01. Go to LISTS then PATIENTS/GUARANTORS AND CASES.
02. In the left side of the window, select a patient, and then click in the right side of the window. The buttons at the bottom of the window will change to reflect that you are now in the Case section.
03. If you want to edit an existing record, highlight it then click EDIT. Otherwise click NEW to create a new entry.
04. The Case will open to the Personal tab by default. Note; you can hide or show tabs in the Case by right-clicking anywhere in the tabs area, and checking (show) or unchecking (hide) the tabs.
05. Starting at the top of the PERSONAL tab, the Case Number field will be automatically assigned by the program and will be a unique number. First enter a DESCRIPTION for the case. What you enter here may depend on your reason for creating different cases. Some examples are: Headaches, or Medicare, or November, or Dr. Jones, etc.
06. If this patient does not have insurance and is going to pay cash then place a check-mark in the “CASH CASE” box. Please note, “CASH CASE” patients should not have an insurance entered on the Policy 1, 2, or 3 tabs. Also note, if the “CASH CASE” box checked and that “PRINT PATIENT STATEMENT” box is not checked the patient/guarantor will not receive a statement. If the “PRINT PATIENT STATEMENT” box is checked the program will allow you to print statements to the patient or guarantor.
07. If you enter a procedure for this case that has Global Surgical Procedure as the procedure type, the GLOBAL COVERAGE UNIT field will default a date according to the Global Period entered in the procedure code’s record.
08. The GUARANTOR field will default to the patient’s Chart Number, which is fine if they’re self-insured, but should be populated by the Guarantor’s Chart Number if not.
09. If known, select a MARITAL STATUS and STUDENT STATUS which correspond to Box 8 on the CMS-1500 form.
10. You can enter information in the “Employment” section if known, but this is typically only needed on Workers Comp type claims.
11. Next click on the ACCOUNT tab.
12. In the top section of this tab you can specify Provider(s), Referral Source, Attorney, and Facility for the case. The ASSIGNED PROVIDER is the provider in your office whom performed the health services or procedures on the patient.
13. In the next section you can specify a CASE BILLING CODE which is a user-defined field for whatever purposes you may need. The code is limited to 1 to 2 characters (A-Z, 0-9). For example, you could differentiate between Workers Comp (WC), and standard Claims (SC), or split billing responsibility between two billers (B1, B2…), etc.
14. The PRICE CODE field determines which charge amount specified in the Procedure Code gets used.
15. The OTHER ARRANGEMENTS field is another user-defined field for whatever purposes you may need. This field allows for a 4 character code (A-Z, 0-9).
16. In the last section of this tab you can specify an AUTHORIZATION NUMBER (assigned by the insurance), the LAST VISIT DATE which is auto-populated by the last visit entered in Transaction Entry (but you can make changes if needed), the AUTHORIZED NUMBER OF VISITS, and ID, and the LAST VISIT NUMBER.
17. Next click on the DIAGNOSIS tab.
18. In the top section of this tab you can specify a PRINCIPAL DIAGNOSIS and DEFAULT DIAGNOSIS 2, 3, and 4. It is not required to enter diagnoses here, but if you do they will automatically populate when entering charge procedures in Transaction Entry (which will be discussed in a later manual). The POA column can be checked to signify the diagnosis was “Present on Admission”.
19. The EDI REPORT section is for attachments for claims. See the help article “Case – Diagnosis” for more information on what code values to enter.
20. Next click on the POLICY 1 tab.
21. This tab is where the patient’s primary insurance and other information is entered. If the patient pays cash and does not have insurance, do not enter anything here. Otherwise enter the INSURANCE 1 code, or select it via the drop-down arrow, or lookup (Magnifying Glass). Next select the POLICY HOLDER 1, either the patient or the guarantor. If not “Self” select the RELATIONSHIP TO INSURED. Enter the POLICY NUMBER, and if applicable the GROUP NUMBER and GROUP NAME. The Policy Dates are optional, but could be entered if known. The CLAIM NUMBER field is for electronic claims sent in the ANSI format. It is used on property/casualty/auto claims. This number is assigned by the property and casualty payer.
22. In the next section place a check-mark in the ASSIGNMENT OF BENEFITS/ACCEPT ASSIGNMENT field if the practice is to receive payment from the insurance payer. Otherwise payment will go to the patient / guarantor.
23. Click the CAPITATED PLAN check box if the patient’s plan is capitated; leave it blank if not. If this field is checked, enter 100 in the Insurance Coverage Percents by Service Classification A field. On the secondary insurance tab, this option becomes Crossover Claim.
