NextGen Training PM Manual Patient Services

NextGen Training PM Manual

Patient Services Coastal Health & Wellness

For Coastal Health & Wellness use only. Rights Reserved.

TABLE OF CONTENTS

1. GETTING STARTED WITH PM

A. How to Access, Login and Exit the NextGen Application Pg

I. Accessing NextGen 1

II. Logging In 2

III. Logging Out/Closing the NextGen Application 3

B. Common NextGen PM Elements

I. Shortcuts 4

II. PM Buttons and Fields 5

III. PM Toolbar and Icons 6

IV. PM Desktop 8

V. Patient Information Toolbar 9

C. Changing Your Password in PM

I. Changing your Password 10

D. PM Advisor

I. Accessing the Advisor screen 11

II. Using the Advisor 12

2. APPOINTMENTS

A. Scheduling an Appointment

I. Resources 13

II. Events 14

III. Categories 15

IV. Locations (Sites) 15

V. Appointment Book Toolbar 16

VI. Icons 16

VII. Views 19

Daily 19

Weekly List 20

Weekly Schedule 20

Monthly 21

Multi-View 21

VIII. Scheduling an Appointment 22

Person Lookup 25

Person not listed 26

Appointment Reminder (EDI Patient Preference) 31

Scheduling Conflicts 33

Person is listed 34

TABLE OF CONTENTS

B. Confirming an Appointment

I. Appointment Lookup 36

II. Person not listed 37

III. Person is listed 37

IV. Appointment Reminders 38

C. Canceling an Appointment

I. Appointment Lookup 40

II. Person not listed 41


IV. Canceling an Appointment 43

3. PATIENT SERVICES

A. Determining Eligibility

I. Person Lookup 44

II. Person Not Listed 45


IV. Person with Healthcare Coverage 46

Employer tab 49

Contracts 50

V. Person without Healthcare Coverage 50

B. Tasking

I. Creating a Task 52

II. Retrieving a Task 54

Worklog Manager 54

Task Types

57

Worklog manager added fields 57

C. Creating And Managing Charts

I. Collecting Required Documentation 58

II. Searching Persons/Patients 58

III. Person is not Listed 59

o Patient Lookup

59

o Name 59

o Social Security Number (SSN) 60

o Birth Date (DOB) 60

o Birth Sex 60

Address

60

o Billing/Secondary Address 60

Demographics 60

o Marital Status 60

o Student Status 60

o Preferred Language 60

o Primary Care and Primary Dental Provider 61

TABLE OF CONTENTS

Contact Information 61

o Contact Method 61

o Preferred Contact 62

o Notifications 62

IV. UDS 62

o Homeless Status 62

o Migrant Status 62

o Language Barrier 63

o Race 63

o Ethnicity 63

o Veteran Status 63

o Primary Medical Coverage 63

o Consent to Treat 64

Self Pay Checkbox 64

Head of Household 64

V. Chart Details

64

TVFC Form Date 64

Marketing Plans 65

VI. Insurance 65

Adding an Insurance 66

Insurance Maintenance 67

o Detail Tab 67

O Detail – 2 Tab (Patient name clarification on insurance card)

o

68

o Ins Cards (Scanning insurance cards) 68

Adjusting the scanned card 71

o Benefit Info Tab 72

o Authorizations 73

VII. Creating a Chart 76

VIII. Privacy 79

IX. Employer 80

X Relations/Roles/Contact/Guarantor/Head of Household 82

Relationship

73

o Person not listed in Matching Records 84

o Person is listed in Matching Records

86

Support Role

87

Guarantor 88

o Self Guarantor 89

o Not Self Guarantor 89

Head of Household 91

o Self Head of Household 91

o NOT Self Head of Household 92

XI. Accounts 94

Family Information 95

Sliding Fee Schedule Verification 96

Expiring Family Information and Sliding Fee Schedule Verification 97

Sliding Fee Alert 98

TABLE OF CONTENTS

XII. Taking the Patient’s Picture 98

XIII. Clinical History/Notes 101

Accessing built-in forms 101

o What and when is the Patient Acknowledgment Form required

o

103

o What and when is the TVFC Eligibility Form required

o

104

Acquiring signatures 104

Sealing notes 105

Documenting verbal notes 106

XIV. Scanning Documents 106

Creating a batch 107

Verifying the Scanned Documents 109

Filing the scanned documents to a patient’s chart 109

D. Creating a Batch and Set as Active

I. Creating a batch 113

II. Batch description 114

III. Securing the Batch 114

IV. Set as active 115

E. Checking In Patients with AutoFlow

I. Accessing the Appointment 117

II. Check-In/Create Encounter 117

III. How to Change a Guarantor for Specific Encounters 120

Person as Guarantor 120

Employer as Guarantor 122

Self as Guarantor 122

IV. Appointment Link Selection 123

V. AutoFlow Begins 124

Confirming Demographics 124

Confirming UDS Required Fields 125

Chart Details 126

o TVFC Form Date (refer to TVFC Eligibility Form Memo) 126

o Marketing Plans 126

Attaching an Insurance to an Encounter 126

Charge Posting 127

Patient Balance 129

Payment Entry 130

VI. Printing the Receipt 131

VII. Autoflow Interruption 132

F. Patient Payments

I. Accessing the Active Batch 133

II. Accessing the Account/Encounter 134

Account Source 134

Encounter Source 134

Denture Contract Payments 134

TABLE OF CONTENTS

o Person is not listed 135

o Person is listed 135

V. Entering the Payment 137

Unapplied Payments 137

Payment Posting To Outstanding Line Items 138

VI. Printing the Receipt 138

G. Medical/Dental Record Payments

I. Scheduling The Patient On The Medical/Dental Records Schedule 140

II. Creating The Medical Records Encounter 140

III. Entering the MedRec Charge 141

IV. Payment Entry 142

V. Printing the Receipt 143

H. Posting the Batch and End of Day Balancing

I. Accessing the Active Batch 144

II. Accessing the Batch Listing Report 145

III. Balancing the Batch with the Cash Drawer 146

Ledger 146

o Modifying An Incorrect Transaction 146

Header 147

IV. Posting the Batch 148

I. Other

I. Denture Contract Process 150

II. ClaimRemedi 160

Getting Started With NEXTGEN

HOW TO ACCESS, LOGIN AND EXIT THE NEXTGEN APPLICATION

For Coastal Health & Wellness use only. Rights Reserved. Return to table of contents

1

I. ACCESSING NEXTGEN

1. Double left click on the NextGen 5 icon located on either the desktop or through RDS.

The NextGen Application Launcher will display.

2. Left click once on Practice management (PM) The NextGen login window will display. The

database name will display on the top banner based on which database the user is accessing.




2

II. LOGGING IN

3. Left click once in the User field and enter your user name.

(First time logging in, user name will be provided by IT)

4. Left click once in the Password field and enter your password

(First time logging in, a password will be provided by IT)

5. Confirm the following fields display “Coastal Health & Wellness”

Enterprise

Practice

6. Left click once on Logon, the appropriate database desktop will display

PM




3

III. LOGGING OUT/CLOSING THE NEXTGEN APPLICATION

7. Left click once on File, then Logout or Exit or the Down arrow in EDR, then Log Off or Exit

PM

A NextGen alert will display,

Are you sure you want to

logout of NextGen? All open

screens will be closed. Left click once on Yes

Common NextGen PM Elements SHORTCUT MENUS, BUTTONS AND FIELDS, TOOLBAR AND ICONS, DESKTOP


4

The Practice Management (PM) database is used to conduct all business aspects of CHW. Users

will be able to perform/access the following:

Maintain and schedule appointments

Maintain patient demographic charts

Create and maintain billing encounters

Bill for services provided

Generate paper and electronic claims

Generate standard and customized reports

Generate customized letters to send to patients

I. SHORT CUT MENUS

Mouse and Keyboard

Throughout the Nextgen application there are short-cut menus. Users can access short-

cut menus by right-clicking in the appropriate area.

Users can usually complete a task by clicking on an icon from the toolbar menu located

across each desktop or by right clicking on an item and selecting the option from the

shortcut menu.

Mouse Usage:

Use the left mouse button to select and click items.

Use the right mouse button to display a shortcut menu of options.

Minimize:

Click on the Minimize button on the title bar of the active window. The program

window will minimize to the Windows taskbar.

Maximize/Restore:

On the Windows taskbar, click the Icon of the database to restore.

NextGen Application Launcher

PM

On the PM title bar, select the Maximize button to change the sizing of the user

screen or restore to normal size



5

II. PM BUTTONS AND FIELDS



6

III. PM TOOLBAR AND ICONS



7

PM TOOLBAR AND ICONS (CONTINUED)

Click the EHR button to launch

the EHR application.

Click the Doc Mgmt button to launch

the Document Management application.



8

IV. PM DESKTOP

When a user logs into the PM application, the PM’s main desktop window will display.

All PM functions are performed within this window.

Toolbar: Contains a row of icons

that give access to functions and

modules.

Menu Bar: Contains several shortcut menus. When clicking on an item in the menu bar, the short cut menu displays

Title Bar: Displays the “NextGen” the name of the practice: Coastal Health & Wellness

Current User Status Bar: Displays the current

status of PM. (i.e.) When generating

a report, the status bar displays

“Generating Report”… Current Version, Date, and Time

Current DB



9

V. PATIENT INFORMATION TOOLBAR

Users can easily identify patient information when switching between the patient chart, charges

and payment entry

A. Patient Demographic Row – Contains the patient’s name, sex, DOB, person number,

medical record number and other ID

B. Patient Picture

C. Alerts Button – allows users to access patient chart alerts

D. Contact information & Contact Preference – displays perfered contact number. Hovering

over “contact” displays all contact numbers

E. Patient Status - displays patients if in collection or budget statuses

F. Preferred Language - helps identify the language patients prefer to speak

G. Patient Portal - indicates if patient is registered with the patient portal – if patient is

registered with the patient portal, the patient portal icon is blue . if patient is not

registered with the patient portal, the patient portal icon is greyed-out

H. Email address – displays current email address.

This field is required.

I. Encounter Information – displays when the encounter tab is active and an encounter is

selected. Displays encounter primary insurance, if patient is self pay, self pay will display.

Rendering and Guarantor infomation of the current encounter displays

J. Patient Information Badges – provides quick access to patient appointments, insurance,

patient balance, & recall plans

K. Hyperlinks – Appointment search ahead & UDS

A

B

C

D

E

F

G

H I

J

K

K

Getting Started With PM

CHANGING YOUR PASSWORD IN PM


10

I. CHANGING YOUR PASSWORD 1. Complete “Getting Started with NextGen - How to Access, Login and Exit the

NextGen Application” process

2. Left click once on Tasks from the menu bar

3. Left click once on Change Password, the Change Password screen displays

4. Left click once on the Old Password field and enter your current password

5. Left click once on the New Password field and enter your new password

6. Left click once on the Confirm New Password field and re-enter your new password

7. Left click once on OK

Getting Started with PM ADVISOR


11

Definition:

The Advisor is a dashboard built in utility containing data sections that supply users with a

quick, at-a-glance summary information about the status about Coastal Health and Wellness

as a practice or per location.

1. Complete “Getting Started with NextGen - How to Access, Login and Exit the NextGen

Application” process

I. ACCESSING THE ADVISOR SCREEN

Users can access the Advisor by accessing Tasks from the menu bar and selecting Advisor

A message can

display from the CHW

here

A tally of

appointments is

tracked here

A tally of encounters

is tracked here

A tally of all accounts

receivable

A tally of all

statements/invoices

A tally of claims is

tracked here

All tasks are

accessible here

Letters available to

send out if applicable

Getting Started with PM ADVISOR


12

Most users will only access Messages, Appointments, and Tasks

II. USING THE ADVISOR

2. Left click once on the down arrow next to Location to view one location at a time

3. Left click one on the down arrow next to Rendering to view one provider at a time,

specific to appointments

4. Left click once on the print icon, to print a face sheet of the advisor

5. Left click once on the refresh icon, to manually refresh the advisor screen

6. Left click once on the close icon, to close the advisor

7. Left click once on Tasks on the menu bar, then Advisor to re-access the Advisor at anytime

NEXTGEN PM

SCHEDULING AN APPOINTMENT


13

Purpose:

To allocate a specific time for a patient to receive services from a resource for a

specific event (type of appointment)

Definition:

The act of creating a new or follow up appointment for a patient



2. Understand “Getting Started with PM - Common NextGen PM Elements”

I. RESOURCES Resources can be a person, such as, a provider (Physicians, Physician Assistants, Family Nurse

Practitioners, Counselors, Dentist, Dental Hygienist, Nurse). A resource can also be a place or

thing such as, scheduling a patient to go to the Lab/X-Ray

Medical Provider Specialty Duration of Appt

(Minutes)

Doctor of Medicine

MD

Family Practice 20

Doctor of Osteopathic Medicine

DO

Family Practice 20

Physician Assistant

PA-C

Family Practice 20

Family Nurse Practitioner

FNP-BC

Family Practice 20

Counselor Specialty Duration of Appt

(Minutes)

Licensed Clinical Social Worker

LCSW

Mental Health 20/60

Licensed Professional Counselor

LPC

Mental Health 20/60

Dental Providers Specialty Duration of Appt

(Minutes)

Dentist

DDS

General Dentistry 30

Dental Hygienist Specialty Duration of Appt

(Minutes)

Hygienist

RDH

Dental Hygienist 30

Other Resources Specialty Duration of Appt

(Minutes)

Dental Walk-In Dental 20

Medical Walk-In Medical 20

Medical / Dental Records Medical 20

Lab/X-Ray Only Medical 20

Nurse Only Medical 20

OB/GYN Medical 15

NEXTGEN PM



14

II. EVENTS

Events are types of appointments. When patients schedule an appointment with a

resource an event informs the resource what type of an appointment the patient is seeking

services for.

