Insurance Grid

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

Default Sub Navigation Links

Link Description Appts Opens a window that lists any appointments for the patient and their statuses. Phone Call Opens the Telephone Call template where you can document phone communications with or regarding the patient. See Telephone Call Template. Transcription Opens a template where you can document information about the patient in a letter format. See Transcription Template. Documents Opens a configurable picklist of available documents that you can manually generate. Cancel Opens a template where you can document a canceled visit or no-show. See Cancel Template. Pre-cert Opens a template where you can document pre-certification requirements and authorizations. See Pre-cert Template. Worklog Opens a configurable picklist of available worklogs. See Worklogs. ABN Opens the ABN template where you can document the need for an Advance Beneficiary Notice (ABN) and print the document for the patient to sign. See Document an Advanced Beneficiary Notice of Non-Coverage (ABN). CCDA Narrativ

NextGen® Therapy Suite Help 30.3.13.0

Pre-cert Template

The Pre-Cert template has a grid showing information for all payers attached to the case, a panel for messages that can be sent to payers, and a panel to view and record information on pre-certification and authorization. Pre-Cert template Insurance Information Messages Precertification/Authorization Panel Understanding the Pre-cert Count Explanation of why the pre-certification count differs between the Pre-certs grid on the NTS Homepage and the Pre-Cert template. Parent topic: Using NextGen Therapy Suite

NextGen® Therapy Suite Help 30.3.13.0

Precertification/Authorization Panel

The grid in the Precertification/Authorization panel initially displays all authorizations entered for that case. When you select a payer in the Insurance Information grid, you then see authorizations for that payer. You can enter new information, update it, or remove authorizations. Precertification/Authorization panel No Authorization Required Enter a New Authorization by Visits Re-certify an Existing Authorization Enter a New Authorization by Units Mark an Authorization as Done Editing an Existing Authorization Establish a Patient as Self Pay View Usage and Fix/Apply Precert Parent topic: Pre-cert Template

NextGen® Therapy Suite Help 30.3.13.0

Enter a New Authorization by Visits

Select the payer from the Insurance Information grid. Select the Visits option below the Precertification/Authorization grid. Use the fields below the Precertification/Authorization grid to enter the authorization information: NBR, Authorization #, Effective Date, Expiration Date and Visits. Note: You can use the Get button to populate the fields with authorization information that has already been attached to the Insurance in the NextGen® Enterprise PM. Select Get and then select the appropriate authorization from the picklist to pull into the Pre-Cert template fields. You must assign the NBR manually. Entries for Pre-Cert Company, Expiration Date, and Associated Diagnosis are optional. The Associated Diagnosis grid only displays Dx codes after you have established the treating diagnosis. Select Add to save the authorization. The authorization appears in the Precertification/Authorization grid. Parent topic: Precertification/Authorization Panel

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

Insurance Grid

Recommendations

Precert Grids

Default Sub Navigation Links

Pre-cert Template

Precertification/Authorization Panel

Enter a New Authorization by Visits

Add Pre-Cert Payers to Payer Defaults

Precert Grids

Default Sub Navigation Links

Pre-cert Template

Precertification/Authorization Panel

Enter a New Authorization by Visits

Add Pre-Cert Payers to Payer Defaults