In addition to that, the Case Management feature can be used as a tracking feature for other cases or scenarios for tracking or comparing certain Patient disits done versus approved or amount billed versus approved by associating a Case Number to those visits.
The following two scenarios are supported for Case Management:
Unil now, to keep data separate for each Case, specially Workers Comp cases, the same Patient was defined multiple times, one for each injury case. Now, with the Case concept, there is no need to add the same Patient again and again just to keep injury-wise documents separate.
- One-to-Many (One Patient-Multiple Cases-Case Wise Visits-Default): With the ability to assign a case to a visit, users will be able to easily filter the documents per case. This can be achieved by Scenario 1: One-To-Many.
- One-to-One (One Patient-One Case-New Patient Per Case): If Clinics want to continue to define one Patient per Injury Case, they will be able to achieve this by Scenario 2: One-to-One.
- If the property patient.allow.one.case is set to Y, only one Case will be allowed for one registered Patient. For every new case, a new Patient record will have to be added. By default, this property is set to N, allowing multiple cases for the same Patient.
- If the property patient.use.case.management.search is set to Y, then 3 additional fields are shown in Patient Searches: Case No, Date of Injury, Body Part. This is used only for One-To-One setting i.e where one case for one Patient is allowed and same Patient has to be defined multiple times. All major Patient Search screens like Patient Registration, Appointment, Refill Request, Claims, Remittances, Compose Message, etc. will show these additional 3 columns when the above property is set to Y.
Note:
The copy button on Patient Registration screen is helpful when One-to-One scenario is enabled.
The copy button when clicked, allows copying all the Registration and Encounter details for a Patient to a new Patient.
So for every new injury, when the same Patient has to be defined again, this copy button is handy.
Case Details
Case No: Enter a unique Case Number for the Patient. This is a mandatory field which supports alphanumeric characters and has a character limit of 20. Special characters are not supported in this field. On entering a Case Number and clicking the SAVE button, a new database entry is created with the entered Case Number and associated Case details.Note:
In case of One to Many i.e. One patient – Multiple Cases or injuries, after the first Case Management record is saved, the Case Management popup additionally displays the Add new icon and Select Case dropdown menu.
Add New icon: Click on the icon to add a new case for another injured body part. This field is enabled in case of One to Many i.e. One patient – Multiple Cases or injuries.
UDF Button: The UDF button is displayed on Case Management popup only when value 11- Patient Case Management is set in the property udf.supported.types. The label for the UDF button can be configured in the property udf.type.label.
Note:
When a new case is added and saved, the UDF button on Case Management popup is shown as enabled.
Clicking the UDF button invokes a popup with the title Case No: XXXX.
Once data is added in this popup and OK button is clicked, a tick mark is shown on the UDF button.
If auser adds a Case with a space in the Case Number then a validation message gets displayed as: ‘Case No should not contain spaces or special characters’.
A tick mark will be shown on the UDF button even after the user adds data and then tries to remove it.
Case Provider: The Case Provider field is based on property case.provider.mandatory. If this property is turned ON then Case Provider field is a mandatory field. This field is provided with a search icon and a Clear hyperlink. On clicking the search icon, the Providers popup is displayed. The Providers displayed in this popup are of DR type. On clicking the Clear hyperlink, the selected Provider gets reset. If this property is turned ON and the Case Number is present but the Case Provider is not selected, then a message Please select Case Provider is displayed on the Case Management popup. Upon using the Case Provider for any Encounter, if user changes the Case Provider, then the new Provider is reflected on Encounter screen.
Select Case: Select the appropriate case number associated to the Patient from the drop-down list. The Case Numbers are listed in format of <Case No.> – <Body Part> for e.g. 39729 - Hand. This field is enabled in case of One to Many i.e. One patient – Multiple Cases or injuries.
Date of injury: Enter the date of injury for the selected case or select a date from the calendar icon. User may enter date in standard format MM-DD-YYYY. Data from this field gets transferred to Claim if PrognoCIS Billing is turned ON. If data is present in Encounter as well, priority will be given based on property billing.case.fields.preffered.onclaim.
Body Areas: Enter the name of the body part injured during the accident.The character limit of this field is 250 characters. A Zoom
icon is present beside the Body Areas field. On clicking on this icon, the Body Areas popup along with the Cancel and Ok buttons is invoked. The User can enter the name of the body part injured during an accident. On entering the required data, the User can click on the Ok button on the Body Areas popup, the added data is displayed on the Body Areas field. The User can also click on the up and down arrows on this field to view
the added data.
