Eligibility for Unattached Payers

Help Guide for NextGen® Enterprise PM 8

Submit NextGen® Eligibility Verification for Appointments

Open NextGen® Enterprise PM, and then select Appt List. The Appointment Lookup window opens. In Search Criteria, enter the patient's information, and then select Find. In Appointment List, select the appointment. The Edit Appointment window opens. Select Ins/Diag. Right-click Appointment Insurance Listing, and then select Eligibility Verification > Submit Request. Note: You can submit eligibility requests only for insurances that are attached to the appointment. Parent topic: Eligibility Requests

Help Guide for NextGen® Enterprise PM 8

Submit Eligibility From Appointment Scheduling

When enabled from File Maintenance, the NextGen® Eligibility Verification appears when users create an appointment and the following conditions are met: The user has security rights to submit eligibility inquiries. The patient has at least one eligibility-enabled payer attached. The appointment creation date is within the number of days specified in Practice Preferences. An NextGen® Eligibility Verification for the first payer listed for the patient, that is eligibility-enabled, has not successfully processed an inquiry within the time-frame specified in the payer’s Eligibility Profile Library. Event chosen on appointment is selected in Practice Preferences to submit eligibility during appointment scheduling. The standard NextGen® Eligibility Verification window appears when all conditions are met. Parent topic: Eligibility Requests

Help Guide for NextGen® Enterprise PM 8

Submit Eligibility Requests from Encounters

Before you begin When an eligibility request is submitted from an encounter, eligibility only references the insurance attached to the encounter. Open NextGen® Enterprise PM, and then select Chart. The Patient Lookup window opens. Enter the patient details, and then select OK. The Patient Chart window opens. Select Encounters, right-click the encounter, and then select Add Insurance. The Encounter Insurance Selection window opens. In the Selected Insurance section, select the payer, and then select OK. On the NextGen® Enterprise PM toolbar, Select Encounter. The Encounter Lookup window opens. Enter the encounter number. In the Encounter List section, right-click the encounter, and then select Eligibility Verification > Submit. The Eligibility Verification window opens. Note: When you submit an eligibility request for the encounter without insurance attached, a message appears stating that this patient has no eligibility verification-supported insurance. You can select Other Payer for a

Help Guide for NextGen® Enterprise PM 8

Eligibility for Unattached Payers

Eligibility inquiries can be submitted for a payer without first attaching it to a patient’s chart. In the case of Medicare or Medicaid replacements, this process can occur multiple times per patient. This feature enables you to submit NextGen® Eligibility Verification for a payer that is not attached to a patient’s chart. If active coverage is obtained, then the payer can be attached to the patient with a single selection. This feature is optional and enabled in Practice Preferences. Enable Eligibility Preferences in Practice Preferences You must enable eligibility submission for unattached payers in Practice Preferences to be able to submit eligibility inquiries. Submit Eligibility for an Unattached Payer You can submit eligibility inquiries for a payer that is not attached to a patient's chart. Parent topic: Eligibility Requests

Help Guide for NextGen® Enterprise PM 8

Eligibility Requests

When a NextGen® Eligibility Verification is submitted from the NextGen® Enterprise PM application, it is electronically sent to the transaction server, and then the inquiry is sent to a designated trading partner. The trading partner sends the response back through NextGen® Eligibility Verification where the inquiry results are saved in the patient's chart on the Clinical History/Notes tab under Chart Notes and in the patient’s insurance maintenance on the Elig/Ref tab. If a chart does not exist, the results are saved until a chart is created. Once the chart is created, the results are automatically attached to the patient's chart. Note: Only users who have security rights for this function can submit inquiries. Submit Eligibility Requests You can submit inquires regarding a patient's eligibility and benefit coverage. NextGen Eligibility Verification Submission You can access NextGen® Eligibility Verification from multiple points within NextGen® Enterprise PM. Submit Eligibility in Bat

Help Guide for NextGen® Enterprise PM 8

Submit Eligibility for an Unattached Payer

Select Other Payer. If available, enter MemberID. If MemberID is not available, use another alternate search option. Select Submit. The Eligibility Response window opens. Select OK when prompted with an eligibility message to confirm submission. If you want to attach the payer to the patient, select Add to Patient. Select OK when prompted that the payer has been successfully added to the patient. The next time you submit an eligibility for this patient, the previous unattached payer automatically displays in the Payer Selection. Parent topic: Eligibility for Unattached Payers

Eligibility for Unattached Payers

Recommendations

Submit NextGen® Eligibility Verification for Appointments

Submit Eligibility From Appointment Scheduling

Submit Eligibility Requests from Encounters

Eligibility for Unattached Payers

Eligibility Requests

Submit Eligibility for an Unattached Payer

Eligibility for Unattached Payers

Submit NextGen® Eligibility Verification for Appointments

Submit Eligibility From Appointment Scheduling

Submit Eligibility Requests from Encounters

Eligibility for Unattached Payers

Eligibility Requests

Submit Eligibility for an Unattached Payer