Managing and creating patient cases is essential to ensure that providers and billing specialists are informed about whether that patient has insurance coverage or is self-pay. It helps in determining the billing process, including verifying insurance details, processing claims, and accurately billing patients for services rendered. Additionally, it aids in tracking patient financial responsibility, such as copayment, deductibles, and outstanding balances, ensuring efficient revenue cycle management.
Create a new case
From patient dashboard
Navigate to the Patient Dashboard, and click Case.
Click, New Case.
Choose the Case Type from the dropdown menu. You can choose to either create a Healthcare Insurance or Self-Pay case.
To opt out of sending statements to the patient, simply click the checkbox next to Opt Out of Statements. This action indicates that you prefer not to send any statements from the provider to the patient.
Choosing the Insurance Only option indicates that the provider will exclusively receive payments from the insurance companies, with any remaining patient balance being automatically written off.
Add a Case Name and Description. RXNT recommends naming the case based on the type of case and related condition (e.g., regular health insurance, auto accident, self-pay, etc.) to help find the case easily when creating claims for the patient.
Enter details for the patient's condition, if applicable. These are used to indicate an auto accident case, an employment case (worker's compensation), or another type of accident.
When choosing Employment, you can select the option to Send Relationship as Employee on the claim form by checking the checkbox.
Enter referring provider information if it's applicable to this case only (for example, a lawyer who has referred a patient for an auto accident). If the referring provider relates to the patient in general or to more than one case, add them to the patient demographics (see how to update patient demographics).
Insurance tab
Click, Add Payer.
Choose the Subscriber from the dropdown menu. If the patient isn't the subscriber, navigate to the Patient Relations/Case Dates tab to input the subscriber information.
After adding the subscriber information, return to the Insurance tab and choose the subscriber from the dropdown menu.
Choose the Payer from the dropdown menu. The payer list will include only payers that have been added to your insurance companies under utilities.
Choose the Priority from the dropdown menu. The priority will automatically default to the next available, but this can be changed using the dropdown.
Enter the Policy Number and, if applicable, the Group Number.
Enter the From Date, which is usually the date the insurance coverage became active. If applicable, enter the To Date, which will be the date the insurance coverage is termed.
If applicable, enter the patient's Copay amount.
Some payers require additional information (e.g., Medicare secondary). Click the Folder icon to open additional payer details.
Add additional payer details and click Save.
Prior Authorization tab
If you have obtained prior authorization from a payer for a certain procedure, click Prior Authorization to add it to the case and monitor it in RXNT.
Click + Add Prior Auth.
Set the prior authorization by Units or Visits using the checkboxes.
Enter a Prior Auth Name (for example, "Chiropractor Visits" or "Chemo Units") and add the Prior Auth No.
Select the Payer for the prior authorization. This field can be left blank but may result in visits or units being "double-counted" if a prior authorization claim is sent to primary and secondary insurance.
Add the From Date and To Date. These are the dates that the prior authorization is valid for. The prior authorization will not be available to link to an encounter with a service date outside of this range. The From Date will default to the current date but can be adjusted if needed.
Add the number of units or visits that have received prior authorization in the Valid for Units or Valid for Visits section. The remaining units or visits will automatically populate and will count down as claims are sent with the prior authorization.
Patient Relations/Case Dates tab
To add a subscriber or guarantor to the case that is different from the patient or to add important case dates, click Patient Relation/Case Dates.
Click + to add a new guarantor or subscriber.
Clicking on Search Subscriber/Guarantor or Search Patient allows you to add the patient relation from an existing patient or relative in the system.
To add a new patient relation, fill in essential details for the individual such as Relationship, First Name, Last Name, Date of Birth, Address, Zip Code, City, State, Sex, and Phone Number. Once completed, click Save to add the relation.
Use the Subscriber and Guarantor checkboxes to update the case's subscriber(s) and guarantors. The subscriber is the policyholder for a particular insurance. The Guarantor is the individual who is responsible for the remaining encounter balances that weren't covered by insurance. A case can have multiple subscribers but can only have one guarantor. The guarantor is typically only different from the patient if the patient is a minor.
Case dates are typically required for cases related to accidents or worker's compensation, but they may also be necessary for some regular health insurance cases. To add a case date, click + after Case Dates.
Choose the Date Type from the dropdown.
Add the From Date and/or To Date for the case date.
From professional encounter
Patient cases can be created from an encounter in Billing. If no case or insurance has been added for the patient, the Case dropdown will be empty.
Click, the green + and follow the steps From Patient Dashboard.
Update an existing case
Navigate to the patient dashboard, select Case, then click on the Case Number to update the case information.
After updating the case information, click Save to apply the changes.
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