Submit NextGen® Eligibility Verification for Appointments

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

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

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 NextGen® Eligibility Verification While Adding or Editing an Appointment

Perform the following steps to submit eligibility inquiries for a patient from the Edit Appointment window. From the Appointment Book, access the Edit Appointment window. Select the Ins/Diag tab. Right-click in the Insurance Information section, and then select Eligibility Verification > Submit Request. The patient's eligibility response appears. 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

View Latest Successful Eligibility Response from Appointment Lookup

Before you begin Submit NextGen® Eligibility Verification request for a patient. See Submit Eligibility Requests. To view the latest NextGen® Eligibility Verification response from an appointment in the appointment lookup, do the following: In NextGen® Enterprise PM, select ApptList. The Appointment Lookup window opens. Using the search criteria, find the appointment with the NextGen® Eligibility Verification request and yet to receive the response. Right-click the appointment and select Eligibility Verification > View Latest Successful Response. The system searches for the eligibility response for the latest successful transaction during the time period specified in the user preferences. If the eligibility response is available, the Real-Time Eligibility Response page opens displaying the response for the latest successful transaction. If the eligibility response is not available, a message appears stating that the successful eligibility response for the specified period is not found.

Submit NextGen® Eligibility Verification for Appointments

Recommendations

Submit Eligibility Requests from Encounters

NextGen® Eligibility Verification Submission

Submit Eligibility From Appointment Scheduling

Submit NextGen® Eligibility Verification While Adding or Editing an Appointment

Eligibility Requests

View Latest Successful Eligibility Response from Appointment Lookup

Submit Eligibility Requests from Encounters

NextGen® Eligibility Verification Submission

Submit Eligibility From Appointment Scheduling

Submit NextGen® Eligibility Verification While Adding or Editing an Appointment

Eligibility Requests

View Latest Successful Eligibility Response from Appointment Lookup