Unable to Work From: Enter the date from when Patient is unable to perform job duties on work for a period of time due to an injury or select a date from the calendar icon. User may enter date in standard format MM-DD-YYYY. Data from this field gets transferred to Claim if PrognoCIS Billing is turned ON. If data is present in Encounter as well, priority will be given based on property billing.case.fields.preffered.onclaim.
Unable to Work Upto: Enter the date until which the Patient is unable to perform job duties at work for a period of time due to an injury or select a date from the calendar icon. User may enter date in standard format MM-DD-YYYY. Data from this field gets transferred to Claim if PrognoCIS Billing is turned ON. If data is present in Encounter as well, priority will be given based on property billing.case.fields.preffered.onclaim.
By clicking on the Log
icon invokes the Unable to Work Log popup that displays the details of the date modified by the User.
Hospitalization From: Enter the date since when the Patient is hospitalized for an injury or select a date from the calendar icon. User may enter date in standard format MM-DD-YYYY. Data from this field gets transferred to Claim if PrognoCIS Billing is turned ON. If data is present in Encounter as well, priority will be given based on property billing.case.fields.preffered.onclaim
Hospitalization Upto: Enter the date upto which the Patient is hospitalized for an injury or select a date from the calendar icon. User may enter date in standard format MM-DD-YYYY. Data from this field gets transferred to Claim if PrognoCIS Billing is turned ON. If data is present in Encounter as well, priority will be given based on property billing.case.fields.preffered.onclaim.
By clicking on the Log
icon invokes the
Hospitalization Log popup that displays the details of the date modified by the User.
Restricted Duty From: Enter the date since when the Patient will commence working under restricted duty or select a date from the calendar icon. User may enter date in standard format MM-DD-YYYY.
Restricted Duty Upto: Enter the date upto which the Patient will commence working under restricted duty or select a date from the calendar icon. User may enter date in standard format MM-DD-YYYY.
By clicking on the Log
icon invokes the Restricted Duty Log popup that displays the details of the date modified by the User.
On updating the date in the From and Upto fields, a Reason pop-up is triggered for each field: Unable to Work, Hospitalization, and Restricted Duty.
Place of Accident: Enter the name of the place where the accident occurred.
State of Accident: Select the name of the state where the accident occurred from the dropdown menu list. Data from this field gets transferred to Claim if PrognoCIS Billing is turned ON. If data is present in Encounter as well, priority will be given based on property billing.case.fields.preffered.onclaim.
First Date of Similar Illness: Enter the first date of similar illness caused to a Patient or select it from the calendar icon. User may enter date in standard format MM-DD-YYYY. Data from this field gets transferred to Claim if PrognoCIS Billing is turned ON. If data is present in Encounter as well, priority will be given based on property billing.case.fields.preffered.onclaim.
Initial Treatment Date: Enter the date on which initial treatment was given to the patient or select it from the calendar icon. User may enter date in standard format MM-DD-YYYY. Data from this field gets transferred to Claim if PrognoCIS Billing is turned ON. If data is present in Encounter as well, priority will be given based on the property billing.case.fields.preffered.onclaim.
P/S Status: Select the nature of the disability caused to patient due to the injury from the dropdown list. The options are: Permanent and Short Time Disability.
Case Description: Enter the exact location of the accident which can be entered along with how the accident occurred, sequence of events, etc. for the selected case. A Zoom icon
is present beside the Case Description field. On clicking on this icon, the Case Description popup along with the Cancel and Ok buttons is invoked. The User can also click on the up and down arrows added on the field to view data. The tooltip on this field for the User to view the details added in this field.External ID: This is a data entry field. User can enter the external id on the Case Management popup.
Insurance/Employer/Patient
Pri Insurance: Select the name of the Insurance company from the dropdown list. The list displays all the active Insurances from the Patient Insurance which can further be associated with a case on the Case Management screen. The Insurances in this dropdown list are arranged in 'Insurance [Effective From - Upto] Insurance Policy (Classified As)' format.Insurance icon
:
Click on this icon to invoke the Insurance popup and add a Patient’s Insurance.
Users can edit the Patient’s Insurance details by selecting the Insurance from the Pri Insurance dropdown and clicking this Insurance icon .
Pri Subscriber ID: This field gets auto populated with the Subscriber ID of the Primary Insurance selected from the Pri Insurance dropdown on the Case Management screen. This is a display-only which remains grayed out.
