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.
Self pay case
Choose Self Pay from the Case Type dropdown menu.
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.
You can attach a self-pay fee schedule by choosing it from the Fee Schedule dropdown menu. Once linked, this fee schedule will automatically populate for each encounter created.
You may also enter a rate in the Self Pay Rate field. This rate is visible only within the patient case and does not appear in the encounter.
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 must also choose Employee as the Patient Relationship in the Patient Relation / Case Dates tab.
Navigate to the Patient Relation / Case Dates tab and click the Green Plus (+) sign.
Choose Employee from the Relationship drop-down menu. Then, fill in the required details, including First Name, Last Name, Date of Birth, Address, Sex, Employee, Preferred Phone type, and Phone number.
Click Save.
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.
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).
Health insurance case
Select Health Insurance from the Case Type dropdown menu.
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.
When Health Insurance is selected as the Case Type, selecting the Insurance Only option indicates that the provider will be paid exclusively by the insurance companies, and any remaining patient balance will be automatically written off but can be edited if needed.
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 entering the subscriber information, select the Subscriber checkbox.
Then, go back 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 case payer details.
Select the appropriate Medicare Secondary option from the dropdown menu, then click Save.
If Medicare is selected as the secondary payer and no Medicare Secondary has been chosen, a warning pop-up will appear when saving the case with the following message: Medicare Secondary is missing. Some secondary Medicare payers require a Medicare secondary. Please verify requirements and add before submitting.
You will have two options: Save Anyway or Cancel.
- Selecting Save Anyway will save the case without a Medicare Secondary.
- Selecting Cancel will close the warning pop-up without saving.
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.
If the prior authorization is based on units, enter the approved quantity in the Valid for Units field. If it is based on visits, enter the approved number in the Valid for Visits field.
The Remaining Units or Visits will automatically populate and decrease as claims are submitted using the 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 the green (+) icon to add a new patient relationship for a 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.
The Relationship dropdown menu includes four options:
- Spouse - Select this if the spouse is the subscriber or guarantor.
- Child - Select this if a parent is the subscriber or guarantor.
- Other - Choose this if the subscriber or guarantor is not the Spouse, Parent, or Employee.
- Employee - Select this if the Employer is the guarantor and the services are related to workers compensation.
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 you've entered and selected the appropriate information, click Save to add the Relationship Profile.
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. Click the green (+) to add a case date type.
Select the Date Type from the dropdown menu, then enter the From Date and/or To Date for the date type.
Click Save to save your case details.
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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