Cases and Authorizations

Cases and Authorizations


CASES 

'Cases’ hold information to be used on multiple charges for a patient's episode of care.  Common uses include authorizations, workers comp, hospital charges, OB, DME, accidents, pre-cert, etc.  

 

To use, click 'CASE' from the Patient Dashboard, Charge entry page or Add/Edit Appointment screen. If you do not need Dx to be mandatory, ask your System Administrator to use the 'keys' to make this field 'not mandatory'. 

 

We recommend a good naming convention for the description, such as DOI, location or others that are recognizable to your team. 

 

 

  1. Type - For reporting purposes 
  2. Case Description - Displays in charge entry/scheduling 
  3. Active - If 'Active' the Case is available to use in charge entry and scheduling 
  • Default - All new charges, appointments will auto-select this Case (may be manually overridden) 
  1. Insurance Profile- best practice always choose an insurance  
  2. Case Number - User defined 
  3. Cause – 
  • Illness [L] - sends 431-onset date  
  • Injury [I] 454- sends INITIAL treatment 
  • Pregnancy [P] - sends LMP (2300 loop on ANSI) 
  1. Date of Current - Used by specialties, i.e. OB for LMP, DC/Therapy  
  • Enter onset date / date of initial treatment under Date of Current 
  1. Accident - For Employment (Workers Comp) , Auto Accident (MVA) or other 

Accident   

  • Click [Accident] for the popup to key in information (includes date, cause and state) 
  • Generally there is only ONE Cause - unless the employee drives for work and has had a car accident for instance

 

  1. Click 'Add Authorization' to expand the fields to key in authorization details 
  2. Click 'Other Fields' for:  
  • Admitted date 
  • Disability 
  • Consult 
  • CMN - Certificate of Medical Necessity - for DME 

 

 

 

Worker's Comp Cases 

  1. Use the Type Dropdown > Worker’s Comp -For reporting purposes only  
  2. Choose a naming convention including the DOI, side, location- Displays in charge entry/scheduling 
  3. Choose  
  • Active- allows use of this case - uncheck if this case is expired or no longer needed 
  • Default - Most likely to be used for a new appointment or charge 
  1. Choose an Insurance - this can be added later 
  2. Click [Accident] to add DOI, Cause, and State 
  3. For Authorization> Click Add Authorization or just Save 

 

 

 

a.  Manually add WC Claim ID * we populate Y4 when this field is filled out 

 

 

 

 

Skilled Nursing Facility Case 

Use the following workflow, when the claim needs to go to a Skilled Nursing Facility (SNF) instead of the patient's insurance, for the SNF to pay the practice directly.  

  • In the insurance library create an 'Insurance' indicating Skilled Nursing Facility   

 

  • On the patient create an Insurance profile with this 'insurance'  

 

 

  1. Add a Case, use custom 'type' to indicate Skilled Nursing 

 

  1. On the Appointment choose the Case for SNF  

 

  1. On the Charge choose the SNF case 

 

ADD a Case on the Appointment 

You may have a workflow that requires the Scheduler or Front Desk person ADD a case for pending Workers Comp Cases 

  • Use Case Dropdown > Add New  
  • Use Type Workers Comp and a naming convention such as pending > SAVE  

 

 

How to customize Case Type 

On the Add/Modify Case page 

  1. In the Case 'Type' dropdown > Choose 'Manage' 
  2. [ADD] 
  3. Add a code and Description > [SAVE] 

           A. Click the pen icon to 'Edit' 

 

  

Authorization  

How do I add an Authorization  

  • Click 'Add Authorization' on the Case 

 

  • Authorization number displays in HCFA Box 23  and 2300 electronic ANSI 
  • Add limiting factors and trigger Alerts for Scheduling and Charge Entry, by entering any of the following: Effective/Expiration Dates, # of Visits, Dollars, Days or Units, CPT Code(s) 
  • Authorizer is a free form field for name, contact for Authorization
  • Note: displays in the Authorization dropdown 

 

 

To a Charge 

To add an Authorization to the Charge 'on the fly': Use the 'Authorization' drop-down > 'Add Manually'.   

  • 'Add New' is ONLY for adding an authorization to an existing Case  

 

 

 

How do use a Visit countdown on an Authorization? 

  • Add a Case 
  • Add an Authorization to the case with the Visit field filled in > SAVE 

 

The Visit Counts will appear when the Case/Authorization are chosen when creating an Appointment 

 

The Visit Counts will appear when the Case/Authorization are chosen when entering a Charge