Insurance Section

NextGen® Therapy Suite Help 30.3.13.0

Insurance Information

The Insurance Information grid displays all payers attached to the case. Insurance Information grid Parent topic: Pre-cert Template

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

NextGen® Therapy Suite Help 30.3.13.0

DC Override

Use the D/C Override button to pull data forward on a patient when a patient has been discharged if the previous encounter in the same case was labeled as a D/C documentation-only encounter. Select D/C Override button. The NTS Enc Dc Config window opens with a list of past encounters within the case. NTS Enc Dc Config window Select the PT D/C – doc only visit, and then select OK. The Homepage pulls all info from the documentation-only encounter into the new visit. Note: D/C Override only works on documentation-only discharges. The system does not allow you to select a regular discharge visit because the patient was in the facility for that visit. Parent topic: Insurance Section

NextGen® Therapy Suite Help 30.3.13.0

Payer Override

Use Payer Override button to override payer rules as set on the Billing Configuration system template. For example, if the patient has Blue Cross Blue Shield of California (BCBS of CA) as an insurance payer, but you must submit charges to your local BCBS, you can use the Payer Override button to override the local rules (as set in the Billing Configuration system template) with the BCBS of CA rules. Parent topic: Insurance Section

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

Help Guide for NextGen® Enterprise PM 8

Insurance/Diagnosis Tab

The Insurance/Diagnosis tab on the Add/Edit Appointment window displays insurance and ICD information for the patient. The Appointment Insurance section displays insurances linked to the appointment. Authorizations and/or referrals numbers are listed below each insurance, if applicable. The ICD-CM section displays a listing of ICD codes linked to the current open appointment, if applicable. Add or Modify an Insurance Authorization Add or Modify an Insurance Referral Parent topic: Appointment Information

Insurance Section

Recommendations

Insurance Information

Insurance Grid

DC Override

Payer Override

Precertification/Authorization Panel

Insurance/Diagnosis Tab

Insurance Information

Insurance Grid

DC Override

Payer Override

Precertification/Authorization Panel

Insurance/Diagnosis Tab