View a Patient's Benefits Details

The Summary section of the Eligibility Verification window includes the following:

• Preferred Benefits or All Benefits is displayed in the Eligibility Verification window.
  • Preferred Benefits or All Benefits. Preferred benefits refers to the benefits of specific service types that are defined for a patient in Practice Preferences. All benefits refer to information such as type of coverage, in- and out-of-network deductible, copay, and out-of-pocket amounts. Use the toggle key to switch between all benefits and preferred benfits.
  • If a particular service type is defined for a patient in the Practice Preferences window, then the benefits for that service are displayed in preferred benefits. If you select anywhere on the left navigation panel of the Eligibility Verification window, the system directs you to all benefits.
  • If preferred benefits are not configured for a patient in Practice Preferences, then the system defaults the user to all benefits.
  • If the payer response is invalid, then the user must use the correct information and resubmit eligibility. For example, if the subscriber or the insured is not found, then the response is invalid.
  • If the payer response is rejected, then the user must use the correct information and resubmit eligibility. For example, if the provider NPI is not on file with the payer, then the response is rejected.
• Member Information: Displays information as it exists in the NextGen Healthcare application. A yellow warning symbol appears when there is a discrepancy.
• Additional identification includes other identifying values as returned by the payer such as group number, plan number, or social security number.
• Date Details include date information for the payer (for example, policy begin date).
• Payer Details include payer details and provider name.
• Payer Information includes payer-related information such as payer name, payer ID, and payer address.