Event Abbreviation Department Duration of Appt

(Minutes)

Medical Annual Exam ANU Medical 20

Medical Family Planning FP Medical 20

Medical Hospital Follow Up HFU Medical 20

Medical New Patient MNP Medical 20

Medical New Prenatal Visit NOB Medical 15

Medical Newborn Visit NB Medical 20

Medical Prenatal Visit OB Medical 15

Medical Procedure PRO Medical 20

Medical Visit MV Medical 20

Medical Well Child Visit WCC Medical 20

Medical Well Woman Exam WWE Medical 20

Medicare Annual Preventive MAP Medical 20

Medicare Initial Preventive MIP Medical 20

Initial Counseling Visit ICV Medical 60

CHSBE CHS Medical 20

Counselor Visit CV Counselors 20

Couple/Family Counseling CFC Counselors 40

Dental Follow Up DFU Dental 30

Dental Hygienist Visit DH Dental 30

Dental New Patient DNP Dental 30

Dental Pedi DP Dental 30

Denture Contract DC Dental 30

Lab Only LAB Medical 20

Nurse Only NUR Medical 20

X-Ray Only XR Medical 20

Medical / Dental Records MDR Medical / Dental 20

NEXTGEN PM



15

III. CATEGORIES

Categories are types of events that are specific to the location (site) and events (type of

appointments) to be restricted to a time period and a resource.

Category Color Type of Appt

Duration

of

Category

(Minutes)

Admin Time Blocked Time for Medical and Dental Providers 20

Dental Walk-In Dental Walk-In Providers Only 20

Denture Contract Denture Contract 30

G-Counselor Galv Counselor Only 20

G-Dental Galv Dental Only 30

G-Medical Galv Medical Only 20

Lab/X-Ray Only Lab Only 20

Medical Walk-In Medical Walk-In Providers Only 20

Mobile Clinic Mobile Clinic 20

OB/GN Prenatal 15/30

Same Day Same Day Appointment 20

Nurse Only Nurse Only 20

Out of Office Blocked Time for Out of Office for Providers 20 / 30

Medical / Dental Records Only Medical / Dental Records 20

TC-Counselor TC Counselor Only 20

TC-Dental TC Dental Only 30

TC-Dental Pedi TC Dental Pedi Only 30

TC-Medical TC Medical Only 20

IV. LOCATIONS (SITES)

Locations are where patients are scheduled to be seen by a resource with a specific event

Site Color

Galv Coastal Health &

Wellness

GALVESTON

TC Coastal Health & Wellness MID COUNTY ANNEX

NEXTGEN PM



16

V. APPOINTMENT BOOK TOOLBAR

VI. ICONS

(a). Change Dates:

Left click once to view the monthly calendar

Left click once on the date to view the schedule for that day, this option can be used in all

views

(b). Go To Today:

When searching in-between resources and dates, left click once to return to today’s date,

this option can be used in all views

(c). Previous Day:

When searching in-between resources and dates, left click once to return to the previous

day or year, this option can be used in all views

(d). Next Day

When searching in-between resources and dates, left click once to view the schedule for

the next day, this option can be used in all views

(e). Change Resources (Daily View Only)

When searching in-between resources and dates, left click once to change one resource at

a time, this option can only be used in Daily View

NEXTGEN PM



17

(f). Change Resources (Multi-View)

When searching in-between resources and dates, left click once to change multiple

resources at a time, this option can only be used in Multi-View

(g). Change Location (Multi-View)

When searching in-between resources and dates, left click once to change locations, if

user prefers to view all providers in the Gal Coastal Health & Wellness clinic at once,

this option can only be used in the Multi-View

(h). Add Appointment

Left click once in any view to add an appointment to the appointment book

(i). Edit Appointment

When an appointment is selected in the appointment book, left click once to edit

the selected appointment

NEXTGEN PM



18

(j). Make Recurring

Appointments can be made recurring at anytime, such as, a patient who is on a

pain contract who will see one specific provider every month on the same day of

the week, left click once to make appointment recurring

Edit the end after or edit the end on

Edit the Occurs

Edit the Daily

Left click once on OK

(k). Refresh

Left click once to manually refresh the appointment book

(l). Reset Desktop

Left click once to reset users’ desktop back to defaulted settings

(m). Hide Patient Names

Left click once to hide the patient’s name on the appointment book screen and

only show the event (type of appointment), can be used for HIPAA

(n). Appointment Search

Left click once to search for any appointments by event, service location,

resources, date, time, day of the week, and patient.

Left click once on Find, the system will search for any available appointment with

specific search criteria

NEXTGEN PM



19

(o). Exit Desktop

Left click once to exit the appointment book

VII. VIEWS

Daily View

Left click once on the Daily Tab at the bottom left of the appointment book screen

o The daily view allows users to view one resource one day at a time. Users

can also view the To Do List and the Nextgen Inbox Mail from the Daily

View.

Location - TC Category – TC-

Medical

Category – TC-

Medical

Category – Lunch

One resource, one day

NEXTGEN PM



20

Weekly List:

Left click once on the Weekly List Tab at the bottom left of the appointment book

screen

o The Weekly List view allows users to view one resource’s weekly list of

appointments.

Weekly Schedule:

Left click once on the Weekly Schedule Tab at the bottom of the appointment book

screen

o The Weekly Schedule view allows users to view one resource’s weekly

schedule of appointments.

Location - Galv

Category – G

Medical Location - TC

NEXTGEN PM



21

Monthly:

Left click once on the Monthly Tab at the bottom of the appointment book screen

o The Monthly view allows users to view one resource’s monthly total of

appointments.

Multi-View:

Left click once on the Multi-View Tab at the bottom of the appointment book screen

o The Multi-View allows users to view all resources at once including both

locations. Using the Change Multi-View Location can also limit the

resources by viewing by location, left click once on change

locations icon, the end user can now view all resources per location.

NEXTGEN PM



22

VIII. SCHEDULING AN APPOINTMENT

1. Left click once on the appointment book icon

The appointment book may be defaulted specifically to job functions. Contact

Center staff will be able to view both medical and dental resources, while Dental

Staff will only be able to view dental resources.

2. Right click once on a cell within a Resource’s schedule, the time slot must be

available based on the current “Scheduling Appointment Guidelines”

Example:

a. Right click once on the 9:20 A time slot, on the resource selected template. to

view the shortcut menu

NEXTGEN PM



23

3. Left click once on New, the Add Appointment screen displays

4. Confirm the Date and Time selected to confirm it is correct, located of the upper left

hand side of the Add Appointment screen

5. Left click once on the down arrow next to the Event/Event Chain field to choose an

event.

When adding appointments by individual resources on both the daily

and multi-view tabs, users should only be able to view the following:

o Medical providers, should only be able to view medical

events

o Dental providers, should only be able to view dental events

o Counselors, should only be able to view counseling visit

o Lab Only, should only be able to view lab only

o Etc…

NEXTGEN PM



24

6. Left click once on the event (type of appointment)

7. Confirm Service Location

NEXTGEN PM



25

PERSON LOOKUP

8. Left click once on the Norton icon, next to the First (Name) field on the

upper right side of the Add Appointment screen, to display the shortcut menu and

search for the person who is requesting an appointment

9. Left click once on Lookup..,the People Lookup screen displays

10. Left click once in the Last (name) field and enter the person’s last name

11. Left click once in the Birth Date field and enter the person’s date of birth

12. Left click once on the Find button to display a search result of Matching Records of

all persons with the same last name and date of birth

NOTE: The less search criteria the user enters, the more person search result will

display. If person is not listed based on search ALWAYS perform a double

search by removing data from a field. Ex: Only enter a last name without a DOB

or enter a DOB without a last name.

Review each result in the matching records list and determine if the person is

listed

PM distinguishes between a person and patients. A Person does not have

a chart and a Patient has a chart;.

NEXTGEN PM



26

Person (displayed with a globe next to the name): A person is an

individual who has or will not receive medical/dental services. Users may

enter them in the system as the parent of a child or as the insurance

guarantor. A person may also be an individual who has made an

appointment to be seen for the first time and has not yet been seen.

Patient (displayed with a chart next to the name): A patient with a

chart receives medical/dental services. A patient is considered a “person”

before the chart is created.

PERSON NOT LISTED IN MATCHING RECORDS

If users determine a person is not listed in the Matching Records list, which

means the person does not exist in the database, an appointment can still be

made. Users can add the person by entering required data and ONLY based on

the current “Scheduling Appointment Guidelines”.

13. Left click once on the New button, the Add Person Information screen displays, the

Demographics tab will be defaulted open. Required information will display in bold

red but, the following information must always be completed

NEXTGEN PM



27

14. Left click once in the Last (Name) field and enter the person’s full last name (DO

NOT ENTER SPECIAL CHARACTERS)

15. Left click once in the First (Name) field and enter the person’s full first name (DO

NOT ENTER SPECIAL CHARACTERS)

16. Left click once in the Birth Date field and enter the person’s date of birth, in the

following format MM/DD/YYYY

The age is populated by the system automatically

17. Left click once in the Birth Sex field and select the person’s sex

18. Left click once in the Street 1 field of the Address Billing section and enter the

person's billing address.

This address is where a billing statement can be mailed to the person, if this is

the person’s physical address complete Billing address fields only. If the

person’s billing address is not the physical address, such as, a PO BOX,

complete the Address Secondary section.

Enter the person’s address in the following format: 1234 My Lane Ave Apt 1

in the Street 1 field

DO NOT enter special characters in a person’s address fields, such as,

periods, or # signs.

NEXTGEN PM



28

19. Left click once in the Zip field and enter the person’s zip code in the following

format:

77591

Using the Tab key on the keyboard, tab through the Zip, so the system will

populate the City, State, County, and Country automatically

20. Left click once on the down arrow next to the Preferred Contact field and select the

correct contact preference for the person, by asking

o What is the best way to contact you?

21. Left click once on the down arrow of the Notifications field and select the preferred

notification method the patient would like to be contracted.

22. Left click once in the any of the following and enter the person’s Contact Methods,

by asking


o Required: Home Phone

Cell Phone

E-Mail

NOTE: A N/A option checkbox is available if a required field cannot not be collected,

due to the person not having what is required.

o Optional:

Day Phone

Alternate Phone

Secondary Phone

For each contact method, the area code is populated by the system automatically

Users can also re-sequence the telephone numbers and email in any order the patient

prefers to be contacted first.

NEXTGEN PM



29

Left click once on title of the Number/Address field of the Contact Method

needed to be re-sequence and left click once on the up or down blue arrows to

re-sequence as preferred

23. Left click once on the UDS red required category, located on the left hand side of the

Add Person Information screen, users must complete all required fields

Left click once on the down arrow of the Homeless Status field and select

once of the following:

Left click once on the down arrow of the Migrant Worker Status field and

select one of the following:

Left click once on the down arrow of the Language Barrier field and select

one of the following:

Left click once on the down arrow of the Veteran Status field and select one

of the following:

NEXTGEN PM



30

24. Left click once on OK, on the Add Person Information screen

The person information will now display on the add appointment screen.

In the Description field, the person’s last name and first name displays,

this description displays on the resource’s schedule in the specific time

slot selected in the daily and multi-view option

NEXTGEN PM



31

25. Left click once in the Details field to add any other important information for call

center, nursing and or providers such as the following:

Patient needs transportation

o Send task to call center to add patient to transportation list

Patient on pain contract

26. Left click once in the Translator Needed field and enter a language of the person

who needs the translator

Enter exact language as listed below or the word No, if the person does not

need a translator: Sign Language

Spanish

Vietnamese

Any other language

27. Left click once in the Insurance (Yes/No) field and enter in the following:

Yes

Patient’s appointment is covered by insurance

No

Patient’s appointment will not be covered or does not have insurance

28. Confirm a resource displays in the Rendering Physician field. This could be a

generic resource like “Medical Walk-in”

APPOINTMENT REMINDER (EDI PATIENT PREFERENCE)

29. After creating the appointment, but before selecting OK, left click once on the

“Add-Ons” option on the menu bar and select EDI Patient Preference. The

NextGen EDI Patient Preference pop-up will display

NEXTGEN PM



32

30. Left click once in the checkbox to select a preference in the Contact Option/Order

section

Phone Call Reminder (unless patient opts-out, all reminders are defaulted to phone

call)

o Select this option if patient prefers a phone call voice reminder

o Select the down arrow to select a phone number patient would like to

receive the reminder

Text Message Reminder

o Select this option if patient prefers to receive a text



Email Reminder

o Select this option if patient prefers to receive an email



Opt-out

o Select this option if patient prefers to not receive a reminder

31. Left click once on Save to save the selection

Changes will not save unless the Save button is selected

Other options:

Reload – returns options to previously selected prior to saving

Reset – returns options to practice default – phone call voice

reminder

Cancel – cancels current window and closes

32. Left click once on OK to complete scheduling the appointment, scheduling conflicts

may appear, if scheduling conflicts display, continue to Scheduling Conflicts section.

NOTE: A reminder tab within the Add or Edit Appointment window is available

to review all patient reminders after the latest 5.9 version upgrade

NEXTGEN PM



33

SCHEDULING CONFLICTS

Confirm no warnings display after the appointment is scheduled

A warning is displayed when an appointment conflict is made, such as,

when a dental event is being scheduled with a medical provider or when

an appointment is scheduled on a day the provider is out of the office

33. Left click once on Cancel on the Scheduling Conflicts screen to be able to make

changes as needed

34. Left click OK on the Scheduling Conflicts screen to proceed, the Appointment

Confirmation will display

NEXTGEN PM



34

35. Confirm the appointment with the person

Patient Information: Name, Address, Phone Numbers,

Appointment Information: Date, Time, Event, Location, and Resource

PERSON IS LISTED IN MATCHING RECORDS

If user determines the person is listed in Matching Records list, meaning the

person exists in the database

36. Confirm the person listed is the correct person by verifying the last name, first name,

and date of birth

37. Left click once on the person’s last name to highlight and make active within the

Matching Records result list

38. Left click once on Open, the Update Person Information screen displays

Alerts may display, read carefully and take any action as applicable

NEXTGEN PM



35

39. Confirm or update the following sections of the person’s chart:

o Billing Address

o Contact Information

Users can also re-sequence the telephone numbers and email in any order

the patient prefers to be contacted first.

