Certificate of Medical Necessity

Help Guide for NextGen® Enterprise PM 8

Certificate of Medical Necessity

In File Maintenance, you can create Certificate of Medical Necessity (CMN) forms for Durable Medical Equipment (DME) devices by SIM code. Each form includes specific questions and answer formats that are required by payers for a specific DME device. When you create the CMN form, it is used in NextGen® Enterprise PM to enter information and answer questions related to a patient’s DME device. This information is then included in the electronic 837P (1500) claim file for payers that require CMN information for that specific CPT4 code. Note: The CMN Information is not related to the Medical Necessity functionality in NextGen® Enterprise PM that evaluates CPT4 and ICD codes to determine whether the procedure is medically necessary. Access the CMN Information Window You can enter the CMN information for a patient's encounter insurance from the Certificates of Medical Necessity Information window. Add or Modify CMN Information for an Encounter Insurance You can add or modify the CMN informati

Help Guide for NextGen® Enterprise PM 8

Access the CMN Information Window

In the Certificates of Medical Necessity Information window, you can enter the CMN information for a patient encounter insurance. Certificates of Medical Necessity Information window can be accessed from the following areas in NextGen® Enterprise PM. Patient Chart > Encounters tab Charge Posting window To open the Certificates of Medical Necessity Information window from the Patient Chart > Encounters tab, do the following: Open NextGen® Enterprise PM. Select Chart. The Patient Lookup window opens. Select the desired patient, and then select Open. The Patient Chart opens for the desired patient. Select the Encounters tab, and then select the desired encounter from the Encounters list. Select the Insurance sub-tab. In the Encounter Insurance section, highlight the insurance that requires the CMN information and do one of the following: Right-click on the insurance and select CMN from the menu. Select Open Record in the Verification section, and then select Open Record in the Certificate

Help Guide for NextGen® Enterprise PM 8

Encounters in NextGen® Enterprise PM

An encounter is an interaction between a patient and a provider in the practice on a specific date and time. In NextGen® Enterprise PM, office encounters are typically created from the appointment book when each patient checks in for their appointment. Facility encounters that are not related to an appointment, such as hospital and nursing home visits, can be created from the patient's chart. Clinical information related to a specific encounter is documented by the provider in NextGen® Enterprise EHR. Financial information, such as charges, billing and transactions, is entered on that same encounter by users in NextGen® Enterprise PM. The Encounters tab on Patient Chart lists all encounters for a patient, and the Encounters Detail tab on Account Profile lists all encounters for a guarantor. For more information on encounters in NextGen® Enterprise EHR, go to the NextGen Healthcare Success Community and download the Layout and Preferences Guide for NextGen® Enterprise EHR. Encounter Sta

Help Guide for NextGen® Enterprise PM 8

Add or Modify CMN Information for an Encounter Insurance

You can enter CMN information for a patient's encounter insurance. Open the CMN Information window for the desired patient, encounter, and insurance. The Patient and Insured fields cannot be modified. Select a different encounter insurance in the Insurance field, if needed. Note: If you change the insurance, a message appears stating that this will delete all data associated with this CMN form for this encounter and payer. Are you sure you want to delete this data? Select CMN Form, and then select the desired form. Forms are listed with the following information: Form Number Form Name Service Item Code Note: If you change the CMN form, a message appears stating that if the CMN form is changed, all data entered on the existing CMN form will be lost. Select Certification Type, and then select one of the following: Initial Revised Recertification Select Certification Date, and then enter a date for the selected certification type. Select Height, and then enter the patient's height in inch

Help Guide for NextGen® Enterprise PM 8

Access the CMN Information Window

In the Certificates of Medical Necessity Information window, you can enter the CMN information for a patient encounter insurance. Certificates of Medical Necessity Information window can be accessed from the following areas in NextGen® Enterprise PM. Patient Chart > Encounters tab Charge Posting window To open the Certificates of Medical Necessity Information window from the Patient Chart > Encounters tab, do the following: Open NextGen® Enterprise PM. Select Chart. The Patient Lookup window opens. Select the desired patient, and then select Open. The Patient Chart opens for the desired patient. Select the Encounters tab, and then select the desired encounter from the Encounters list. Select the Insurance sub-tab. In the Encounter Insurance section, highlight the insurance that requires the CMN information and do one of the following: Right-click on the insurance and select CMN from the menu. Select Open Record in the Verification section, and then select Open Record in the Certificate

Help Guide for NextGen® Enterprise PM 8

Add Medical Necessity Certificate

Open NextGen® Enterprise PM. On the main toolbar, select Chart, and then in Patient Lookup, enter your search criteria, and then select Find. Matching people and patient records appear in the search results. In Matching Records, select a patient record , and then select Open. The Patient Information tab opens in the Patient Chart window. Select the Encounters tab, and then select an encounter from the Encounters list, and then select the Insurance tab. Select the appropriate insurer, right-click and then select CMN. In Certificates of Medical Necessity Information, enter the necessary information, and then select OK. Parent topic: Add Insurance for Patients and Persons

Certificate of Medical Necessity

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Certificate of Medical Necessity

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Access the CMN Information Window

Add Medical Necessity Certificate

Certificate of Medical Necessity

Certificate of Medical Necessity

Access the CMN Information Window

Encounters in NextGen® Enterprise PM

Add or Modify CMN Information for an Encounter Insurance

Access the CMN Information Window

Add Medical Necessity Certificate