Submit New Referral Inquiry

Help Guide for NextGen® Enterprise PM 8

Referral History Inquiries

Do the following to submit a referral history inquiry: Right-click and select Referral History from one of the defined access paths. The Provider Referral Inquiry appears. Complete the following required fields: Patient Insurances Requesting Physician Complete the optional fields: Requesting Location (leave blank) Referred To Entity Type Code Qualifier (leave blank) ID Code (leave blank) Reference Code Qualifier (leave blank) Reference ID Code (leave blank) Notes (not sent to payer but displays on response - 255-character limit) Select OK. The inquiry is now being processed. The progress bar at the bottom of the dialog box displays under Ready to Submit. When the submission is complete, the system displays the response in the Referral Result window. View the Transaction Details, Service Provider Details, and Subscriber Details. Note: Scroll-down and view additional information; for example, Services Detail and procedure and diagnosis codes, and benefit dates. To print a copy of the eli

Help Guide for NextGen® Enterprise PM 8

Submit New Referral Inquiry

To submit a New Referral Inquiry: Right-click and select New Referral from one of the defined access paths. The New Referral Entry appears. Complete the following required fields: Replace with table Patient Insurances Requesting Physician Referred To Entity Type Place of Service Complete the optional fields: Requesting Location (leave blank) Code Qualifier (leave blank) ID Code (leave blank) Reference Code Qualifier (leave blank) CPT4 ICD-CM Reference ID Code (leave blank) Number of Encounters Notes (not sent to payer but displays on response - 255-character limit) Select OK. The inquiry is now being processed. The Progress bar appears under Ready to Submit. When the submission is complete, the system displays the response in the Referral Result window. To print a copy of the eligibility response for your records, select the print option. Select Close. Note: Each time an inquiry is submitted and a response is received, a significant event is logged. When a response is received, a chart

Help Guide for NextGen® Enterprise PM 8

Referral History Inquiries

Do the following to submit a referral history inquiry: Right-click and select Referral History from one of the defined access paths. The Provider Referral Inquiry appears. Complete the following required fields: Patient Insurances Requesting Physician Complete the optional fields: Requesting Location (leave blank) Referred To Entity Type Code Qualifier (leave blank) ID Code (leave blank) Reference Code Qualifier (leave blank) Reference ID Code (leave blank) Notes (not sent to payer but displays on response - 255-character limit) Select OK. The inquiry is now being processed. The progress bar at the bottom of the dialog box displays under Ready to Submit. When the submission is complete, the system displays the response in the Referral Result window. View the Transaction Details, Service Provider Details, and Subscriber Details. Note: Scroll-down and view additional information; for example, Services Detail and procedure and diagnosis codes, and benefit dates. To print a copy of the eli

Help Guide for NextGen® Enterprise PM 8

Add a New Authorization Entry

Enter the information for the new authorization. Select Add New Authorization from one of the defined access paths. The New Authorization Entry window appears with the patient's name. Enter field information using the following table. Field Description Patient Insurances (Required) Select the patient's insurance(s). Note: For the payer to display in the Patient Insurances field, it must be listed on the Insurance Listing for the specified patient and it must be added to the Eligibility/Referral system. Requesting Physician (Required) Select the physician requesting NextGen® Eligibility Verification Certification Type (Required) Select the Certification Type. Type of Service (Required) Select one or more types of service. CPT4 Select a procedure code by clicking the Open Record button. This field enables you to determine coverage for the treatment of a specific procedure. You can select up to 99 CPT codes. If you exceed 99 codes, you receive a message that you have exceeded the number o

Help Guide for NextGen® Enterprise PM 8

Authorization Inquiry

Select Authorization Inquiry from one of the defined access paths. The Authorization Inquiry appears. Enter field information according to the following table: Field Description Patient Insurances (Required) Select the patient's insurance(s). Note: In order for the payer to display in the Patient Insurances field, it must be listed on the Insurance Listing window for the specified patient and it must be added to the Eligibility/Referral system. Requesting Physician (Required) Select the physician requesting for NextGen® Eligibility Verification. Requesting Location Select the location for the requesting physician. If there are no additional locations in the practice, this field does not display. Note: If the list in the Requesting Location field is empty, you do not have a valid provider number for that location and payer. Check the Group Information section of the Provider master file to see if the payer name and a provider number exist for the Requesting Physician Select Authorizatio

NextGen® Enterprise EHR Help

Referrals

The Referrals call type concerns communications that involve referring a physician to a patient. Select the New Call button and select Referrals from the Call Type list. The Panels and Panel Items opens. Select the Call Information and Contact Information panel items from the panels. Select Requested Referral. The Requested Referral option appears. Requested Referral Select the specialty from the Requested Specialty list. Select a physician to refer to the patient from the Physician list. Select Action(s). The Action(s) option appears. Select the Action(s) associated with the call. You can select more than one. Note: Select Sent letter due to inability to contact generates a document that can be sent to the patient. For more information, see Inability to Contact Letter. Select Call Status and select a status for the call. In the Comments section, enter any comments related to the call or attach a phrase. Select Add. The call is saved and logged on to the Communication Component Grid. P

Submit New Referral Inquiry

Recommendations

Referral History Inquiries

Submit New Referral Inquiry

Referral History Inquiries

Add a New Authorization Entry

Authorization Inquiry

Referrals

Submit New Referral Inquiry

Referral History Inquiries

Submit New Referral Inquiry

Referral History Inquiries

Add a New Authorization Entry

Authorization Inquiry

Referrals