40. Follow all steps in the “Person NOT LISTED in Matching Records” section of this

document to complete scheduling an appointment.

41. The appointment will display with person/patient’s Last Name, First Name, Event (type of

appointment) on Daily and Last Name, First Name, Event in abbreviations in the Multi-View

NEXTGEN PM

CONFIRMING AN APPOINTMENT


36

Purpose:

To inform the patient when, where, and what type of an appointment they have

scheduled




3. Complete “Scheduling an Appointment” process

I. APPOINTMENT LOOKUP

4. Left click once on the Appointment Lookup icon, the Appointment Lookup

screen displays



7. Left click once on the Find button to display a search result of Matching Records of all

persons with the same last name and date of birth

NOTE: The less search criteria the user enters, the more person search result will display.

If person is not listed based on search ALWAYS perform a double search by removing

NEXTGEN PM



37

data from a field. Ex: Only enter a last name without a DOB or enter a DOB without a last

name.


listed











II. PERSON NOT LISTED IN APPOINTMENT LIST FIELD

If users determine the person is not listed in Appointment List field, this means -

there are no past or future appointments for this patient. Inform patient there is no

appointment, but an appointment can be made today by following the “Scheduling

An Appointment” process

III. PERSON IS LISTED IN APPOINTMENT LIST FIELD

If user determines the person is listed in the Appointment List field

8. Confirm the searched person is the correct person, by verifying the last name, first name, and

date of birth

NEXTGEN PM



38

9. Confirm the Date/Time

4. Confirm Patient

5. Confirm Event

6. Confirm Resource

7. Confirm Location

APPOINTMENT REMINDERS o CHW has systems in place to send appointment reminders 48 hours prior to an

appointment based on the patient’s preference. (keep in mind, an appointment

must be pre-scheduled 48 hours prior to the reminder sent)

o NOTE: A reminder tab within the Add or Edit Appointment window is available

to review all patient reminders after the latest 5.9 version upgrade

8. Left click once on Open to access the Edit Appointment window

9. Left click once on the Reminder tab located on the bottom right of the Edit Appointment

window

NEXTGEN PM



39

NEXTGEN PM

CANCELING AN APPOINTMENT


40

Purpose:

To accurately cancel an appointment that was previously scheduled for a person




3. Complete “Confirming an Appointment” process

I. APPOINTMENT LOOKUP

4. Left click once on the Appointment Lookup icon, the Appointment Lookup

screen displays






display. If person is not listed based on search ALWAYS perform a double search by

removing data from a field. Ex: Only enter a last name without a DOB or enter a

DOB without a last name.


listed

NEXTGEN PM



41











II. PERSON NOT LISTED IN APPOINTMENT LIST FIELD

If user determines the person is not listed in Appointment List field, this means -

there are no past or future appointments for this patient. Inform patient that there

is no appointment, but an appointment can be made today by following the

“Scheduling An Appointment” process

III. PERSON IS LISTED IN APPOINTMENT LIST FIELD

If user determines the person is listed in the Appointment List field

8. Confirm the searched person is the correct person by verifying the last name, first name,

and date of birth

NEXTGEN PM



42

9. Confirm the Date/Time

10. Confirm Patient

11. Confirm Event

12. Confirm Resource

13. Confirm Location

14. Confirm Status

Expected

Kept – NEVER cancel

No Show – NEVER cancel

15. Left click once on the appointment to highlight which appointment the patient is referring

to

10. Left click once on Open, the Edit Appointment screen displays

NEXTGEN PM



43

11. Confirm all appointment information with patient

If appointment needs to be canceled per patient request, provider request and/or

scheduling error confirm and/or inform patient of reason for canceling

IV. CANCELING AN APPOINTMENT

All CHW appointments are cancelled and NOT re-scheduled.

12. Left click once in the Canceled checkbox to cancel the appointment

13. Left click once on the down arrow of the Reason field and select a reason for cancelation

14. Follow the “Scheduling An Appointment” process to schedule a new appointment to

replace the cancelled appointment

15. Continue to next patient

NEXTGEN PM Patient Services

DETERMINING ELIGIBILITY


44

Purpose:

Users will determine eligibility prior to checking – in a patient. This step secures

access for services rendered by a patient.

Definition:

A prerequisite met by the patient to access services provided by Coastal Health &

Wellness




I. PERSON LOOKUP

3. Left click once on , to search for a person in the system, the People Lookup screen

displays






display. If person is not listed based on search ALWAYS perform a double search

by removing data from a field. Ex: Only enter a last name without a DOB or enter

a DOB without a last name.


listed











45




II. PERSON NOT LISTED IN MATCHING RECORDS

If the user determines the person is not listed in matching records list, this means

– the person does not exist in the database. The person has the following options:

YES

become a patient today

NO

Prefer to return another day

DOES THE PATIENT HAVE HEALTHCARE COVERAGE?

INSURANCE, CONTRACT, MEDICAID, OR MEDICARE

Yes, I have coverage No, I do not have coverage Yes, I have coverage No, I do not have

coverage

Does the person have

their insurance card or a

contract eligibility form?

Add required patient

information to create a

patient chart, “Creating

and Managing Charts”

process, Financial

Screening section

If during walk-in hours -

Verify coverage through

ClaimRemedi (see

document

“ClaimRemedi”)

o Add to walk-in schedule

Check-in process

If not walk-in hours –

Hand the person the Checklist for

Financial Screening and Application for

Discounted Services to be filled out

Discuss the required documents with

the person

o If person does not have required

documents today follow Prefer to

return another day columns

o OR Offer to “Waive” financial

screening and collect required fee

Communicate to the person to complete

the Application for Discounted Services

Ask the person to sit in the Financial

Screening waiting area and a Patient

Services Specialist will do a face to face

interview to determine financial

screening.

Send a task to the financial screeners,

Refer persons with

coverage to call the

Contact Center to

schedule an

appointment or to return

during walk-in hours

Ask the person to bring

in a copy of their

insurance/coverage card

Close out all screens

Continue with next

person

Hand the person the

Checklist for

Financial Screening

and Application for

Discounted Services

to be filled out and

they can return with

all supporting

documents at their

convenience


Continue with next

person

Frito, Chips 123 my avenue 6/11/1971 Frito, Corn 123 my avenue 6/11/1971 Frito, Lays 123 my avenue 6/11/1971




46

Refer to Contact Center

to schedule an

appointment

see “Tasking” process


Continue with next person

III. PERSON IS LISTED IN MATCHING RECORDS

If user determines the person is listed in Matching Records list

Confirm the searched person, is the correct person, by verifying the last

name, first name, and date of birth

7.Left click once on the person’s last name to highlight the person selected in the Matching

Records result list

8. Left click once on Open, the Update Patient Information screen displays

IV. PERSON WITH HEALTHCARE COVERAGE




47

9. Ask the person if they are covered by any Insurance, Medicare, Medicaid, or Contract

COMMERCIAL INSURANCE,

MEDICARE, MEDICAID,

CONTRACTS

CONTRACTS (CONTINUED STEP)

NO COVERAGE

Continue to step #9,

accessing all insurances/contracts

Continue to step #11,

accessing the Employer

tab, to access all

contracts

Continue to step #13 ,

accessing the UDS tab to

access the Sliding Fee

Schedule Verification and

Family Information

10. Verify Available Insurances, located at the bottom of the Update Patient Information

screen.

Use the scroll button of the Available Insurance screen, to view all

insurance/contracts listed




48

PATIENT HAS HEALTHCARE COVERAGE

COMMERCIAL INSURANCE, MEDICARE, MEDICAID, & CONTRACTS

Person’s with coverage CAN ALSO be financially screened

Financial Screening should occur prior to a patient’s appointment

If insurance is NOT LISTED OR

Insurance is EXPIRED

If Person is eligible to be financially screened

Verify coverage through ClaimRemedi (see

document “ClaimRemedi”)

Follow steps in “Creating and Managing Charts”

process, Insurance section, on how to add/update

an insurance to a person’s chart, of the Insurance

Maintenance screen

Continue to step #13, UDS tab, to access and

verify the Sliding Fee Schedule Verification and

Family Information data (SFSV & FI)

Verify if person has a current SFSV & FI, does

not have a SFVI & FI or SFVI & FI is expired

Offer person to be financially screened

o If yes – see step “if person is eligible to

be financially screened”

o If no – follow “Check-in with

AutoFlow” process

Collect appropriate co-pays

Verify any current listed SFSV & FI Expiration

Date

Add/update the SFSV & FI by following starting

with the “Creating and Managing Charts” process,

Financial Screening section, Family Information

section

If insurance is LISTED AND

Insurance is NOT EXPIRED

If Person is eligible to be financially screened

Verify information in “Creating and Managing

Charts” process, Benefit Info “Eligibility and

Benefit Information History” and Note section of

the Detail Tab of the Insurance Maintenance

screen to determine verification of insurance and

the ability to check-in patient


verify the Sliding Fee Schedule Verification and

Family Information data (SFSV & FI)

Verify if person has a current SFSV & FI, does

not have a SFVI & FI or SFVI & FI is expired


o If yes – see step “if person is eligible to

be financially screened”


AutoFlow” process


Verify any current listed SFSV & FI Expiration

Date

Add/update the SFSV & FI by following starting

with the “Creating and Managing Charts” process,

Financial Screening section, Family Information

section

**MEDICAID clients must have CHW as PCP**

**CONTRACT clients must also have an employer entered, follow “Financial Screening” process, Employer

section** And a required mini registration form must be collected from these agencies

11. Close any Insurance Maintenance screens to return to the Update Patient Information screen




49

EMPLOYER TAB

12. Left click once on the Employer section of the Update Patient Information screen, to access

the list of Contracts

13. Request the mini-registration form from the agency, from the patient




50

CONTRACTS

Person’s with coverage CAN ALSO be financially screened

Financial Screening should occur prior to a patient’s appointment

If person has mini-registration form If Person is eligible to be financially screened

Scan the mini-registration form, follow

“Creating and Managing Charts” process,

Scanning Documents section

Follow steps in “Financial Screening”

process, Insurance section, on how to

add/update an insurance to a person’s chart,

of the Insurance Maintenance screen


verify the Sliding Fee Schedule Verification

and Family Information data (SFSV & FI)

Verify if person has a current SFSV & FI,

does not have a SFVI & FI or SFVI & FI is

expired


o If yes – see step “if person is eligible

to be financially screened”


AutoFlow” process


Verify any current listed SFSV & FI

Expiration Date

Add/update the SFSV & FI by following

starting with the “Creating and Managing Charts”

process, Financial Screening section, Family

Information section

If person DOES NOT have mini-registration form

Obtain the mini-registration from the agency by calling for a faxed copy

Patient must wait for collection of mini-registration form

Follow – the same steps as indicated in section “If person has mini-registration form”

V. PERSON WITHOUT HEALTHCARE COVERAGE

14. Left click once on the UDS section, to access Sliding Fee Schedule Verification and Family

Information (SFSV & FI)




51

15. Confirm the Sliding Fee Schedule Verification and Family Information is not expired by

verifying the Expiration Date

EXPIRED NOT EXPIRED

Communicate to the person that if they would like to receive

services today, they must update their eligibility and go

through financial screening

If person agrees and has all required documents

Hand person the Checklist for Financial Screening and

Application for Discounted Services

Communicate to the person to complete the Application

for Discounted Services

Ask the person to sit in the Financial Screening waiting

area and a Patient Services Specialist will call the person

and do a face to face interview to determine financial

screening.

Send a task to the financial screeners, see “Tasking”

process

If person does not agree or does not have required documents

Hand the person the Checklist and Application for

Discounted Services and they can return with all

supporting documents at their convenience

Continue to check-in patient using the

“Check-in with AutoFlow” Process

16. Close all screens and continue to the next person


TASKING


52

Purpose:

A means of communication from the front desk users to the financial screeners.

Required when a person requests to be financial screened

Definition:

The act of assigning a user a task assignment to perform electronically




I. CREATING A TASK

3. Left click once on Tasks from the menu bar, the shortcut menu will display

4. Left click once on Create Task, the Add Task screen displays


TASKING


53

5. Creating tasks will be specific to each department, see task list at the end of this document

6. Left click once on the down arrow of the Task Type field, a drop down menu will display

with tasks that can be assigned, select the appropriate task

7. Press the Tab key once on the key board, the Status, Priority and the Assigned To field

will auto populate according to the Task selected


TASKING


54

8. Left click once in the Subject field and document appointment or walk-in time, provider,

patient last name and any other language than English

a. Example:

Appointments should be entered - 1:00 Tigrett, Appointment time and provider

Walk-in patients should be entered - 10:08 Wilson, Walk-in time and patient last

name

Add “SP” after a provider name or patient name to indicate Spanish speaker

o Vietnamese and Sign Language is also a majority of other translations needed

9. Left click once in the Details field and always document the following:

a. Type in the patient’s full name

b. Type in the patient’s DOB

c. Type in the appointment information:

o Resource Name

o Time

10. Left click once on the “Ctrl-Shift-D adds current date/time and signature” hyperlink

a. This documents the date and time users are documenting the task

11. Left click once in the Start Date field and enter the date the task is being created

12. Left click once in the Follow Up Dt field and enter the date the task is being created

13. Left click once in the Due Date field and enter the date the task is being created

14. Leave the Expiration Dt blank

15. Left click once on OK, the task is sent to all that is assigned to

II. RETRIEVING TASKS

WORKLOG MANAGER

16. Left click once on Worklog icon on the PM toolbar


TASKING


55

17. Left click once on the down arrow of the Task Type field and select the tasks types to view

a. If scheduled to be in Galveston as the financial screener select both

Galveston Appointment

Galveston Walk-In

If scheduled to be in Texas City as the financial screener select both

Texas City Appointment

Texas City Walk-In

18. Left click once on the down arrow of the Status field and select Not started

19. Left click on Find, a list of tasks will display in the Task List field, based on the above

filters


TASKING


56

Sort the tasks by priority and subject, first come first served, bases

Appointments must be financially screened prior to walk-ins

20. Double left click on the task to complete, the Edit Task screen will display

21. Left click once on the down arrow of the Status field and select In Progress

This status notifies other users the patient has been selected to be called

Physically call the patient to the financially screen area


TASKING


57

22. Left click once on the down arrow of the Status field and select Completed, once the patient

arrives at the financial screening area

This status notifies other users the patient is being financially screened and no longer

waiting

23. Left click once in the Completion Reason field and select one of the following

a. Completed – patient was successfully financially screened

b. Patient Left W/O Financial Screening – patient left without being financially

screened

24. Left click once on OK and the task is complete and should not be listed within the worklog

as “not stated” status

TASK TYPES

TASK REASON

Galveston Appointment For Patients with appointments in need of

financial screening in Galveston

Galveston Walk-In For Patients without appointments in need of

financial screening in Galveston

Texas City Appointment For Patients with appointments in need of

financial screening in Texas City

Texas City Walk-In For Patients without appointments in need of

financial screening in Texas City

WORKLOG MANAGER ADDED FIELDS

o Filters can be utilized to search for previously completed tasks

o Utilize the Task Type, Status, and the Create Dates fields to filter searches


CREATING AND MANAGING CHARTS


58

Definition:

Financial screening is conducted to evaluate if a person is eligible for discounted rate

for services provided by CHW. Users must complete all required demographics,

insurance, family size, income and UDS fields.




