Before you begin
- Ensure that you have the license for medical necessity check.
- Ensure that you have configured medical necessity check in File Maintenance.
- Ensure that you have selected the insurance information for the patient in the All tab.
Note: Computerized Physician Order Entry (CPOE) derives the insurance settings from the Practice Preferences configuration. For more information on
Practices Preferences in File Maintenance, go to
NextGen Healthcare Success Community and download the latest
File Maintenance Preferences Guide for NextGen® Enterprise.
Medical necessity includes a defined list of tests that are linked to medical problems. Government insurances such as Medicare Part B require approval of a test's necessity before it can be ordered and paid for. CPOE automatically checks for medical necessity when you assign a diagnosis to a laboratory and diagnostic order item. You can view the medical necessity check results and print the Advance Beneficiary Notice (ABN) for order items with tests that fail the medical necessity check.
- Open CPOE.
- Select an order item.
- Assign a diagnosis to the selected order item.
Note: CPOE derives the diagnosis settings from the
Practice Preferences configurations in File Maintenance. For more information, go to
NextGen Healthcare Success Community and download the latest
File Maintenance Preferences Guide for NextGen® Enterprise.
- Select the All , Laboratory, or Diagnostic tab and check the medical necessity status corresponding to your selected order item.
One of the following results appear.
Medical Necessity Passed.
Medical Necessity Failed.
Medical Necessity Cannot be Calculated.
Note: Medical necessity check only provides decision support assistance and does not restrict you from placing orders with tests that fail the medical necessity check.
If a test fails the medical necessity check, you can print the Advance Beneficiary Notice (ABN) for the patient or select Medical Necessity Check to manually run the medical necessity check and select an alternative test.
