Prior Authorization

Help Guide for NextGen® Enterprise PM 8

Open Authorization Lookup

In NextGen® Enterprise PM, click Tasks > Lookup > Authorization. The Authorization Lookup displays. Enter the search criteria and click Find. The Authorization Listing displays the authorizations as shown in the following image. Authorization Lookup Details Parent topic: Prior Authorization

Help Guide for NextGen® Enterprise PM 8

Authorization Results

Authorization Results are saved to a patient's chart and are available for review and reporting. Access Authorization Results on Patient Chart You can view authorization results and history, resubmit or submit a new authorization. Authorization History to Authorization Verification The authorization verification displays patient name. Parent topic: Prior Authorization

Help Guide for NextGen® Enterprise PM 8

Access Authorization Results on Patient Chart

In NextGen® Enterprise PM, open a patient's chart. From the topics list on the far left, click the Clinical History/Notes tab to expand the Chart Notes folder. From the Chart Notes folder, click Authorization Results. The patient's authorization history opens and displays details like date and time of authorization, type of authorization, status of an authorization, and so on. From the authorization details, right-click to do the following: Open - View the authorization results Resubmit - Resubmit a previously submitted authorization New Authorization - Submit a new authorization Authorization History - opens Authorization Inquiry Parent topic: Authorization Results

Help Guide for NextGen® Enterprise PM 8

Add Authorization and Referral information in the Encounters tab

Authorization involves requests for payer approval for services to be provided. You can track authorizations by using a single location, a single location and a speciality, and a single location and one or more providers line-level and claim-level authorizations. When authorization is not required to attach to a claim, you can track the authorization information for internal reference. You can track referrals by encounters use, pending encounters, and the number of encounters remaining on the referral. 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 Insurance. In Encounter Insurance, right-click a listed insurance, and then select Authorization. Optional: T

NextGen® Therapy Suite Help 30.3.13.0

Enter a New Authorization by Visits

Select the payer from the Insurance Information grid. Select the Visits option below the Precertification/Authorization grid. Use the fields below the Precertification/Authorization grid to enter the authorization information: NBR, Authorization #, Effective Date, Expiration Date and Visits. Note: You can use the Get button to populate the fields with authorization information that has already been attached to the Insurance in the NextGen® Enterprise PM. Select Get and then select the appropriate authorization from the picklist to pull into the Pre-Cert template fields. You must assign the NBR manually. Entries for Pre-Cert Company, Expiration Date, and Associated Diagnosis are optional. The Associated Diagnosis grid only displays Dx codes after you have established the treating diagnosis. Select Add to save the authorization. The authorization appears in the Precertification/Authorization grid. Parent topic: Precertification/Authorization Panel

Help Guide for NextGen® Enterprise PM 8

Authorizations Report

You can track insurance authorizations by using the Authorizations report. The report filters can be set up by effective date, payer, number of encounters, number of encounters left, units, and number of units left. To access the report in NextGen® Enterprise PM, Select the Reports menu and select General and then select Authorizations. Authorizations Report Columns Parent topic: General Reports

Prior Authorization

Recommendations

Open Authorization Lookup

Authorization Results

Access Authorization Results on Patient Chart

Add Authorization and Referral information in the Encounters tab

Enter a New Authorization by Visits

Authorizations Report

Open Authorization Lookup

Authorization Results

Access Authorization Results on Patient Chart

Add Authorization and Referral information in the Encounters tab

Enter a New Authorization by Visits

Authorizations Report