I. COLLECTING REQUIRED DOCUMENTATION

3. Collect the following information to complete financial screening

Application for Discounted Services, if applicable

Proof of Identification

Proof of Income

Proof of Address

II. SEARCHING PERSONS/PATIENTS

4. Left click once on , to search for a person in the system, the Patient Lookup screen

displays

5. Left click once in the Last name field and enter the person’s last name


7. Left click once on the Find button to display a search result of Matching Records of all persons

with the same last name and date of birth


display. If person is not listed based on search ALWAYS perform a double search by

removing data from a field. Ex: Only enter a last name without a DOB or enter a DOB

without a last name.

Review each result in the matching records list and determine if the person is listed

PM distinguishes between a person and patients. A Person does not have a chart

and a Patient has a chart;.




59


individual who has or will not receive medical/dental services. Users may enter

them in the system as the parent of a child or as the insurance guarantor. A

person may also be an individual who has made an appointment to be seen for

the first time and has not yet been seen.

Patient (displayed with a chart next to the name): A patient with a chart

receives medical/dental services. A patient is considered a “person” before the

chart is created.

III. PERSON NOT LISTED IN MATCHING RECORDS

o If the user determines the person is not listed in matching records list, this means – the

person does not exist in the database.

8. Left click on New button located on the Patient Lookup screen, to add a new person, the Add

Patient Information screen displays with the Demographics category defaulted open.

Some fields will be required “IN RED” but most of the person’s information will

always need to completed or confirmed

9. Left click once in the Last (Name) field and enter the person’s full last name (DO NOT ENTER

SPECIAL CHARACTERS)




60

10. Left click once in the First (Name) field and enter the person’s full first name (DO NOT

ENTER SPECIAL CHARACTERS)

11. Left click once in the SSN (Social Security Number) field and enter the person’s SSN.

12. Left click once in the Birth Date field and enter the person’s date of birth, in the following

format MM/DD/YYYY

The age is populated by the system automatically

13. Left click once in the Birth Sex field and select the person’s sex

ADDRESS

14. Left click once in the Street 1 field of the Address Billing section and enter the person's billing

address.

This address is where a billing statement can be mailed to the person, if this is the

person’s physical address complete Billing address fields only. If the person’s billing

address is not the physical address, such as, a PO BOX, complete the Address

Secondary section as well.

Enter the person’s address in the following format: 1234 My Lane Ave Apt 1 in the

Street 1 field

DO NOT enter special characters in a person’s address fields, such as, periods, or

# signs.

15. Left click once in the Zip field and enter the person’s zip code in the following format:

77591

Using the Tab key on the keyboard, tab through the Zip, so the system will populate

the City, State, County, and Country automatically

DEMOGRAPHICS

16. Left click once on the down arrow of the Marital Status field and select one of the following

17. Left click once on the down arrow of the Student Status and select one of the following

18. Left click once on the down arrow of the Pref Language and select a preferred language the

person prefers to speak




61

19. Left click once on the down arrow of the Primary Care Provider and select a primary

“medical” provider the patient will become a patient with, if the patient does not know at the

time of financial screening select the “…………………….” dummy.

20. Left click once on the down arrow of the Primary Dental Provider and select a primary

“dental” provider the person will become a patient with, if the patient does not know at the time

of financial screening select the “…………………….” dummy.

CONTACT INFORMATION

21. Left click once in any of the Number/Address fields for each Contact Method, by asking


o Required: Home Phone

Cell Phone

E-Mail

NOTE: A N/A option checkbox is available if a required field cannot not be collected, due to

the person not having what is required. This checkbox will grey-out the required fields.

o Optional:

Day Phone

Alternate Phone

Secondary Phone

For each contact method, the area code is self-populated by the system automatically

Users can also re-sequence the telephone numbers and email in any order the patient prefers to

be contacted first.




62

Left click once on title of the Number/Address field of the Contact Method needed to

be re-sequence and left click once on the up or down blue arrows to re-sequence as

preferred

22. Left click once on the down arrow next to the Preferred Contact field and select the correct

contact preference for the person

23. Left click once on the down arrow of the Notifications field and select the preferred notification

method the patient would like to be contracted.

IV. UDS

24. Left click once the UDS red required category located on the left hand side of the Add Patient

Information screen, users must complete all required fields, but not limited to the following

25. Left click once on the down arrow of the Homeless Status field and select once of the

following:




63

26. Left click once on the down arrow of the Migrant Worker Status field and select one of the

following:

27. Left click once on the down arrow of the Language Barrier field and select one of the

following:

28. Left click once on the down arrow next to the Race field and select one of the following:

NOTE: If a patient has documented/stated more than one race select the “More than one

Race” option NOT multiple races

29. Left click once on the down arrow next to the Ethnicity field and select one of the following:

30. Left click once on the down arrow of the Veteran Status field and select one of the following:




64

31. Left click once in the Primary Medical Coverage field and type in the first letter of the

primary medical insurance name. An Insurance List will display with insurance names that

start with the first letter in the Primary Medical Coverage field, using the scroll button, search

and select the medical insurance

32. Left click once in the Consent to Treat checkbox to indicate a signature was obtained on the

“Patient Acknowledgment Form” section Consent to Treatment

33. Left click once in the Consent to Treat Date field and enter the date the person signed the

“Patient Acknowledgment Form” section Consent to Treatment

SELF PAY

34. Left click once in the self-pay check box if:

Patient is underinsured and is eligible for a discounted rate, regardless if patient has

coverage

Patient is uninsured and is eligible for a discounted rate and has NO coverage

HEAD OF HOUSEHOLD

Perform this task for ONLY patients determined eligible for a discounted rate. See also

section Relations/Role category, Head of Household

35. Left click once on the manila folder of the Head of Household section

SEE SECTION RELATIONS/ROLES/CONTACT/GUARANTOR/HEAD OF

HOUSEHOLD OF THIS DOCUMENT TO COMPLETE

V. CHART DETAILS

36. Left click once on Chart Details red required category located on the left hand side of the Add

Patient Information screen, users must complete all required fields, but not limited to the

following




65

TVFC FORM DATE (TVFC Eligibility Form Memo – must be completed)

37. Left click once in the TVFC Form Date field and enter the date the patient became eligible

Enter just a date: mm/dd/yy - for all patients WHO ARE eligible for Texas

Vaccines – based on the information collected on the TVFC form

Leave blank – if a patient is determined NOT eligible for TVFC immunizations

MARKETING PLANS

38. Left click once in the down arrow of the Marketing Plan field, a list of options will display.

39. Left click once on the best option. If the option is not available, select option “other” and enter

the response in the Marketing Comments field. For clarification or detail of any option listed

above, use the Marketing Comments for this response.

For example:

o If the Advertising option is selected and the patient stated they saw a

billboard, enter the word billboard in the Marketing Comments field.

o If the Contracted Facility option is selected and the patient states they were

referred by a contracted site, such as, Bay Area Recovery, enter Bay Area

Recovery in the Marketing Comments field.

o Etc…

VI. INSURANCE

ONLY for person's with Commercial Insurance, Medicare, Medicaid and Contracts

Follow ClaimRemedi process

If no insurance, continue to Sliding Fee Schedule Verification, to document financial

screening




66

ADDING AN INSURANCE

40. Left click once on Norton, of the Available Insurance grid located at the bottom of

the Add Patient Information screen, to access the shortcut menu

41. Left click once on New Insurance, the Payer Lookup screen displays

42. . Left click once in the Payer Name field, type in the first letter of the insurance or the whole

name of the insurance and click once on Find

A Payer List will display with insurance names that start with the first letter that

was typed in the Payer Name field

If the insurance presented by the patient is not available, send email with all

pertinent information by email to the insurance verification department.

43. Double left click on the name of the insurance to select the insurance, the Insurance

Maintenance screen displays




67

INSURANCE MAINTENANCE

o DETAIL TAB

44. Confirm the Insurance selected is correct in the Plan Name field

45. Left click once in the HIC/Policy Nbr field and enter a policy number

If the policy number is a social security number user can use the, Ctrl S command

and it will copy the person's social security number from the PM chart

46. Left click once in the Group Number field to enter a group number, if applicable

47. Left click once in the checkbox next to Active to activate the insurance, it will indicate active

with a check mark

48. Left click once in the Effective Date field and enter the date the insurance will be effective

49. Left click once in the Expiration Date field and enter the date the insurance verification will

expire

50. Left click once in the Note and enter pertinent information related to the verification of the

insurance

51. Left click once on the Amount radio button next to indicate the Co-Payment




68

52. Left click once in the Co-Payment field to enter a co-pay amount that is indicated on the

person's insurance card

53. Left click once in the Deductible field, during the ClaimRemedi process, a deductible amount

should display in the report, enter this amount here

O DETAIL – 2 (Patient name clarification on insurance card)

54. Left click once on the Detail - 2 Tab next to the Detail Tab

This tab is designed to enter a different name, DOB or sex listed on the patient

insurance card.

Left click once in any of the fields and document any different information listed on

the patients’ insurance card.

Example:

Frito-Pie Chips is what is displayed on the Medicare card, but the clinic is

financially screening Frito Chips because that is what is on the ID

O INS CARDS TAB (scanning insurance cards)

55. Left click once on the Ins Cards Tab next to the Detail-2 Tab, in this tab the insurance card

will be scanned




69

56. Left click once on Norton, to access the shortcut menu \

57. Left click once on New Insurance Card..., the scanning device input screen will display




70

57. Confirm the Description field displays the correct name of the insurance and the date the

insurance card is being scanned

58. Left click once on Norton to the left of the Front field, to access the shortcut menu

Insert card into scanner appropriately according to the scanner settings, to scan the front

of the insurance card

Confirm the correct scanner is selected with a check mark indicator

59. Left click once on Acquire

The scanner will scan the card




71

ADJUSTING THE SCANNED CARD

60. Left click once on Crop

A small cross will appear +

61. Left click once at the top left side of the insurance card, hold while dragging the curser to the

bottom right and release

The photo of the card will now only display what the user cropped

62. Left click once on the rotate left icon, the card will display right side up

Repeat steps for section Ins Card tab, to scan the Back side of the insurance card




72

o BENEFITS INFO TAB

63. Left click once on the Norton button and select New to enter Eligibility and Benefits

information

It is expected that staff enter all pertinent insurance information in the following fields

o Spoke with:

Enter a specific person’s name as the person who you received the information

from

o Eligible for DOS

Select Yes or No

If “No” is selected enter a note in the “Reason NOT Eligible on DOS”

field. Example – adult who has Medicaid but today’s visit is for dental




73

services and this patient’s coverage does not cover dental services. Also

select Type of Benefit as Medical Only

NOTE: Insurance should not be attached to the encounter if the insurance

does not cover the type of service.

o PCP Name

Enter the patient’s “PCP” Primary Care Provider’s name if not CHW

o Type of Benefit

Dental Only

Medical & Dental

Medical Only

o Specific Note Regarding COPAY and Deductible Information

Enter specific information regarding co-pay and/or deductible for the patient’s

coverage. Example – patient has met all co-pays for this calendar year or no need

to collect co-pay for today’s type of service.

o Pre-Authorization Required

Select Yes or No

If “Yes” is selected – save the Eligibility and Benefit Information

window and access the Authorizations tab

o AUTHORIZATIONS

64. Left click once on the Norton button and select New Authorization




74

65. Left click once in the Authorization Code field and enter authorization number

66. Left click once in the Effective and Expiration Date fields and enter the appropriate dates

67. Left click once in the Nbr Encounters field and enter a total encounter numbers covered by the

authorization code

68. Left click once on OK on any open tab to return to the Insurance Maintenance screen.

69. Left click once on OK on the Insurance Maintenance screen to return to the Modify Patient

Information screen to view the newly entered insurance.




75

Once an insurance has been added to a person’s chart , the insurance will become

available to attach to an encounter at Encounter Creation and a green check mark

will display to indicate that it is available

An insurance can be deactivated in this screen as well, by left clicking once on the

green arrow, the green arrow will disappear and the insurance is no longer available

when linking patients through relations, all insurance information is listed for all

patients linked.

For example, Patient58 (Child) (Patient) is covered by Aetna and Patient0516

(Parent) (Father) is not covered by Aetna, users will see Patient58 (Child)

(Patient) insurance(s) display in Patient0516 (Parent) (Father) insurance listings

when linked through relations

Users will need to remove the green check mark under the "Available" column from

the non-covered patient/parent/child insurance listing. This will unlink the insurance

and not be available for selection. Only patients covered by the insurance should

have the green check mark attached.




76

An expired insurance will display with a red X on the file folder

VII. CREATING A CHART

For ALL new persons entered into NextGen, users must create a chart to continue

data entry. Data will not be saved for all other categories if a chart is not created

first. A warning will display stating data will not be saved without creating a chart.

