Appointments Requiring Precerts

NextGen® Therapy Suite Help 30.3.13.0

Expiring or Expired Pre-certs by Visits & Never Pre-certed

The grid in the Expiring/Expired Precerts by Visits & Never Pre-certed panel displays patients who have never had pre-cert or those who have an authorization by visits that is about to expire or has expired. This grid also displays any patient who was previously in the Appointments Requiring Precerts grid for whom an authorization is yet to be entered. Expiring/Expired Precerts by Visits & Never Pre-certed panel Expiring thresholds per payer are set up on the Precert Config system template. To open the patient chart to update any patient-specific pre-certification information, you can select the patient row, and then select the Launch Chart button. Parent topic: Precert Worklog

NextGen® Therapy Suite Help 30.3.13.0

Precert Worklog

The Precert Worklog is a practice-level template that you can use to manage patient appointments that require pre-certification or that have a pre-cert that is about to expire. The Precert Worklog has the following panels. Appointments Requiring Precerts Expiring/Expired Precerts by Visits & Never Precerted Expiring/Expired Precerts by Units You can use the Launch Chart button to open a patient’s chart and update any patient-specific pre-certification information. NTS Pre Cert Worklog template Appointments Requiring Precerts The Appointments Requiring Precerts grid displays patients that have upcoming appointments scheduled for payers that require a pre-cert. Expiring or Expired Pre-certs by Visits & Never Pre-certed The grid in the Expiring/Expired Precerts by Visits & Never Pre-certed panel displays patients who have never had pre-cert or those who have an authorization by visits that is about to expire or has expired. Expiring or Expired Precerts by Units The grid in the Expiring/Ex

NextGen® Therapy Suite Help 30.3.13.0

Precert Grids

The Precert grids on the NTS Homepage template are view-only. They show any authorizations or yearly limits entered for the patient. All information in these grids is added from the NTS Pre-cert template. Refer to Pre-cert Template section for more information. Note: Authorizations do not pull automatically to the NTS Homepage and NTS Pre-cert templates if added to the patient in NextGen® Enterprise PM. Precert grids Precerts only appear in these grids if the encounter date falls within the effective date range for the authorizations entered. Precerts can be tracked by total Encounters/Visits (top grid) or by Units (bottom grid). If tracking by units, the units can be broken down by individual codes or a group of codes. The templates automatically begin deducting on each billable encounter from the total number of visits or units authorized. When the authorization/yearly limit reaches the threshold that is configured on the Precert Configuration system template an alert on the NTS Home

NextGen® Therapy Suite Help 30.3.13.0

Add Pre-Cert Payers to Payer Defaults

Add payers to this grid if they often require authorization for treatment. The system will alert users when patients with this payer have upcoming evaluation or 'new patient' appointments. Select the Payer field, and then select a payer from the picklist. The picklist only has the payers that you entered into the Payer Picklist on the left. Ainf Pre Cert Payers picklist list matches Payer Name column in grid Note: You can enter a Group #, but it is not required. NextGen Healthcare does not recommend it due to frequent insurance company policy changes. Mark the appropriate checkbox(es) if the: Evaluation is included in the approved number of visits – this automatically checks the Eval Included checkbox on the PreCert template when this payer is selected. Payer requires pre-cert when they are the secondary payer – this automatically adds the payer to the Precert Worklog Appointments Requiring Precerts grid when they are listed as the secondary payer. Select the Add/Update button. This ad

NextGen® Therapy Suite Help 30.3.13.0

Payer Picklist and Payer Defaults

Use the Payer Picklist and Payer Defaults sections to set up which payers may require pre-cert timeframes or allotments other than the default (7 days, 2 visits). You must set up the Payer Picklist before you can set up the Payer Defaults. The Payer Picklist grid comes pre-configured with a default setting of 7 days (from the precertification expiration date) or 2 visits (remaining of the precertification visit allotment) at which time the patient’s name appears on the Pre-Cert Worklog. The Default row in the grid alerts for all payers except payers otherwise listed in the grid to have a different alerting timeframe. Note: Only the payers that are configured in the Payer Defaults grid will have appointments that appear in the Appointments Requiring Precerts grid on the Pre-Cert Worklog. Add a Payer to the Payer Picklist Edit a Payer Picklist Entry Add Pre-Cert Payers to Payer Defaults Update or Remove Payers in the Payer Default Grid Parent topic: Pre-Certification Configuration

NextGen® Therapy Suite Help 30.3.13.0

Insurance Grid

The Insurance grid displays any insurance attached to the case. The Pre-Cert Req column of the grid shows whether a payer attached to the case requires precertification/authorization prior to treatment. Payers that require authorization are configured in the Precert Configuration system template. For more information and instructions on configuring precertification, go to NextGen Healthcare Success Community and download the latest Configuration Guide for NextGen® Therapy Suite. If a payer is marked as “Required”, the only type of visit you will be able to submit charges on without entering a precertification authorization number is an Evaluation. All other visit types require you to enter a valid authorization or mark that payer as “Not Required” prior to submitting charges (see the Pre-cert Template chapter). Parent topic: Insurance Section

Appointments Requiring Precerts

Recommendations

Expiring or Expired Pre-certs by Visits & Never Pre-certed

Precert Worklog

Precert Grids

Add Pre-Cert Payers to Payer Defaults

Payer Picklist and Payer Defaults

Insurance Grid

Expiring or Expired Pre-certs by Visits & Never Pre-certed

Precert Worklog

Precert Grids

Add Pre-Cert Payers to Payer Defaults

Payer Picklist and Payer Defaults

Insurance Grid