup window. You can open the Patient Lookup window by selecting Chart on the toolbar or selecting Tasks > Lookup > Charts. You can use the search criteria to find the desired patient. To open the Estimate Patient Cost window, you can right-click the specific patient and select Estimate Patient Cost. If you initiate cost estimation for a patient using the Patient Lookup window, the following information is displayed. Demographic information of the person or patient and the guarantor All active and unhidden insurances Parent topic: Estimating Patient Cos

Help Guide for NextGen® Enterprise PM 8

Setting Network Type and Coverage Level for Cost Estimation

In NextGen® Enterprise PM, select the Est Patient Cost. The Estimate Patient Cost window opens. In Select Provider/Location/Service Type, do one of the following: To retrieve co-pay, co-insurance, and deductible amounts from the eligibility results, select < none > in Network Type and Coverage Level. To generate in network co-pay, co-insurance, and in network individual deductible values, select In Network in Network Type, and then select Individual in Coverage Level. To generate out of network co-pay or co-insurance and out of network individual deductible values, select Out of Network in Network Type, and then select Individual in Coverage Level. To generate in network co-pay or co-insurance and in network family deductible values, select In Network in Network Type, and then select Family in Coverage Level. To generate out of network co-pay or co-insurance and out of network family deductible values, select Out of Network in Network Type, and then select Family in Coverage Level. Par

Help Guide for NextGen® Enterprise PM 8

Generate Cost Estimation

The default information appearing on the Estimate Patient Cost window depends on the source of the cost estimation. You can specify the necessary data such as provider information, service location, service type, service items, and units of service items required for estimating cost. Additionally, you can keep notes and assign diagnosis codes. In NextGen® Enterprise PM, select Est Patient Cost on the toolbar. The People Lookup window opens. Double-click to select a person. The Modify Person Information window opens. You can make necessary changes to the person record and then select Ok. The Estimate Patient Cost window opens for the selected person or patient. On the Estimate Patient Cost window, to select the payer in the Payer Selection section, do one of the following: Note: Payer Selection is a required field. If the person or patient wants to use insurance coverage for the services, select a payer from the list. Note: You can select only one payer from the list. If you select a pa

Help Guide for NextGen® Enterprise PM 8

Estimating Patient Cost

In NextGen® Enterprise PM, the Estimate Patient Cost window enables you to specify the inputs required for calculating the patient and insurance responsibility amounts for services planned or rendered. You can initiate cost estimation from: The People Lookup window for a person. The Patient Lookup window for a patient. The Appointment Lookup window or the appointment book for an appointment or event. The Encounter Lookup window or the Encounters tab on the Patient Chart window for an encounter. The Estimation Results in the Clinical History/Notes tab on the Patient Chart window. When you initiate the cost estimation, the Estimate Patient Cost window opens: Estimate Patient Cost window Every time you specify and submit data on the Estimate Patient Cost window, a new cost estimation record will be created with a unique cost estimation ID. Multiple cost estimates can be created for one person, patient, appointment, or encounter. Estimate Patient Cost Fields Estimate Patient Cost window fi

Appointment Level Insurance for Cost Estimation

Recommendations

Cost Estimation for an Appointment

Cost Estimation for a Person

Cost Estimation for a Patient

Setting Network Type and Coverage Level for Cost Estimation

Generate Cost Estimation

Estimating Patient Cost

Appointment Level Insurance for Cost Estimation

Cost Estimation for an Appointment

Cost Estimation for a Person

Cost Estimation for a Patient

Setting Network Type and Coverage Level for Cost Estimation

Generate Cost Estimation

Estimating Patient Cost