70. Left click once on the button located on the bottom left of the Add Patient

Information screen, NextGen alert will displaying, “Are you sure you would like to create a

chart?”

71. Left click once on OK, a chart is now created, alerts may display and the system requires an

encounter to be created – this is hardcoded

Close out alerts

Cancel from encounter creation




77

Return to completing the rest of the chart




78

72. Left click once on the Patient Information tab

73. Left click once on the manilla file folder located to the left of the patient’s name and below the

Patient Informaiton tab, the Modify Patient Information screen displays




79

VIII. PRIVACY

74. Left click once on the Privacy category located on the left hand side of the Modify Patient

Information screen

75. Left click once in the Privacy Notice Issued to Patient and enter a date in which the patient

was issued the Privacy Noticed as indicated in the Patient Acknowledgment Form

If patient is not present to sign – leave blank, the privacy alert will display when the patient

returns




80

76. Left click once in the Privacy Notice Received from Patient field and enter a date in which the

patient signed the Patient Notice section of the Patient Acknowledgment form

If patient is not present to sign – leave blank, the privacy alert will display when the patient

returns

77. Left click once on the down arrow of the Privacy Notice Reason and select from the following:

78. Left click once in the Privacy Notice Notes field and enter any pertinent notes pertaining to

privacy notice information

IX. EMPLOYER (CONTRACTS COVERAGE ONLY)

79. Left click once on the Employer category, the category is ONLY for patients who are

covered by a contract.

See current list of contracts

Ask the person for a copy of the mini registration form on the contracted agency's

letter head, exception - Title V

If the person does not have the form contact the agency for a fax copy

This form will be scanned into the person's PM chart

If no contract needs to be added, continue to

Relations/Roles/Contact/Guarantor/Head of Household section

80. Left click once on Norton, to access the shortcut menu




81

81. Left click once on New, the Employer Lookup screen displays

82. Left click once on Find, a list of current available contracts will display in the Matching

Records

83. Double left click on the contract the person is covered under, this action is only to add the

contract to the PM chart. At Encounter Creation, this contract will also need to be added as as

a Guarantor to invoice the contracted agency




82

84. Confirm that at least an address is listed and left click once on OK, the contract will display in

the PM chart for selection at Encounter Creation

X. RELATIONS/ROLES/CONTACT/GUARANTOR/HEAD OF HOUSEHOLD

85. Left click once on Relations/Role category, this category is used to:

Link other family members in the same household

Document emergency contacts

Guarantors – who is responsible for balances accrued for services rendered

Head of Household – who finances are used to determine eligibility for a

discounted rate




83

RELATIONSHIP

86. Left click once on Norton, to access the shortcut menu, in the Relationship grid

87. Left click once on New, the Relationship Lookup screen box will display, to search for the

head of household or a person that the head of household is financially responsible for




84





NOTE: The less search criteria the user enters, the more person search result will display.

If person is not listed based on search ALWAYS perform a double search by removing

data from a field. Ex: Only enter a last name without a DOB or enter a DOB without a last

name.

Review each result in the matching records list and determine if the person is listed

PM distinguishes between a person and patients. A Person does not have a chart

and a Patient has a chart;.


individual who has or will not receive medical/dental services. Users may enter

them in the system as the parent of a child or as the insurance guarantor. A

person may also be an individual who has made an appointment to be seen for

the first time and has not yet been seen.

Patient (displayed with a chart next to the name): A patient with a chart

receives medical/dental services. A patient is considered a “person” before the

chart is created.

o Person not listed in Matching Records

If the user determines the person is not listed in matching records list, this means

– the person does not exist in the database.

91. Left click once on New to add a new person, the Add Relationship Information screen

displays with the Demographics tab defaulted open




85

Some fields will be required “IN RED” but the following information will

always need to be completed or confirmed with any relations

Demographics category

Full Name (Last and First)

Relationship

Birth Date

Birth Sex

Address (Billing)

Race

Contact Information

92. Left click OK and the person will display in the Relationship grid




86

o Person is listed in Matching Records

If user determines that the person is listed in Matching Records list

Confirm the searched person, is the correct person, by verifying the last name,

first name, and date of birth

93. Left click once on the person’s last name to highlight the person selected in the Matching

Records result list

94. Left click once on Open, the Modify Relationship Information screen displays




87

95. Confirm the following and add a relationship if one does not exist.

Demographics category

Full Name (Last and First)

Relationship

Birth Date

Birth Sex

Address (Billing)

Race

Contact Information

96. Left click once on OK, to return to the Relations/Roles category and the person will display

in the grid

SUPPORT ROLE

97. Left click once on Norton, to access the shortcut menu, in the Support Role grid




88

98. Left click once in the following fields and enter or select from list

Last

First

Relationship

Support Role

99. Left click once on OK, to return to the Relations/Roles category and the person will display

in the grid

GUARANTOR

100. Left click once on the Norton button below Guarantor section

101. Left click once on Person as Guarantor,

Never select Employer as a Guarantor in this section, Employers should ONLY be

attached as guarantors at encounter creation




89

o SELF GUARANTOR

Any person age 18 years and older within their own chart, will be Self Guarantor. This

person is responsible for their own bill, a balance accrued for services rendered

102. Left click once on the Self button, the Self Guarantor will display in the Guarantor section

o NOT SELF GUARANTOR

Any person under 18 years of age must have an adult responsible for their bill, a balance

accrued for services rendered.

Once persons are attached through Relationship, these persons will display for selection

here

If user determines the person is not listed in the Matching Records list, add the person

through the Relationship section of this document







90


Records result list

104. Left click once on Open, the Modify Guarantor Information screen will display

There is no information to change on the Modify Guarantor Information screen,

these updates were performed through the Relationship section

***For those patients with a guarantor already attached, left clicking on the manila folder of the

guarantor field will auto populate the Modify Guarantor Information screen.

105. Left click once on Change

106. Left click once on Person and select from the Guarantor Lookup list

107. Left click once om OK to proceed




91

HEAD OF HOUSEHOLD

108. Left click once on the manila file folder below Head of Household, the Head of Household

Lookup will display

o SELF HEAD OF HOUSEHOLD

Any person age 18 years and older who will be using their finances as determination for

eligibility for a discounted rate, will be Self Head of Household.

109. Left click once on the Self button, the Self Head of Household will display in the Head of

Household section




92

o NOT SELF HEAD OF HOUSEHOLD

Any person who will utilize another adults finances to determine eligibility for a

discounted rate, will be Head of Household.

Once persons are attached through Relationship, these persons will display for selection

here

If user determines the person is not listed in the Matching Records list, add the person

through the Relationship section of this document





Records result list

111. Left click once on Open, the Modify Head of Household Information will display




93

There is no information to change on the Modify Head of Household Information

screen, these updates were performed through the Relationship section

***For those patients with a head of household already attached, left clicking on the manila

folder of the head of household field, will auto populate the Modify Head of Household

Information screen.

112. Left click once on Delete

113. Left click once on OK to confirm deletion of current Head of Household attached and

follow section Head of Household

114. Left click once on OK once the Head of Household is selected to proceed




94

XI. ACCOUNTS

ONLY CREATE ACCOUNTS FOR HEAD OF HOUSEHOLDS

If person is not the head of household, return to the UDS section and attach head of

household information to complete

115. Left click once on the Account button to create the account for the head of household.

all other family members or anyone other than the head of household should NOT have

accounts. The head of household should be attached in the Relations/Role category also

attached in the UDS category \

116. Left click once on OK, on the Confirm create of account? screen.

An Account will only be created for the head of household

117. Left click once or confirm the Properties Tab is opened

Users can view the Account Demographics, Account Settings, and Family Information

Add the Family Information here




95

FAMILY INFORMATION

118. Left click once on Norton, of the Family Information grid

119. Left click once on New, the Family Info screen displays

120. Left click on the up and down arrows under the Family Size field, to select the correct

family size

121. Left click once on in the Income field and enter the household income in whole dollar

amounts

122. Left click once on the down arrow of the Income Cycle field and select one of the

following:




96

123. Left click once in the Verify Date field and enter today's date as the date the Family Size

and Income is verified

124. Left click once in the Effective Date field and enter today's date as the date the Family Size

and Income is effective

125. Left click once on the Expiration Date field and enter the expiration date, according to the

Sliding Fee Schedule Verification

SLIDING FEE SCHEDULE VERIFICATION

126. Left click once on Norton, under the Sliding Fee Schedule Verification, to access

the shortcut menu and left click once on New, the Sliding Fee Verification screen will

display

127. Left click once on the down arrow of the Sliding Fee Schedule field and select the correct

sliding fee verification schedule

CHW 1 Year Discount (year)

Complete financial screening




97

CHW 6 Month Discount (year)

Unemployed, seeking employment

128. Left click once in the Effective Date field and enter today's date as the date the Sliding Fee

Schedule is effective

129. Left click once in the Expiration Date field and enter a date based on either the 1 year or 6

month date range of the Sliding Fee Schedule

130. Left click once on OK, on the Sliding Fee Verification screen, to return to the Family Info

screen

The Sliding Fee Schedule Verification will display

EXPIRING A FAMILY INFO AND SLIDING FEE SCHEDULE VERIFICATION

When updating non-expired Family Information and Sliding Fee Schedule Verification,

users must expire the Family Information by opening the current Family Information

and changing the expired date to yesterday’s date. This must be preformed prior to

adding a new Family Information and Sliding Fee Schedule Verification

131. Left click once on OK, on the Family Info screen to return to the Account, Family

Information will display

132. Left click once on the icon to exit the Account profile and return to the patient’s chart




98

SLIDING FEE ALERT

o The Sliding Fee alert will not display as the user returns to the person’s chart. The chart

must be closed for the Sliding Fee alert to update.

o Sliding Fee alerts are real time, if the alert displays, the patient has a current Sliding Fee,

if the alert does not display, the Sliding Fee Schedule Verification and Family Income

has expired

o All sliding fee patient responsibility percentages will also display per encounter when an

encounter is created

XII. TAKING THE PATIENT’S PICTURE

133. Left click once on the Norton button of the Patient’s Picture field, located on the Patient

Information tab




99

134. Left click once on New, the Scanning Device Input box displays

135. Left click once on Norton, under the Image box

136. Left click once on Acquire to take the patient’s picture

137. Adjust the camera to take the picture of the patient

Once the image is adjusted properly by viewing the image on the screen




100

138. Left click once on Capture button, the patient’s picture will display

139. Left click once in the Selected Segment box

A small cross will appear +

140. Left click once in the Image box, starting with any part of the image that needs to be

cropped, hold while dragging the curser to the bottom right and release

The picture will now only display what was cropped in the Selected Segment box




101

141. Left click once on OK on the Scanning Device Input and the person picture will display, in

the Patient Picture field

XIII. ACCESSING CHART NOTES

ACCESSING BUILT IN FORMS

142. Left click once on Clinical History/Notes Tab

143. Left click once on the Notes manila folder in the Chart Notes section




102

144. Right click once in the white field of the Details field, to access the shortcut menu

145. Left click once on New, to access the Note...section

146. Left click once on Note, the Chart Notes screen displays with a prelisted documents

147. Left click once in the Subject field and type the current approved titles for each of the

prelisted documents

148. Confirm the Editor field displays Microsoft




103

149. Left click once to highlight the form needed

150. Left click once on OK, the form will generate and open in a Microsoft Word format

o What and when is the Patient Acknowledgment Form required

Required for all patients seen through CHW

Financial Responsibility o Required at each visit, enter a date

o WAIVER – required for patients who decline financial

screening and do not have healthcare coverage.

Patient Rights, Responsibilities and Notice of Privacy Practices

o Required yearly or if changes to policy occur

Consent to Treatment




104

o Required yearly or if changes to policy occur, enter a date

o Enter a description of legal representative if applicable

Financial Screening Outcome o Required ONLY for patients who are financially screened and

eligible for a discounted rate

o Enter a date

o Left click once in the Complete checkbox to indicate a completed

financial screening outcome

o Enter dates indicating length of time the financial screening is

effective to

o Enter a percentage of discount

o Enter a nominal fee or deposit amount

o What and when is the TVFC Eligibility Form required (refer to TVFC Eligibility

Form memo)

Required for all patients 18 and under

Enter a parent/guardian name on line 3

Enter dates and indicate by left clicking in any of the columns A-G check

boxes for table 5

Enter or Confirm Medicaid, CHIP, or Private Insurance is entered at the

bottom of the form

DO NOT SEAL THIS DOCUMENT (same document is used)

ACQUIRING SIGNATURES

151. Double left click in the electronic signature box on the form and the IntegiSign Desktop

screen displays

152. Left click once in the Signer Name field and type in the patient’s full name

153. Ask patient to sign on the electronic signature pad

o The electronic signature will appear in the electronic signature box on the form




105

154. Left click once on OK on the IntegiSign Desktop screen and collect signatures for each

section of the documents as needed, including user signatures if required

155. Left click once on X of the Microsoft Word form to close, after all required signatures have

been captured, Microsoft Word will ask to save changes to form, left click Save, the

NextGen system will display

156. Left click once on Yes, on the NextGen pop up window to save document within the

Clinical/History/Notes tab

The latest form will appear in date order

SEALING NOTES

o Users are required to seal notes, if required specifically per form. Sealing a note will

prevent future editing of the form.

