A Case is a mapping between a patient’s insurance and an encounter. A case is established on every patient and is necessary for every visit. A case identifies who the payer is for the patient’s visit.
Each patient can have multiple cases depending on the class, coverage type or contract.
A case is automatically created when primary insurance is added to the patient’s profile. However, there are occasions where a case needs to be manually created.
The following are the steps for creating a case manually. Before adding a case, Patient Information and Insurance information must be completed.
Adding A Case
The following are the steps for creating a case manually.
1. Select Patient from the main menu and search for the patient in the Patient Search screen to open the Demographics page (see Image 1).
2. Click the button to open the Case window, as shown in Image 2.
3. Click on button. On clicking the button, the new case information can be entered in Main tab. The fields marked with * are mandatory. These are Name, Start Date, Type, Primary, and Fee Schedule. The Name, Type, Status, Start Date, etc. are automatically filled in except when the patient has multiple Primary/Secondary/Tertiary insurances. The system generates a name for the case; you can change it or opt to keep the system-generated name.
4. For creating cash cases, select Type as ‘Cash’. The Fee schedule will then be defaulted to the latest active self pay fee schedule.
5. If you wish to add additional information related to the case like Associations, Condition, Accident, Diagnosis, etc., click on the Others tab.
Under the Others tab, enter the following information:
6. Click the Save button to save the case; the case is displayed, as shown in Image 3.
Search and Edit A Case
1. All the cases of the patient are listed in the top portion of the case screen. This is the place where you search for cases related to the patient. Select the case you wish to edit from the list.
2. The details of the case like Case Name, Case Type, Case Status, Fee Schedule, Start Date, etc. would be displayed below. Primary, secondary and tertiary insurances of the case are listed in the Insurance section. The listed insurances would be the payers in the selected case. After performing the required edits, click the Save button to update the changes to the case.
1. Once a claim has been generated for an encounter under a particular case, insurance details of the case cannot be edited.
2. You can also view the Case details from the Charge Master screen, as shown in Image 5.
Close A Case
1. From the list of existing cases displayed in the top portion of the case screen, select the case you wish to Close.
2. Enter the Close Date to close the case in the close date field.
3. Click the Save button to update the changes and the case will be closed after the given Close Date.