24. The DEDUCTIBLE MET field is used to indicate whether the patient has met his or her annual deductible. You can enter the ANNUAL DEDUCTIBLE and COPAYMENT AMOUNT in those fields.
25. In the TREATMENT AUTHORIZATION field you can enter the treatment authorization code from the insurance company. This is typically only used with UB-04 claims.
26. If applicable enter the DOCUMENT CONTROL NUMBER (original control number) if processing a replacement claim or voided claim.
27. See the “Insurance Coverage Percents by Service Classification” article in the help files for more information on the last section of this tab.
28. If the patient has a secondary insurance click on the POLICY 2 tab to enter that information. Also, if the patient has a tertiary insurance, click on the POLICY 3 tab to enter that information. Both of those tabs are filled out similarly to the POLICY 1 tab.
29. Next click on the CONDITION tab.
30. The first section of this tab relates to Boxes 10 (Employment Related), 14 (Injury, Illness, LMP), 15 (Similar Symptoms), and 24c (Emergency).
31. The next section relates to Boxes 10 (Auto Accident), 16 (Unable to Work), 18 (Hospitalization), and other information for Workers Comp Claims, etc. The bottom of this section is for Condition Codes used with UB-04 claims.
32. Next click on the MISCELLANEOUS tab.
33. Starting with the top section, if OUTSIDE LAB WORK was done place a check mark in that field, and note the LAB CHARGES amount.
32. The LOCAL USE A field is typically used to populate Box 10d, while the LOCAL USE B field is used to populate Box 19.
33. The case INDICATOR code is an up to five-character user-defined alphanumeric code that can be used to divide the practice into groups for sorting diagnoses, etc. The Case Indicator field in the Create Claims window is one of the possible filters to identify claims. This field is used strictly as a practice management tool.
34. REFERRAL DATE and PRESCRIPTION DATE can be entered if known.
35. If a PRIOR AUTH NUMBER was obtained it can be entered here to populate Box 23 on the claim form.
36. The EXTRA 1, 2, 3, and 4 fields provided in this window are user-defined fields which can be used for special entries required by insurance carriers.
37. If the Primary Care Provider is not a physician who practices in your office he or she can be specified in the OUTSIDE PRIMARY CARE PROVIDER field, and the DATE LAST SEEN by that provider can be entered here.
38. Next click on the MEDICAID AND TRICARE tab.
39. This tab is split into 2 sections, the top for Medicaid, and the bottom for Tricare/Champus.
40. Next click on the MULTIMEDIA tab.
41. Images can be attached to the patient’s case here. Any already attached images will be listed on the left side of the tab, and a preview of the selected image will be seen on the right side. To attach a new image click the NEW button, the following window will appear (this will also appear if you EDIT an existing entry).
42. First enter a DESCRIPTION for the image, and a NOTE if needed. The attached image can appear in the Patient record if you place a check-mark in the SHOW ON PATIENT SCREEN box.
43. Next click the LOAD FROM FILE button, and find the file to be attached.
44. Click SAVE when finished. As seen in the image on the previous page, once an image has been attached, you can also PRINT IMAGE, or SAVE TO FILE.
45. Next click on the COMMENT tab.
46. Starting at the top left, you can enter any ALLERGIES AND NOTES, but be aware this field is only for in-office use, and is not sent electronically. It can however appear in Transaction Entry and Office Hours.
47. The EDI NOTES section may or may not be used by your electronic claims solution. Please check with support before attempting to use the NOTE REFERENCE CODE or TEXT.
48. The fields in the CONTRACT INFORMATION section may be used when the health plan contract arrangement with the provider is other than fee-for-service.
49. The COMMENT field may print on statements if you format the statement to include case comments, otherwise it can be used as a generic notes field.
50. Next click on the EDI tab.
51. If applicable, enter a CARE PLAN OVERSIGHT #, HOSPICE NUMBER, or MAMMORGRAPHY CERTIFICATION. If lab work was done you can enter the CLIA NUMBER of the lab here. Medicaid may require a REFERRAL ACCESS #. If you files claims for this patient under demonstration projects, you can enter a number in the DEMO CODE field so they can be tracked properly. The IDE NUMBER is required when there is an investigational device exemption on the claim, this is usually for vision claims but can also be assigned for other types of claims. See the help files article “CASE – EDI TAB” for more information on the ASSIGNMENT INDICATOR and TIMELY FILING INDICATOR fields use. Lastly if the patient is under HOMEBOUND care, that box can be checked.
52. The next section is for VISION CLAIMS, and can be used if applicable.
53. The last section is for HOME HEALTH CLAIMS.
54. When finished click SAVE.