NextGen® Eligibility Verification Submission

From the…	Use this access path
People or Patient Lookup	Tasks > Lookup > People. After you enter the search criteria, select Find and right-click on the applicable person.
Encounter Lookup	Select Tasks menu, then select Lookup, and then select Encounters. Enter search criteria and then select Find. Right-click the applicable encounter
Appointment List	Select the appointment list icon. Enter search criteria and then select Find. Right-click the applicable appointment
Patient Chart	From a patient's chart, select the Encounters tab and then right-click on the applicable encounter From a patient's chart, select the Financial tab. Right-click the applicable encounter.
Appointment Book ( Daily, Weekly List, Weekly Schedule, or Multi-View view)	Right-click the applicable appointment.
Insurance Listing	Select Tasks menu, then select Lookup, and then select People. Enter search criteria and then select Find. Right-click the applicable patient. Select Open, and then select Insurance on the People Maintenance details. Right-click the applicable Insurance.
Insurance Maintenance	Select a patient's chart and then select the Insurance tab. Double-click the applicable insurance, and then select the Elig/Referral tab. Right-click the window. Note: You can also access the Insurance Maintenance dialog box from the Ins/Diag tab on the appointment book.

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 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

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

NextGen® Eligibility Verification Submission

The user interface of NextGen® Eligibility Verification is the same irrespective of where it is accessed from. The following table lists the access points for Eligibility. From the… Use this access path People or Patient Lookup Tasks > Lookup > People. After you enter the search criteria, select Find and right-click on the applicable person. Encounter Lookup Select Tasks menu, then select Lookup, and then select Encounters. Enter search criteria and then select Find. Right-click the applicable encounter Appointment List Select the appointment list icon. Enter search criteria and then select Find. Right-click the applicable appointment Patient Chart From a patient's chart, select the Encounters tab and then right-click on the applicable encounter From a patient's chart, select the Financial tab. Right-click the applicable encounter. Appointment Book ( Daily, Weekly List, Weekly Schedule, or Multi-View view) Right-click the applicable appointment. Insurance Listing Select Tasks menu, the

Help Guide for NextGen® Enterprise PM 8

New Authorization Access Points

From the… Use this access path People Lookup or Patient Lookup Click Tasks menu, then click Lookup, and then click People. Enter search criteria and then click Find. Right-click the applicable person and then select New Authorization. Note: There are two distinct views of Person Lookup. Both support authorization transactions. By default, the new look is used by NextGen® Enterprise PM; this can be overridden with the NGConfig.INI file. Contact your NextGen® Eligibility Verification analyst before editing any NGConfig.ini file. Encounter Lookup Click Tasks menu, then click Lookup, and then click Encounters. Enter search criteria and then click Find. Right-click the applicable encounter and click New Authorization. Appointment List Click the appointment list icon. Enter search criteria and then click Find. Right-click the applicable appointment and click New Authorization. Patient Chart From a patient's chart, click the Encounters tab and then right-click the applicable encounter and cli

NextGen® Enterprise EHR Help

Managing Insurance Information for a Person or Patient Profile

You can associate insurance information on the following windows: Add Person Information and Modify Person Information windows for person records Add Patient Information and Modify Patient Information windows for patient records In the Available Insurance section of the Demographics tab, select the Open Menu to perform the following tasks: Add Insurance to a Person or Patient record Hidden Insurance Information Open Insurance Information for a Person or Patient record Hide Insurance Add an Authorization to a Person or Patient record Add an Eligibility Verification to a Person or Patient record Add a Referral to a Person or Patient record Request a Provider Referral Inquiry Promote or Demote Insurance For more information on adding or modifying insurance information, go to the NextGen Healthcare Success Community and download the latest Encounter Maintenance User Guide for NextGen® Enterprise PM. Add Insurance to a Person or Patient You can use the Insurance Maintenance window to add an

NextGen® Eligibility Verification Submission

Recommendations

Submit NextGen® Eligibility Verification for Appointments

Submit Eligibility Requests from Encounters

Submit Eligibility From Appointment Scheduling

NextGen® Eligibility Verification Submission

New Authorization Access Points

Managing Insurance Information for a Person or Patient Profile

NextGen® Eligibility Verification Submission

Submit NextGen® Eligibility Verification for Appointments

Submit Eligibility Requests from Encounters

Submit Eligibility From Appointment Scheduling

NextGen® Eligibility Verification Submission

New Authorization Access Points

Managing Insurance Information for a Person or Patient Profile