157. Right click once on the newly created note to display the shortcut menu

158. Left click once on Seal, the NextGen User Authentication screen will display




106

159. Left click once in the Login ID field and enter your NextGen username

160. Left click once in the Password field and enter your NextGen password

161. Left click once on OK, a lock icon will display to the left of the date and note title

DOCUMENTING VERBAL NOTES

162. Follow steps in Accessing built in forms but select one of the blank forms to free text notes.

XIV. SCANNING DOCUMENTS

163. Left click once on the icon, to launch the Document Management database, a new

window will open




107

CREATING A BATCH

164. Left click once on the icon, the Batch Information screen displays




108

165. Confirm or select Scanner in the Acquire Profile field

166. Confirm the Secured to User field displays the current users name

167. Confirm all documents are ready to scan

168. Left click once on the Acquire button, the scanner configuration screen displays

169. Left click once on Scan, the documents will start scanning, the Document screen will

display




109

o The last scanned page will always display first

VERIFYING THE SCANNED DOCUMENTS

170. Left click on the left and right arrows on the document toolbar, to scan

through the documents

Confirm all documents scanned correctly

If documents did not scan correctly, exit without saving and repeat all the steps

FILING THE SCANNED DOCUMENTS TO A PATIENT’S CHART

171. Left click once on the File Document icon, to file the scanned documents,

172. Left click once on the down arrow next to the Document Type field




110

173. Left click once on App For Disc Serv & Supp Docs

174. Left click once the Norton icon of the File screen, to access the patient’s chart




111

175. Left click on Access Active Patient, if the patient chart in PM is opened, select Access

Previous Patient for a listing of the last 5 charts accessed in PM

Select the correct patient

176. Left click once on the Application Date field and enter today’s date

177. Left click once on File, at the end of filing ALL documents in the current batch, a NextGen

screen, “There are no more documents in the batch. Would you like to post completed

documents” screen displays

NOTE: the File button will be selected for each document before the NextGen screen displays

to post the documents. Keep in mind, users are posting batches not individual documents

178. Left click once on Yes, the document management desktop will display




112

179. Left click once on File from the menu bar, select Exit, the patient’ chart will display in PM

Documents filed under the App For Disc Serv & Supp Docs document type will display in

PM, in the document management manila folder, in the Clinical History/Notes Tab of the

patient’s chart


CREATING A NEW BATCH AND SET AS ACTIVE


113

Purpose:

A required process to collect and process payments. This action is required prior to

entering any payments in the payment transaction window.

Definition:

A batch is the total accumulation of captured transactions that is stored in the system.

Each batch must be posted at the end of each business day by any user collecting

payments.




I. CREATING A BATCH

3. Left click once on , the Batch Posting screen displays

4. Left click once on Norton to open the shortcut menu

5. Left click once on New - Batch… , the Batch Maintenance screen displays




114

II. BATCH DESCRIPTION

6. Left click once in Batch Desc field and type in, your first initial of your first name, full

last name and today’s date

SWilliams 07/06/2010

o If a coworker happens to have the same initials add a middle initial or the

second letter of your first name

o SBWilliams 07/06/2010

7. Utilize the Default Tracking field if user needs the tracking field in the payment entry to

be the same with this each payment transaction in this batch

Deposit number for all transactions in this batch

8. Utilize the Default Date field if user needs the transaction date to be the same for all

posted transactions of the batch, if not changed, the default date will be the created date

Deposit date is 07/12/2015

III. SECURING THE BATCH

9. Left click once on the down arrow, next to the Secured to User field to select your name

This is a very IMPORTANT STEP, if the batch is not secured to a user, the batch is

opened to any other user access.

It is very important for user to secure each daily batch to you only this will eliminate

from someone else to access and/or modify your batch.

10. Left click once on a user name, this will secure this batch posting to that specific user




115

11. Left click once on OK, the Batch Maintenance screen closes and the Batch Posting

screen re-opens.

IV. SET AS ACTIVE BATCH

12. Right click once on the batch to pull up the shortcut menu

13. Left click once on Set as Active Batch




116

A green check mark will confirm your batch is active

14. Left click once on the red located in the upper right hand corner of the Batch Posting

window.

15. Your batch is now complete for use when checking in a patient and collecting payments

16. Anytime a user logs out of NextGen, the user must “Set Batch as Active,” by following

steps # 11-12

NEXTGEN PM Patient Services CHECK-IN With AUTOFLOW


117

Purpose:

The Check-In Autoflow process will be used for Pre-Scheduled, Walk-ins, Lab/X-Ray Only,

and Nurse Only appointments.

Definition:

The act of granting clinical access to a patient who has successfully completed the financial

screening process or has healthcare coverage and who has either a scheduled appointment or

presents as a walk-in

A feature in NEXTGEN that activated when checking in a patient with an appointment and

guides users through the process of checking in a patient



2. Understand “Getting Started with PM - Common NextGen PM Elements” process

3. Complete “Creating a New Batch and Set as Active” process

4. Understand “Determining Eligibility” process

5. Understand “Scheduling an Appointment” and “Confirming an Appointment” process

6. Understand “Creating and Managing Charts” process

I. ACCESSING THE APPOINTMENT

Follow “Confirming an Appointment” process

7. Left click once on the confirmed patient’s appointment to highlight the appointment

o Based on the event of the appointment, users will check-in patient’s properly and

collect the appropriate co-pays, nominal fees, or deposits

o Based on the age of the patient, users will complete the TVFC Eligibility form and

TVFC Form Date, refer to TVFC Eligibility Form memo

II. CHECK-IN/CREATE ENCOUNTER

8. Right click once on the confirmed person’s appointment to display the shortcut menu



118

9. Left click once on Checkin/Create Encounter, alerts may display, read all alerts carefully and take

any action as applicable

Users at this time will also note the patient’s discount, if the patient’s event is covered by the

Sliding Fee

10. Left click once on red “X” of the alert to close and continue, the Create Encounter screen displays



119

11. Confirm the General tab displays

12. Left click once on the down arrow of the Patient Type field to select a patient type

Established Patient

o Any patient that has been seen at least once within the last 3 years

New Patient

o Any patient that has never been seen or has not been seen within the last 3 years



120

13. Confirm or select a Rendering and Referring provider, by left clicking once on the down arrow of

the Rendering and Referring fields, under the Providers section, the rendering and referring must

be the same.

o Most appointments are pre-scheduled with the “person” who will exam the patient. If the

resource is a “place” use the “Walk-in” provider, such as, if a patient is visiting the lab

14. Left click once on the name of the provider to select, the Rendering/Referring fields will display

the name of the selected provider

15. Left click once on the down arrow of the Supervisor field and select the appropriate provider name

o Medical provider – choose the Medical Director

o Dental providers – choose the Dental Director

16. Confirm or choose a Service Location by left clicking once on the down arrow of the Service

Location field

Galv Coastal Health & Wellness for all patients checking in Galveston

TC Coastal Health & Wellness for all patients checking in Texas City

17. Confirm a Guarantor is selected or correct (see accessing the appointment section of this

document)

Must be confirmed or changed at each encounter creation

This is preselected based on the Guarantor attached in the chart, see “Creating and Managing

Charts” process

III. HOW TO CHANGE A GUARANTOR FOR SPECIFIC ENCOUNTERS

18. Left click once on Norton, in the Gurantor section box to display shortcut menu

PERSON AS GUARANTOR (MINORS ONLY)

Minors (17 and under)ONLY choose the guardian who signed the financially

responsible section for the minor patient and who should be receiving the statement for

payment of the minor’s visit

19. Left click once on Person as Guarantor, the Encounter Guarantor Lookup screen displays.

Search for the guarantor and correctly select from the Matching Records list



121

If this screen does not display

There is not a Person as Guarantor available and person is self

guarantor

For minors this determines that financial screening is

incomplete because a guarantor was never selected at the chart

level. Except if a minor is declared emancipated, this is

usually determined during financial screening

o Follow “Creating and Managing Charts” Relations/Role category, Guarantor section.

20. Left click once on OK and the Person as Guarantor will display



122

EMPLOYER AS GUARANTOR (CONTRACT)

This option will ONLY to be used for persons seeking services under contracts, such

as, ACCT, TITLE V contracts, this is determined during financial screening

If a patient’s appointment today is covered under contract, user must change the

guarantor and choose the correct contract

21. Left click once on Employer as Guarantor (Contract), as in step #19 above, on the Create

Encounter screen, the Guarantor Search screen displays and the name of the contract will display

within the Matching Records list

22. Double left click on the contract, the Guarantor will change to Employer as Guarantor (Contract)

SELF AS GUARANTOR (SELF PAY)

Any person seeking service who is financially responsible for themselves, this is usually

determined during financial screening

23. Left click once on Self as Guarantor, as in step #19 above, on the Create Encounter screen, the

patient’s name will display in the Guarantor selection

***There are no other fields to access on the Create Encounter screen



123

24. Left click once on OK, on the Create Encounter screen, this starts the AutoFlow process, starting

with the Update Patient Information screen

IV. APPOINTMENT LINK SELECTION

Patient’s may have more than one appointment in one day, if an Appointment Link Selection

screen appears, after the encounter is created, perform the following

o Confirm only the appointment the user is check-in is the only appointment linked to the

current encounter created

o DO NOT link more than one appointment to one encounter

o Left click once on Cancel to continue, autoflow begins and the Update Patient

Information screen will display



124

V. AUTOFLOW BEGINS

CONFIRM DEMOGRAPHICS

25. Confirm demographics with the patient at each and every visit, by asking

What is your current address?

What is your current phone number?

Make any changes as applicable



125

26. Left click once on the AutoFlow icon, UDS category screen displays

CONFIRMING UDS REQUIRED FIELDS

27. Confirm at each and every visit that all of the following Required UDS fields has been collected

Homeless Status

Migrant Worker Status

Language Barrier

Race

Ethnicity

Veteran Status

Primary Medical Coverage, if the patient has medical coverage

Self-pay check box is selected, if,

o Patient is underinsured and is eligible for a discounted rate, regardless if

patient has coverage

o Patient is uninsured and is eligible for a discounted rate and has NO coverage

Sliding fee schedule verification and family information is attached, if the patient is

covered by a discounted rate

28. Left click once on the AutoFlow icon, on the Modify Patient Information screen,

located on the bottom right of the screen, the Chart Details screen displays



126

CHART DETAILS

O Based on the event of the appointment and patient age, user will add today’s date in the TVFC

Form Date if the patient qualifies for TVFC immunizations. The TVFC Form must be also

completed. Refer to TVFC Eligibility Form Memo and “Creating and Managing Charts”

process

29. Confirm or select a Marketing Plan - required

30. Left click once on the AutoFlow icon, on the Chart Details screen, located on the

bottom right of the screen, the Encounter Insurance Selection screen displays

ATTACHING AN INSURANCE TO AN ENCOUNTER

Based on the patient’s event of the appointment, users will select the insurance coverage for

the current patient, ONLY if the event is covered by an insurance

o Example: Event is for a dental follow up event however, the only insurance coverage

listed only covers medical events



127

If persons are listed in Relations/Roles category for the current patient, these persons are also

listed in the encounter insurance selection screen, as displayed in the examples above.

If a person is covered by a contract, the contract will be listed here as an internal payer.

Contracts are selected as Employer as Guarantor as well.

Based on Visit Type

Self Pay Insured

Commercial, Medicare, Medicaid, Contracts

Left click once on the

Autoflow

icon

Left click once on the insurance name to highlight

the insurance, in the Available Insurance field, if

the person is covered by an insurance o If the insurance file folder displays a red X the

insurance is expired or patient is no longer

covered, this is determined during financial

screening

Left click once on the arrow pointing right, the name

of the insurance will display in the Selected

Insurance field

Left click once on the Autoflow icon

CHARGE POSTING

31. Alerts may display, read all alerts carefully and take any action as applicable and close. The Charge

Posting screen displays. Enter the applicable nominal fee charge, as needed.

***Entering the Nominal Fee of $15.00 charge only applies to patients who have 100% discount. If

this applies, continue. If not applicable, skip to Patient Balance section.

32. Left click once on the New button, located in the middle of the charge posting window

33. Left click once in the Svc Item field to charge the NomFee - Nominal Fee of $15.00

This charge only applies to patients who have a 100% discount.

A $15.00 NomFee line item in the body of the Charge Posting screen, including Date, Svc

Item description, Charge amount and a Line Item Balance will display

Based on current Contract Fees – other Charges could be entered, such as, STD/HIV



128

34. Left click once on the AutoFlow icon, a NextGen Warning screen displays

Warning: The diagnosis has not been entered for this charge and could cause reimbursement

to be denied. Do you want to continue?

35. Left click once on OK to proceed, the Patient Balance screen will display



129

PATIENT BALANCE

The patient balance is displayed based on the guarantor attached to the encounter

The totals listed above and the encounter/invoice information is the account total due

for the guarantor.

o Self As Guarantor

o Employer as Guarantor (Contracts)

36. Inform the total balance due to the patient.

a. Including today’s nominal fee or co-pay, there is a current Amount Due of $30.00, would

you like to make any payments today

37. Left click once on the AutoFlow icon, on the patient balance screen,

If a charge was entered the Payment Entry screen will display



130

If a charge was NOT entered, the patient appointment will display. This will occur for all

patients without a Nominal Fee and only collecting a deposit or co-pay

38. Right click once on the patient name, to display the shortcut menu.

PAYMENT ENTRY

39. Left click once on the “Add Transaction” shortcut to display the Payment Entry screen

ONLY if payments are collect should a user access the Payment Entry screen.

40. Left click once in the down arrow of the Payer field to select Patient

41. Left click once in the Pay Amt field and confirm the Pay Amt displayed is correct or enter the

correct dollar amount based on patient collection:

a. Nominal Fee - $15.00



131

b. Co-Pay ($20, $25, $30, $35) (commercial insurance)

For Co-Pays, no charge will be associated with this transaction apply payment as

UNAPPLIED TO THE ENCOUNTER ONLY

c. For NO PAYMENTS, left click once on clear to clear the dollar amount

42. Left click once on the down arrow of the Pay Code field, to select the pay code

a. Cash Payment, self pay patients

b. Check Payment, self pay patients

c. Credit Card/Debit Card Payment, self pay patients

d. COPAY Cash Payment, private insurance

e. COPAY Check Payment, private insurance

f. COPAY Credit Card/Debit Card Payment, private insurance

43. Left click once in the Tracking field, for Credit Card/Debit Card and Check payments ONLY

a. Enter an authorization number for all Credit Card/Debit Card payments

b. Enter a check number only for all Check payments

44. Left click once on Save

**NOTE: For all payments not associated to a charge or an overpayment of the charge, an

unapplied payment screen will display

UNAPPLIED TO THE ENCOUNTER ONLY

45. Left click once on the AutoFlow icon, the Itemized Bill for Encounter # screen

displays, this is the patient’s RECEIPT

VI. PRINTING THE RECEIPT

46. Left click once on Print, the Itemized Bill for Encounter # will print to the defaulted printer,

make sure the default printer is where Receipts print, this copy is for patient



132

47. Left click once on Print again, the Itemized Bill for Encounter # will print to the defaulted

printer, make sure the default printer is where Receipts print, this copy is the user to reconcile with

End of Day Balancing.

