Create an Eligibility Profile Library

File Maintenance Help for NextGen® Enterprise

Create an Eligibility Profile Library

You can use the Eligibility Profile library to set up rules to automatically fill in data in batch mode and avoid manually data entry when running an eligibility status check in real time. In File Maintenance, select Libraries > Eligibility Profiles. Select Open Menu , and then select New. The RTS Eligibility Profile window opens. RTS Eligibility Profile window sets the rules and automatically enters data in batch mode Select the type of service. Select the details in Option and Setting, and then select OK. To set the eligibility profile as default for payers based on the financial class, select Default to Payers, select a financial class, and then select Default to All or Default if Blank. Select OK. Note: NextGen® Enterprise PM only allows another transaction to be submitted through NextGen® Background Business Processor, when NextGen® Background Business Processor refers to the Eligibility Profile Library setting Do not submit an eligibility if one has been run within and the eligib

Help Guide for NextGen® Enterprise PM 8

Submit Eligibility in Batch Mode Using Background Business Processor

Before you can run eligibility inquiries in batch mode, the eligibility profiles library must be defined. This library enables you to set up rules to automatically complete the required fields and additional data in batch mode that you would manually enter in NextGen® Eligibility Verification in real time. These libraries are set up during implementation by your administrator with the help of an analyst. Prior to submitting eligibility inquiries in batch mode using NextGen® Background Business Processor, two jobs must be created: NextGen® Eligibility Verification request and NextGen® Eligibility Verification response. The request job queries the appointments and submits the data to NextGen for processing while your response job later takes the results from the NextGen server and delivers the response to your database. For information on creating a job in NextGen® Background Business Processor for eligibility requests and responses, go to NextGen Healthcare Success Community and downloa

Help Guide for NextGen® Enterprise PM 8

Submit Eligibility in Batch Mode Using Background Business Processor

Before you can run eligibility inquiries in batch mode, the eligibility profiles library must be defined. This library enables you to set up rules to automatically complete the required fields and additional data in batch mode that you would manually enter in NextGen® Eligibility Verification in real time. These libraries are set up during implementation by your administrator with the help of an analyst. Prior to submitting eligibility inquiries in batch mode using NextGen® Background Business Processor, two jobs must be created: NextGen® Eligibility Verification request and NextGen® Eligibility Verification response. The request job queries the appointments and submits the data to NextGen for processing while your response job later takes the results from the NextGen server and delivers the response to your database. For information on creating a job in NextGen® Background Business Processor for eligibility requests and responses, go to NextGen Healthcare Success Community and downloa

File Maintenance Help for NextGen® Enterprise 8

Create an Eligibility Profiles Library

In File Maintenance, select Libraries > Eligibility Profiles. Select open menu button and select New. The RTS Eligibility Profile window opens. Select one or more types of service in the Type of Service field. Select a search option in the Patient Search Option field. Refer to Appendix A to select the options and settings as described in the tables and then select OK. To default the eligibility profile to payers by financial class, select Default to Payers. Select a financial class in the Financial Class field. Select Default to All or Default if Blank. A NextGen message opens. Select Yes. Parent topic: Eligibility Profiles Library

Help Guide for NextGen® Enterprise PM 8

Run an Eligibility Batch Manually

This type of select-and-submit batch submission is a NextGen® Eligibility Verification Batch. (Long-time RTS users may know this as a pseudo-batch.) In NextGen® Enterprise PM, select Tasks > Lookup, > Appointments. The Appointment Lookup window opens depending on whether you are submitting the inquiry from an appointment. Enter the search criteria and select Find. Select the appointments for the patients that you want to include in your batch submission. You must select more than one appointment from the list for batch processing. Right-click a patient and select Eligibility Verification and then select Submit. The Eligibility Verification Batch Request window opens. Uncheck the Submit in Batch Mode to queue and process one at a time. You get your result in real time. The amount of time it takes to complete is based on the number of appointments. Note: If you leave the Submit in batch mode box checked, the inquiries are queued and sent to NextGen® Background Business Processor. The res

Help Guide for NextGen® Enterprise PM 8

Run an Eligibility Batch Manually

This type of select-and-submit batch submission is a NextGen® Eligibility Verification Batch. (Long-time RTS users may know this as a pseudo-batch.) In NextGen® Enterprise PM, select Tasks > Lookup, > Appointments. The Appointment Lookup window opens depending on whether you are submitting the inquiry from an appointment. Enter the search criteria and select Find. Select the appointments for the patients that you want to include in your batch submission. You must select more than one appointment from the list for batch processing. Right-click a patient and select Eligibility Verification and then select Submit. The Eligibility Verification Batch Request window opens. Uncheck the Submit in Batch Mode to queue and process one at a time. You get your result in real time. The amount of time it takes to complete is based on the number of appointments. Note: If you leave the Submit in batch mode box checked, the inquiries are queued and sent to NextGen® Background Business Processor. The res

Create an Eligibility Profile Library

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Create an Eligibility Profile Library

Submit Eligibility in Batch Mode Using Background Business Processor

Submit Eligibility in Batch Mode Using Background Business Processor

Create an Eligibility Profiles Library

Run an Eligibility Batch Manually

Run an Eligibility Batch Manually

Create an Eligibility Profile Library

Submit Eligibility in Batch Mode Using Background Business Processor

Submit Eligibility in Batch Mode Using Background Business Processor

Create an Eligibility Profiles Library

Run an Eligibility Batch Manually

Run an Eligibility Batch Manually