Pri Pre Authorization hyperlink: Click this hyperlink to invoke the Insurance PreAuthorizations popup which displays the preauthorization information for selected Patient Insurance. This hyperlink is not displayed if Insurance is not selected from the Pri Insurance dropdown.
Pri Classified As: On selecting a Primary Insurance from the Pri Insurance dropdown, this field gets auto populated with the option selected in the Classified As dropdown for that Insurance on the Patient Insurance screen. The options to be displayed in this field are Healthcare, DMERC, MotorAcc, PersonalAcc, WorkerComp or Attorney. This is a display-only field which remains greyed out.
Pri Insurance Attorney: On selecting a Primary Insurance from the Pri Insurance dropdown, this field along with the Search
and Add Insurance Attorney 
icons are enabled.
This field is auto populated if an Attorney is already entered for the selected Insurance on the Patient Insurance screen.
If not, then enter the name of an Attorney associated with the selected Insurance or click on the Search icon to select an Insurance Attorney from the Insurance Attorney List popup.
Click on the Add Insurance Attorney icon to add a new Insurance Attorney
(The entry is added in: Settings → Configuration → Attorney).Click on the Edit hyperlink, the popup invoked has the same fields as for the popup invoked on clicking the Add Insurance Attorney icon. The Edit hyperlink remains disabled when the field(s) is blank. This hyperlink is enabled only when data is added in the respective fields
Click on the Clear hyperlink to reset the data entered in the field.
Pri Insurance Adjuster: On selecting an Insurance from the Pri Insurance dropdown, this field along with the Search
and Add Insurance Adjuster icons are enabled.
This field is auto populated if an Adjuster is already entered for the selected Insurance on the Patient Insurance screen.
If not, then enter the name of the Adjuster associated with the selected Insurance or click on the Search icon to select an Insurance Adjuster.
Click on the Add Insurance Adjuster icon to add a new Insurance Adjuster.Click on the Edit hyperlink, the popup invoked has the same fields as for the popup invoked on clicking the Add Insurance Adjuster icon. The Edit hyperlink remains disabled when the field(s) is blank. This hyperlink is enabled only when data is added in the respective fields.
Click on the Clear hyperlink to reset the data entered in the field.
Sec Insurance: Select the name of the Secondary Insurance company from the dropdown list. The list displays all the active Insurances from Patient Insurance which can further be associated with a case on the Case Management screen. The Insurances in this dropdown list are arranged in 'Insurance [Effective From - Upto] Insurance Policy (Classified As)' format.
Sec Subscriber ID: This field gets auto populated with the Subscriber ID of the Secondary Insurance selected from the Sec Insurance dropdown on the Case Management screen. This is a display-only which remains grayed out.
Patient Attorney: If a Patient Attorney is selected in the Billing Info. tab of the Patient Registration screen, then the same entry is auto populated in this Patient Attorney. If not, then enter the name of the Attorney associated with the selected Patient or click on the Search
icon to select a Patient Attorney.
Click on the Add Patient Attorney icon to add a new Patient Attorney.
(This entry is added in: Settings → Configuration → Attorney). Click on the Edit hyperlink, the popup invoked has the same fields as for the popup invoked on clicking the Add Patient Attorney icon. The Edit hyperlink remains disabled when the field(s) is blank. This hyperlink is enabled only when data is added in the respective fields.
Click on the Clear hyperlink to reset the data entered in the field.
If the property case.attorney.display.name is set to 1- Firm Name, then only the firm name of the Patient Attorney is displayed in the Patient Attorney field. If the property value is set to 2- Firm Name with Contact Name, then the firm name as well as the contact name of the Patient Attorney is displayed in the Patient Attorney field.
Patient Adjuster: Enter the name of the Adjuster associated with the selected Patient or click on the Search
icon to select it from the Patient Adjuster List popup.
Click on the icon to add a new Patient Adjuster.
Click on the Clear hyperlink to reset the data entered in the field. Click on the Edit hyperlink, the popup invoked has the same fields as for the popup invoked on clicking the Add Patient Adjuster icon. The Edit hyperlink remains disabled when the field(s) is blank. This hyperlink is enabled only when data is added in the respective fields.
If the admin-level property, case.hide.patientadjuster is set to On, then the Patient Adjuster field along with the adjacent Search icon
, Add Patient Adjuster icon and Clear hyperlink are hidden.
By default, this property is set to Off.
Case Manager: Enter the name of the Case Manager associated with the case or click on the Search
icon to select it from the Case Manager List popup.