48. Left click once on Close, continue to follow patient services procedures

(Anytime Autoflow is interrupted, access the patient appointment and right click to access the

“Check-in” option)

VII. AUTOFLOW INTERRUPTION

Any time autoflow is interrupted, meaning, any screen is closed prior to ending with

printing the patient receipt.

Users can access all autoflow screens by right clicking on the correct patient name from the

appointment listing to display the shortcut menu

Access all screens from the shortcut menu

NEXTGEN PM Patient Services PAYMENTS ONLY


133

Purpose:

To collect any outstanding balances on patient accounts

Definition:

To accurately collect and apply patient payments for outstanding balances




3. Understand “creating and Managing Charts”

4. Understand “Check-in with AutoFlow” process


I. ACCESSING THE ACTIVE BATCH

6. Left click once on , the Batch Posting screen and the users secured batch displays

7. Double left click once the user secured batch to access the Payment Entry screen



134

16. II. ACCESSING THE ACCOUNT/ENCOUNTER

ACCOUNT SOURCE

Most patient payments must be posted to the Account source with the exception to

payments made to Denture Contract encounters, the source will be Encounter not

Account

ENCOUNTER SOURCE

Only Denture Contract payments will be applied to an encounter source. See both current

“Denture Contract Service Agreement Process” and “Denture Contract Updates

Memo” procedures to probably apply payments

8. Left click once on the down arrow of the Source field, select Account/Encounter



135

9. Left click once on the Search icon, to search for the account/encounter name, the

Account/Encounter List screen displays





o PERSON IS NOT LISTED IN ACCOUNT/ENCOUNTER LIST

If user determines the person is not listed in Account/Encounter List, this

person does not have an account and the account may be in someone else’s name

Access the patient’s chart, relations/role category or communicate with person to

whom the account holder may be, then proceed with person is listed process

below

O PERSON IS LISTED IN ACCOUNT/ENCOUNTER LIST

If user determines the person is listed in Account/Encounter List

13. Confirm the searched person is the correct person by verifying the last name, first name, and

DOB

14. Double left click on the person’s last name to select the patient and apply payments to their

account, the Payment Entry screen displays with patient’s account displaying

Alerts may display, read carefully, take any action as applicable and close



136

ACCOUNT SOURCE

Any charge not paid will display with a balance

ENCOUNER SOURCE

Encounter source is encounter specific, the most recent encounter with a balance will

display first

o Left click once on the down arrow of the Enc/Clam# field and select the

appropriate encounter to enter the payment



137

III. ENTERING THE PAYMENT

ONLY if payments are collect should a user access the Payment Entry screen

15. Left click once on the down arrow of the Pay Code field and select the appropriate payment

method.

16. Left click once in the Tracking field, for Credit Card/Debit Card and Check payments

ONLY

Enter an authorization number for all Credit Card/Debit Card payments

Enter a check number only for all Check payments

17. Left click once in the Pay Amt field and enter the total amount user is collecting

o UNAPPLIED PAYMENTS

If user is collecting more than the balance is displaying, an Unapplied

Payment screen will display

Account Source

Encounter Source

Left click once on OK

Account Source

o An unapplied amount will display in the Acct Credit field

Encounter Source

o An unapplied amount will display in the Enc Credit field



138

PAYMENTS POSTED TO OUTSTANDING LINE ITEMS

Payments will post to the oldest line item with a balance first, as account

payments are collected

Left click once on Save

IV. PRINTING THE RECEIPT

18. Left click once on the printing icon, to print the patient’s receipt, the shortcut menu

will display

19. Left click once on Account Receipt, the Print Account Receipt screen will display

20. Left click once on Print, the Account Receipt will print to the defaulted printer, make sure

the default printer is where Receipts print, this copy is for patient



139

21. Left click once on Print again, the Account Receipt will print to the defaulted printer, make

sure the default printer is where Receipts print, this copy is for the user to reconcile with End

of Day Balancing.


23. Left click once on icon, to close the Print Account Receipt screen, the Payment Entry

screen displays

24. Close all windows and proceed with other Patient Services processes

Patient Info

Account holder

List of

Encounters

payment

posted to Total Payment


MEDICAL/DENTAL RECORD COPY PAYMENTS ONLY


140

Purpose:

To accurately charge a patient for copies of medical or dental records for personal

use

Definition:

To act of entering charges and payments for copies of medical or dental records to

patients for personal use.





4. Understand “Scheduling an Appointment” process

5. Understand “Check-In – With AutoFlow” process

I. SCHEDULING THE PATIENT ON THE MEDICA/DENTAL RECORDS SCHEDULE

Utilizing the “Scheduling an Appointment” process, access the Medical/Dental Records

resource on the appointment book

Schedule the patient on the Medical/Dental Record resource, utilizing the Medical/Dental

Record Copy event

Follow the “Check-In – With AutoFlow” process

II. CREATING THE MEDICAL RECORD ENCOUNTER

When users create the encounter for Medical/Dental Records, alerts may display, read all

alerts carefully and take any action as applicable, perform the following

o Users at this time WILL NOT consider any type of coverage including the

sliding fee discount. Patients are charged a 100% fee for release of records. See

Medical Records Fee.




141

6. Left click once on red “X” of the alert to close and continue, the Create Encounter

screen displays

7. Left click once in the Patient Type field and select “Established Patient”

8. Left click once in the Rendering and Referring fields and select “Walk-In Only”

9. Left click once in the Supervisor field and select the medical supervisor

III. ENTERING THE MEDREC CHARGE

When users access the Charge Posting screen during the “Check-in – with AutoFlow”

process, perform the following

10. Left click once on the New button

11. Left click once in the Svc Item”field and type in “MEDREC” – Medical Record Copies

12. Left click once in the Unit/Override field and enter the total dollar amount due based on

the Medical Records Fee

13. Left click on Save




142

IV. PAYMENT ENTRY

When users access the Payment Entry screen, Follow the Payment Entry process and

enter the total dollar payment due, ALL MEDICAL/DENTAL RECORD PAYMENTS

MUST BE COLLECTED FOR PATIENTS TO RECEIVE COPIES

14. Left click on Save




143

V. PRINTING THE RECEIPT

15. Left click once on the printing icon, to print the patient’s receipt, the shortcut

menu will display

16. Left click once on Encounter Bill, the Itemized Bill for Encounter #, will display

17. Left click once on Print, the Itemized Bill for Encounter # will print to the defaulted

printer, make sure the default printer is where Receipts print, this copy is for patient

18. Left click once on Print again, the Itemized Bill for Encounter # will print to the

defaulted printer, make the your default printer is where Receipts print, this copy is for

the user to reconcile with End of Day Balancing.


NEXTGEN PM Patient Services POSTING THE BATCH AND END OF DAY BALANCING


144

Purpose:

All transactions collected from prescheduled appointments, medical/dental

records payments or payment only collections. This step must be completed at the

end of each business day

Definition:

The act of electronically posting a batch and balancing all collection of payments

at the end of each business day by each user documenting transactions. Users

must confirm, total batch dollars match total dollars collected in drawer, prior to

posting the batch.





I. ACCESSING THE ACTIVE BATCH

4. Left click once on , the Batch Posting screen and the users secured batch displays

5. Right click once on the users batch needing to post, to display the shortcut menu



145

I. ACCESSING THE BATCH LISTING REPORT

6. Left click once on Print, Batch Listing, the batch listing report will display.

The report will list all transactions associated to the batch. All transactions types

should be listed separately

o All cash payments will be listed with at total dollar of cash collected

o All check payments will be listed with a total dollar of checks collected



146

II. PRITING THE BATCH LISTING REPORT

7. Left click once on the Print Report icon, to print the report

8. Left click once on icon, to close the Batch Listing report

9. Compare each total, by transaction type on the report with the cash drawer, all dollars should

match.

III. BALANCING THE BATCH TO THE CASH DRAWER

LEDGER


11. Left click once on Ledger, the Transaction Ledger will display

A list of all accounts and encounters payments received will display

Review the list to confirm the total dollar amounts and transaction codes

(payment type) are correct

o MODIFYING AN INCORRECT TRANSACTION

If a transaction is incorrect



147

o Double left click on the incorrect account or encounter transaction, the

payment entry screen will display

o Left click once on Open to access the saved transaction and be able to

make corrections

Make corrections as needed

Pay Amount

Pay Code

Etc..

o Left click once on Save, to save the changes

o Left click once on icon, to close the Payment Entry screen and

return to the Transaction Ledger screen

HEADER

12. Left click once on the Header button, located on the bottom left hand side of the Transaction

Ledger screen, the Batch Maintenance screen displays

13. Left click once in the Total Billed field on the Batch Maintenance screen and enter the total

billed displayed in the Billed field on the Transaction Ledger screen



148

14. Left click once in the Total Allowed field on the Batch Maintenance screen and enter the total

allowed displayed in the Allowed field on the Transaction Ledger screen

15. Left click once in the Total Paid field on the Batch Maintenance screen and enter the total

payment displayed in the Payment field on the Transaction Ledger screen

16. Left click once in the Total Adjusted field on the Batch Maintenance screen and enter the total

adjustment displayed in the Adjustment field on the Transaction Ledger screen

17. Left click once on OK, on the Batch Maintenance screen, the batch maintenance screen closes

and the Transaction Ledger screen displays

18. Left click once on Close on the Transaction Ledger screen, the Batch Posting screen displays.

Users will notice the Status of the existing batch should now indicate “balanced”

If the status does not indicate “balanced” users must repeat all steps in the Header

section.

IV. POSTING THE BATCH




149

20. Left click once on Post, to post the currently selected batch, the NextGen Confirm post of batch

screen displays

21. Left click once on OK, the batch will now post

22. Left click once on OK

23. Continue to follow all other patient services procedures

Complete a deposit slip

Complete the Daily Transaction Log

Forward all documents to the proper departments

NEXTGEN Patient Services

DENTURE CONTRACTS


150

Coastal Health & Wellness Clinic

Denture Contract Service Agreement Process

I. PATIENT APPOINTMENT

Patient can request a denture contract appointment with either the Dental

Receptionist, Contact Center or Check-Out desk. All denture contract associated

appointments must be identified with the “Denture Contract” event. Selecting the

“Denture Contract” event informs the Check-In staff when not to collect the

nominal fee. Also, apply the appointment to the Denture Contract category/time

slot to schedule denture contract appointments.

II. DENTAL PROVIDER Completes a Comprehensive Exam

Determine patient’s needs and procedures needed to implement a denture

treatment plan, including extractions and all necessary pre-work.

Educate patient on procedures and steps to complete a denture treatment plan

Electronically complete the Pre-Denture Assessment Form, by:

(a) checking the check boxes to the left of the denture CDT codes

(b) enter a tooth number in the free text field to the right of the extraction

CDT code description

ex:

Electronically sign and date Pre-Denture Assessment Form

Print a completed copy of the Pre-Denture Assessment Form for the patient

Explain to the patient if a Denture Contract Agreement is not signed within

30 days of the Pre-Denture Assessment Form, the patient must be

reevaluated and a new Pre-Denture Assessment Form must be completed

by the dental provider

Explain to the patient to deliver the Pre-Denture Assessment Form to a

Business Representative through the Check-out staff. The Business

Representative will assist the patient with executing a Denture Contract

Agreement and discuss payment options

Electronically enter all denture contract appropriate CDTs as “PLANNED”

at the patient’s first denture contract appointment

Will “COMPLETE” all “PLANNED” denture contract CDTs when the

appliance is delivered or a procedure is performed, such as, an extraction,

impression, wax bite, etc..

CDT Description D7140 Extraction, Coronal Remnants Deciduous Tooth 1, 2 ,3, 4


DENTURE CONTRACTS


151

Coastal Health & Wellness

Pre-Denture Assessment Form

CDT Code CDT Description

D7111 Extraction, Coronal Remnants Deciduous Tooth

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation &/or /Forceps Removal)

D7210 Surgical Removal of Erupted Tooth

D7220 Removal of Impacted Tooth - Soft Tissue

D7230 Removal of Impacted Tooth - Partially Bony

D7250 Surgical Removal of Residual Tooth Roots

D7310 Alveoloplasty in Conjunction w/Extractions - 4 or more teeth or tooth spaces per Quadrant

D7311 Alveoloplasty in Conjunction w/Extractions - 1 to 3 teeth or tooth spaces per Quadrant

D7320 Alveoloplasty Not in Conjunction w/Extractions 4 or more teeth or tooth spaces per Quadrant

D7321 Alveoloplasty Not in Conjunction w/Extractions - 1 to 2 Teeth or Tooth Spaces per Quadrant

D5520 Replace Missing or Broken Teeth

D5640 Replace Broken Teeth - Per Tooth

D5110 Complete Denture - Maxillary

D5120 Complete Denture - Mandibular

D5130 Immediate Denture - Maxillary

D5140 Immediate Denture - Mandibular

D5211 Maxillary Partial Denture - Resin Base

D5212 Mandibular Partial Denture - Resin Base

D5213 Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases

D5214 Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases

D5281 Removable Unilateral Partial Denture

D5410 Adjust Complete Denture - Maxillary

D5411 Adjust Complete Denture - Mandibular

D5421 Adjust Partial Denture - Maxillary

D5422 Adjust Partial Denture - Mandibular

D5510 Repair Broken Complete Denture Base

D5610 Repair Resin Denture Base

D5620 Repair Cast Framework

D5630 Repair or Replace Broken Clasp

D5650 Add Tooth to Existing Partial Denture

D5660 Add Clasp to Existing Partial Denture

D5710 Rebase Complete Maxillary Denture

D5711 Rebase Complete Mandibular Denture

D5730 Reline Complete Maxillary Denture - Chairside

D5731 Reline Complete Mandibular Denture - Chairside

D5740 Reline Partial Maxillary Denture - Chairside

D5741 Reline Partial Mandibular Denture - Chairside

D5750 Reline Complete Maxillary Denture (Lab)

D5751 Reline Complete Mandibular Denture (Lab)

D5820 Interim Partial Denture (Maxillary)

D5821 Interim Partial Denture (Mandibular)

D5899 Gold Denture Crown Per Tooth NOTE: This assessment is valid for thirty days. In other words, you have 30 days to execute a contract and payment plan with

CHW. The denture contract must be paid in full within 90 days of the date signed. Once you have paid in full, personnel from

the dental office, will call you to make an appointment to start your denture work. After you get your dentures, the first 3

adjustments and/or relines of new dentures are at no charge. Any additional adjustments and/or relines will be charged to you

based on the dental fee schedule.

