Your guide to
insurance in Nextvisit.

Step by step

1. Select the workspace and environment.

   Open Insurance → Setup. Choose Production for live work or Test environment for training. Confirm the environment before entering patient or account information.

2. Save the clearinghouse connection.

   Under Add connection, choose Claim.MD or Stedi and the matching environment. Enter the Claim.MD account key or Stedi API key. For Stedi, select Enabled Stedi features. A test connection also requires the synthetic-record confirmation. Enable Enable external transaction writes when you are ready to send requests, then select Save connection. The connection form labels the test environment Test account.

3. Refresh payer capabilities.

   Select Refresh payer directory on the saved connection. Resolve any connection error before continuing. Saving a key alone does not verify connectivity.

4. Add the rendering provider.

   Select Add provider. Choose the provider and connection, enter the NPI, tax ID, taxonomy, billing name and address, then select Save provider.

5. Complete payer enrollment by transaction.

   Under Start payer enrollment on a Claim.MD connection, select the provider, enter the Claim.MD payer ID and choose Eligibility, Claims or Electronic remittance. Select Start enrollment, open the returned enrollment link and complete the payer instructions. For Stedi, import history from the connection, then use Record verification.

6. Record the verified payer decision.

   Select Record verification on the payer record. Enter the status, payer reference, source and verification date, confirm the evidence, then select Save verification. Repeat for each required payer and transaction. Use Enrollment not required only with documented evidence.

1. Open the patient’s policies.

   From Eligibility → Check coverage, select the patient. Open Patient policies to add or correct coverage details, then return to the coverage check.

2. Record the policy and its order.

   Choose the correct payer and identifier. Enter the member ID, group information, effective dates and primary or secondary priority.

3. Check patient and subscriber identity.

   For a dependent, enter the subscriber’s name, birth date and relationship separately from the patient’s details. Confirm spelling and dates against the policy information.

4. Save and request fresh eligibility.

   Return to Check coverage, reload policies if needed and select the saved policy. A policy edit creates a new verification context; an earlier response remains historical evidence.

1. Choose the patient and policy.

   Open Eligibility, select Check coverage and choose the patient’s policy. If policies fail to load, use Reload policies or Retry before continuing.

2. Set the visit context.

   Choose the clearinghouse connection, rendering provider, service location and service date. Enter the Service type code and an optional Procedure code. The form identifies MH as mental health and 30 as health plan coverage.

3. Send and wait for the recorded result.

   Submit the coverage check. The request is queued and progresses separately from coverage. A repeated request with the same current context reuses its existing result or pending request.

4. Review the service-specific evidence.

   Open the result and review coverage, payer messages, reference, dates and every relevant benefit row. Match the service, network, individual or family level, and benefit period. Record a follow-up when required information is missing.

1. Add the visit to preparation.

   Open Overview → Add visit. Choose the patient, policy, connection, rendering provider, visit date and time, service type, optional procedure and service location.

2. Choose automatic checking if appropriate.

   Select Run scheduled eligibility checks before this visit to opt in. Save with Add visit to preparation.

3. Work the preparation queue.

   Filter by date or provider. Select the visits you want to verify and choose Check coverage on Visits to prepare. Each visit uses its saved policy, provider and service context.

4. Resolve changes before the visit.

   Review incomplete or changed coverage, authorization requirements and patient estimates. Use Cancel visit for a cancelled preparation item; reserved authorization usage is released.

1. Prepare the encounter.

   Review and sign the encounter before submitting an insurance claim. Confirm the patient, clinical documentation, diagnoses and services performed.

2. Create the draft.

   Open Claims → Create draft. Select the patient and Encounter, then choose the insurance policy, rendering provider and service location. You can also start from the encounter’s insurance claim action.

3. Complete the billing details.

   Enter the service date, place of service, patient billing address and assignment, release and accident responses. Add diagnoses and service lines with procedure codes, modifiers, units and charge per unit. Match each diagnosis pointer to the numbered diagnosis it references.

4. Review supporting material.

   Add authorization numbers where required. If a payer needs an attachment, review the PDF and disclosure authorization before uploading it under Supporting documents.

5. Save, then open the final review.

   Save the draft. An authorized submitter selects Review submission, resolves the field errors and verifies the displayed provider, policy, lines, diagnoses, total and environment.

6. Submit the reviewed version and follow its events.

   Confirm the review and submit. Check Submission attempts and Payer events. Refresh status reloads stored information; the administrator can request clearinghouse polling from Remittances.

1. Retrieve and open the remittance.

   Open Remittances. An authorized reconciler chooses the connection and selects Poll for responses. Open the remittance to review its payer and payment reference.

2. Review exceptions and claim matches.

   Compare the patient, claim and service-line evidence. Where matching is incomplete, use Match claim and lines, select the correct claim and line mapping, confirm review and select Save match.

3. Reconcile money and adjustments.

   Review payer payment, patient responsibility, adjustment groups and codes, and any provider-level adjustments. Resolve unmatched or unbalanced advice before posting.

4. Verify the bank payment and post.

   In Posting preview, enter the Verified bank payment reference, confirm payment verification and review, then post. The remittance and ledger retain the posted result.

Record or reverse a manual transaction

1. Open the claim and choose Record transaction.

   Select the transaction type and responsible party. Enter the amount, transaction date, reference and description. Identify an advance copay or an intentional overpayment when applicable.

2. Review the recorded balances.

   Open Ledger for the posted entry. Payer balance, patient balance and money received represent different amounts.

3. Reverse an incorrect manual entry.

   An administrator selects Reverse entry in Ledger and records a reason. The reversal retains the original transaction. For an ERA posting, use Reverse remittance on that remittance.

Track an authorization

1. Record the payer requirement or decision.

   Open Authorizations → Record authorization. The page heading is Authorizations & estimates. Select connection, policy, provider and service. Enter the payer decision, effective dates, unit type and units authorized.

2. Retain the source and next action.

   Record the authorization number when approved, payer reference and decision evidence. Set the next action and decision due date for work still in progress. Update the record with Update decision as the payer responds.

3. Reserve and release visit usage.

   Select Manage usage, choose the visit, operation and units, then Save usage. Reservations must fit the approved provider, policy, service, dates and remaining units. Release unused reservations when plans change.

4. Consume units for completed visits.

   Consumption requires a completed visit with reserved units. If the visit is not recorded as completed, ask the workspace administrator to confirm its status before consuming units.

Create an estimate

1. Select the visit and payer evidence.

   In Authorizations (page heading Authorizations & estimates), choose the visit and a current payer response. Select the benefit rows that apply to that visit.

2. Document the calculation inputs.

   Enter the Allowed amount and its source, the network and Provider network evidence. Choose the cost-sharing calculation and record assumptions for the reviewer.

3. Calculate and resolve missing information.

   Select Calculate estimate. If the result needs review, resolve the missing or conflicting inputs. Keep returned zero values; do not replace unknown benefits with assumed amounts.

4. Approve and record completed delivery.

   An authorized reviewer selects Approve estimate. After staff deliver the approved estimate, select Record delivery and enter the channel and recipient or delivery reference. This records delivery already performed; it does not send an email or text.

• Provider and account setupHelp-center article · Internet required
• Coverage and pre-visit preparationHelp-center article · Internet required
• Claims and paymentsHelp-center article · Internet required
• Authorizations and estimatesHelp-center article · Internet required
• Encounter billing codesCode library, encounter codes and coding suggestions
• Nextvisit help centerOpen chat for help with your workspace