__________________________________________________________________________


DENTURE CONTRACTS


152

Provider Signature Date

III. BUSINESS REPRESENTATIVE/DESIGNEE

Based on the Pre-Denture Assessment Form completed by the Dental

Provider, discuss with the patient the total denture contract cost using the

current Denture Contract - Fee Schedule form. The Plan is determined

based on the Patient’s Sliding Fee on the day the patient signs the Denture

Contract Service Agreement.

Plan Patient Sliding Fee

Denture Contract 0% Pay 100% discount






Follow “Document a Patient’s Denture Contract Electronically” training

guide.

Complete the Denture Contract Service Agreement electronically within the

patient’s dental record

Verify IDENTITY OF PARTIES, patient name, DOB, address and phone

number are correct

Enter the patient’s sliding fee percentage

Enter information into the following appropriate fields:

Line II – TERM OF THE AGREEMENT

- Enter an “Effective date” (today’s date) and an “Expiration date”

(90 days from the Effective date) in a date format MM/DD/YYYY

Line III – PROFESSIONAL DENTAL SERVICES TO BE RENDERD

BY CHW CLINIC

- Enter the CPT codes documented on the Pre-Denture Assessment

Form Example: – D7111 (1,4,8,20, and 27) - Extraction, Coronal

Remnants Deciduous Tooth

- D5211 – Maxillary Partial Denture - Resin Base

Line IV – PAYMENT FOR SERVICES

- Enter in the total cost of the dentures based on the current Denture

Contract - Fee Schedule and the Plan Chart in numeric format in

whole dollars, such as, 545

Review and explain the entire Denture Contract Service Agreement with the

patient.

Ensure the patient clearly understands (repeats back) the following:

Line II – Term of the agreement - the Effective date and Expiration date

Line III – Professional dental services to be rendered by the CHW Clinic

Line IV – Payment for services –

(a) the total cost of the Denture Contract Service Agreement

(b) Full payment must be received prior to denture services

beginning

(c) making payments is acceptable


DENTURE CONTRACTS


153

Line V – Denture Adjustments

Line VI - No Refunds – explain this section very clearly

Line VII – Entire Agreement

Line VIII – Termination of Agreement

Line IX – Amendments

Line X – Governing Law

Line XI – Written Notice

After explaining the Line items to the patient, continue to follow the “Document a

Patient’s Denture Contract Electronically” training guide and collect electronic

signatures

Add the appropriate Denture Contract % Plan to the patient’s PM chart

Access patient in PM

Left click once on the Modify Patient file folder, the Modify Patient

Information dialog window will open with access to the insurance

button.

Left click once on the Insurance button to access the Insurance Listing

dialog box

Left click once on the Norton button of the insurance listing window,

select New Insurance, to add the new Denture Contract % Plan

Left click once in the Payer Name field and enter the appropriate Denture

Contract % Plan (see chart listed above)

Double click once on the appropriate Denture Contract % Pay Plan


DENTURE CONTRACTS


154

Left click once in both the Effective and Expiration Date fields and enter a

1 year period. The effective date will be the date the contract was signed

and expiration date will be 1 year from the signed date.

Left click once on OK, the Denture Contract % Pay Plan should now

display in the patient’s chart

Close the patient’s PM chart

Offer to make a payment today

Creating a DENCON Encounter

Access patient in PM

Left click once on the Encounter tab (located far right of

the patient chart)

Left click once the on the Norton button and select New. A

Create Encounter screen will display

Left click once on the down arrow of the Patient Type and

select Established Patient

Left click once on the down arrow of the Rendering and

Referring fields and select the dental provider who signed

the Dental Assessment Form

Left click once on the down arrow of the Supervisor field

and select Dr. Foster.

Left click once on the down arrow of the Service Location

and select the appropriate location in which services were

rendered.

Left click once in the Denture Contract field and enter the

total dollar of the Denture Contract Agreement

Left click once in the DC Expiration Date field and enter

a 1 year expiration date from the time the patient signed the

Denture Contract Agreement


DENTURE CONTRACTS


155

Left click once on OK on the create encounter window

Make note of the encounter number located in the

Encounter Information box (667502)

Right click once on the newly created encounter to display

the shortcut menu and select Charges, the charges window

will display

Left click once on New button of the charges window

Left click once in the Svc Item field and enter the dummy

charge of DENCON and use the Tab key on your keyboard

to select the charge


DENTURE CONTRACTS


156

Left click once on the Save button, a diagnosis not entered

warning dialog box will display

Left click once on OK of the alert

Close the charges window

Creating a DENCON Alert

Left click once on the Clinical/History/Notes tab located

to the left of the Encounters tab

Left click once on Alerts

Right click once in the details (white field) to the right of

the selected Topics list, to display the shortcut menu and

select New to create a new Alert

Left click once in the Alert field and enter “Denture

Contract”

Left click once in the Expiration Date field and enter an

expiration date ending in 90 days. This expiration date is

specific to the signed 90 day contract.

Left click once in the Alert Entry field and enter the

following: “PLEASE APPLY ALL DENTURE

CONTRACT DEPOSITS TO ENCOUNTER# 676751

WITH A TOTAL OF $364.00. CONTRACT EXPIRES

12/06/2017”


DENTURE CONTRACTS


157

IV. CHW Billing Will be responsible for notifying the patient in the event full payment has not

been paid in full by letter, at least 30 days prior to the Denture Contract Service

Agreement expiring.

o If only partial payments have been made by the expiration date (not paid

in full), follow the Refund section of the Denture Contract Service

Agreement. For any special requests from patients, in reference to the

Refund section of the contract, consult with management.

Will notify Patient Information Manager, Business Office Manager, and the

Dental Director through email with patient information for those contracts paid in

“full”

Will manage all contracts prior to 9/1/17 plan changes with the old method of

using the A, B, or C plan. These encounters should be identified with the

“Denture Contract” payer.

V. Dental Receptionist/Contact Center

Will contact the patient when a confirmation email from CHW Billing is received

indicating the Denture Contract Service Agreement has been paid in “full”

Will schedule the patient for the first denture contact appointment by using the

“Denture Contract” event for all newly paid in “full” Denture Contract Service

Agreement. Also, apply the appointment to the Denture Contract category/time

slot to schedule denture contract appointments.

VI. Patient Services

Patient Services staff will continue to use the Denture Contract Event to confirm a

patient’s Denture Contract appointment at the time of check-in

Will add the “Denture Contract % Pay” payer to the patient’s encounter at the

time of check-in.

o Keep in mind, CHW will continue to honor denture contract

agreements prior to this change, this means, some patients will

continue to have the old “Denture Contract” payer

**NOTE: When a patient checks-in for a denture contract appointment and a denture contract

payer is not in the patient's chart, please report this to billing by emailing: Cynthia Franklin,

Mary Orange, Theresa Cruz & Luz Amaro. Denture contract payers must be managed by billing.


DENTURE CONTRACTS


158

Do not add any Denture Contact payers to patient's chart.** no denture contract payer attached,

will not affect the patient’s appointment, nor any dental documentation.

Patient Services will no longer hand write Denture Contract payment receipts.

Patient Services to apply all Denture Contract payments to the Denture Contract

encounter indicated by CHW billing within the patient’s chart alert

VII. Check Out

Will contact a Business Representative/Designee if a patient presents with the

Pre-Denture Assessment form and if the patient is willing to sign a Denture

Contract Service Agreement.

Will assist with scheduling follow up “Denture Contract” appointments

Will assist with collecting Denture Contract % Plan payments


DENTURE CONTRACTS


159

DENTURE CONTRACT SERVICE AGREEMENT

I. IDENTITY OF PARTIES

This Service Agreement is between the Coastal Health & Wellness with clinics located at 9850-C Emmett F Lowry

Expressway, Texas City, TX 77591 and 4700 Broadway, Galveston, Texas 77551 AND

┌ ┐

Patient Information Label

└ ┘

II. TERM OF AGREEMENT

This is a 90 day Service Agreement beginning on ____________ (Effective date) and shall end on ____________

(Expiration date) unless this agreement is terminated according to Section VIII.

III. PROFESSIONAL DENTAL SERVICES TO BE RENDERED BY CHW CLINIC Completed by Dental Provider on the Pre - Denture Assessment Form.

IV. PAYMENT FOR SERVICES

In consideration of Denture Service(s), the Patient agrees to pay CHW the sum of

$ ______ .00 for the denture work to be performed under this Service Agreement.

FULL PAYMENT (stated above) must be received before denture services will be performed.

Making payments through installments is acceptable. However, the balance of denture charges must be paid prior to

the 90 day expiration date of this contract.

V. DENTURE ADJUSTMENTS

Patient is eligible for three adjustments within the first three months. After the three months, Patient will be charged at

the established fee schedule for any additional adjustments including the clinic fee for the visit.

VI. REFUNDS

NO REFUNDS will be issued after denture services begin.

REFUNDS will only be issued prior to denture services beginning. Refunds will be made only after the Patient has met

all other CHW financial obligations, including balances which may have occurred for dental and/or medical services

rendered by the CHW clinics.

VII. ENTIRE AGREEMENT This Agreement supersedes all previous agreements between the parties, contains the entire understanding between the

parties, and may not be changed, except in writing, duly executed by each of the parties.

VIII. TERMINATION OF AGREEMENT

This Agreement may be terminated by either party by furnishing a written notice to the other party.

This Agreement will terminate if Patient is no longer allowed to receive medical and/or dental services from CHW,

except if Patient’s denture contract services have begun. Patient will receive refunds according to Section VI.

IX. AMENDMENTS

Any changes to this Agreement must be made and adopted as written amendments signed and approved by both parties.

X. GOVERNING LAW

This interpretation and enforcement of this contract shall be governed by the laws of the State of Texas.

XI. WRITTEN NOTICE

All notices required by this Agreement must be in writing and either mailed by certified or registered mail, return

receipt requested, to the address listed below, or hand delivered.

Coastal Health & Wellness

ATTN: Director of Contracts and Compliance

PO Box 939

La Marque, Texas 77568

For the Patient

Patient’s Address for Service has been provided in Section I of this Service Agreement

By signing this Agreement, the parties have agreed to all the terms and conditions of this Agreement and Patient fully

understands the Dental Provider’s recommendation for treatment on the Pre - Denture Assessment Form.

Patient or Patient’s Legal Representative CHW Business Representative

Date Date


CLAIMREMEDI

Verifying Healthcare Coverage


160

Purpose:

ClaimRemdi is the electronic system to verify eligibility for Commercial,

Medicare, and Medicaid coverage, to accurately bill patients receiving services.

I. ACCESSING CLAIMREMEDI

1. Left click once on , to search for the following address

https://claimremedi.providersportal.com, the Log window will display

II. LOGGING IN

2. Left click once in the User Name field and enter a username

3. Left click once in the Password field and enter a password

4. Left click once on Log In, the Home and Welcome Galveston County Health District.

https://claimremedi.providersportal.com/


CLAIMREMEDI



161

III. CHANGE PASSWORD

5. Left click once on the down arrow next to the user name

to access Settings

6. Left click once on Password on the Settings toolbar

7. Left click once in the New Password field and enter a new password


CLAIMREMEDI



162

8. Left click once on the Confirm New Password field and enter the new password again

9. Left click once on the Save button, a confirmation will display.

IV. NEW ELIGIBILITY

10. Left click once on Submit, located on the left hand side of the screen, the shortcut

menu will display

11. Left click once on Eligibility, the Submit Eligibility screen will display

12. Left click once on the drop down arrow of the Payer field , to display Coastal Health

& Wellness list of available payers to verify healthcare coverage


CLAIMREMEDI



163

13. Left click once on a payer to verify eligibility, the payer’s required fields will display


CLAIMREMEDI



164

14. Follow the Search Options, Payer Help and/or Key for each selected payer


CLAIMREMEDI



165

15. Enter all required information, as applicable

16. Left click once on the Check Eligibility white arrow , located at the right

of the payer selected and top of the Submit Eligibility screen, the verification page

will display.


CLAIMREMEDI



166


CLAIMREMEDI



167

Tab Contains Information

Coverage Active or inactive, displays healthcare

coverage. The bottom of the result page

will display the latest HMO/PPO

information. Financial Co-Payment and Deductible information, is

in Professional (Physician) section

Exclusions Information on what services are excluded

on the plan

V. COVERAGE


CLAIMREMEDI



168

VI. FINANCIAL

VII. EXCLUSIONS

VIII. DOCUMENTING ELIGIBILITY DATA

17. Enter all eligibility status information into the patient’s chart and attach the insurance

to the patient’s encounter as instructed in the checkin process.

IX. ELIGIBILITY SEARCH RESULTS

The eligibility search results display verifications already verified by other staff

members. If an eligibility has already been searched, it is best to re-access the same

eligibility check. Every eligibility check conducted is considered a transaction.

18. Left click once on the down arrow of the Search option to display the shortcut menu


CLAIMREMEDI



169

19. Left click once on Eligibility, a list of eligibility search results will display

X. SIGNING OUT

20. Left click once on the down arrow next to the user name

to access the Sign Out, left click once and close

out the current window