To add a new Case Manager, click on the Add Case Manager icon.
The label for this field can be changed from the property case.manager.labels.
The Case Manager List popup invoked on clicking Search icon displays data which is relevant to the Case Manager label set in the property, i.e. it displays only those records for which the Category is set as Case Manager.
Click on the Edit hyperlink, the popup invoked has the same fields as for the popup invoked on clicking the Add Case Manager icon. The Edit hyperlink remains disabled when the field(s) is blank. This hyperlink is enabled only when data is added in the respective fields.Click on the Clear hyperlink to reset the data entered in the field.
Other Case Contact 1: Enter the name of a second Case Manager or click on the Search
icon to select one from the Case Manager List popup.
The label for this field can be changed from the property case.manager.labels.
To add a new other Case Manager, click on the Add Case Manager icon.
The Case Manager List popup invoked on clicking Search icon displays data which is relevant to the Other Case Contact 1 label set in the property,
i.e. it displays only those records for which the Category is set as Other Case Contact 1.
Click on the Edit hyperlink, the popup invoked has the same fields as for the popup invoked on clicking the Add Case Manager icon. The Edit hyperlink remains disabled when the field(s) is blank. This hyperlink is enabled only when data is added in the respective fields.Click on the Clear hyperlink to reset the data entered in the field.
Other Case Contact 2: Enter the name of a third Case Manager or click on the Search
icon to select one from the Case Manager List popup.
The label for this field can be changed from the property case.manager.labels.
To add a new other Case Manager, click on the Add Case Manager icon.
The Case Manager List popup invoked on clicking Search icon displays data which is relevant to the Other Case Contact 2 label set in the property,
i.e. it displays only those records for which the Category is set as Other Case Contact 2.
Click on the Edit hyperlink, the popup invoked has the same fields as for the popup invoked on clicking the Add Case Manager icon. The Edit hyperlink remains disabled when the field(s) is blank. This hyperlink is enabled only when data is added in the respective fields. Click on the Clear hyperlink to reset the data entered in the field.
Employer: This field displays the name of the Employer associated with the injured Patient. The Employer can be changed by clicking on the Search
icon and selecting an Employer from the Employer search popup.
This field is provided with a Clear hyperlink, clicking on which the selected Employer gets reset.
On adding Insurance to Case, the Employer associated to insurance is displayed in Employer field.
If Employer is changed on Case Management screen, then on Save it gets reset to the Employer associated to Patient Insurance.
Changing the Employer in this field does not affect the already saved Employer Details in the Contact tab of the Patient Registration screen.
If an Employer is not associated with the Patient, then the Search icon next to this field remains disabled.
Employer Job: This field displays the job of the Employer. Click on the Search
icon to select the Employer's job.
Click on the Add Employer Job icon to add a new job.
Click on the Edit hyperlink to edit the selected Employer job's data.
If the Employer Job is not entered in the field, on clicking the Edit hyperlink, a message, Select Employer Job Number is displayed.
Click on the Clear hyperlink to remove the selected Employer Job from the field.
Note:
- Only one Employer Job can be associated with a case.
- Once an Employer Job is associated with the Case, it cannot be deleted.
Other Details
WCAB#: Enter the WCAB (Workers’ Compensation Appeals Board) number.QME Panel #: Enter the QME(Qualified Medical Evaluator) panel number. A panel QME helps to resolve medical disputes in Patient's Workers' Compensation cases.
Lien on File: Select this checkbox to get a report in the future with a list of all Patients with Lien on File, Lien Notes, Patient Attorney Name, Patient Chart Number, Date of Birth (DOB), etc.
Lien Notes: Click the Notes button to add the lien related notes.
Amount Approved $: Enter the maximum amount approved by the Insurance for payment of the selected case across multiple visits.
Billed Amount $: This field displays the billed amount of the claim for the selected case with Status E, H, S, B.
Visit Approved: Enter the number of maximum visits approved or Encounters allowed for the selected case.
Visits Used: This field displays the number of visits used up by Patient.
MPN ID: This field displays the Medical Provider Number applicable for the state of California. This field, along with the Search
icon, is displayed only when the property patient.case.show.mpn is turned On.
Clicking on the Search icon, the MPN search popup is invoked which displays all MPN information imported.
The columns displayed on the MPNsearch popup is ID, Name, Address, Type, and Status.
Click on the Clear hyperlink to clear the selected MPN from the field.
Action Buttons
SAVE button: Click the button to save the case details in PrognoCIS.CLOSE button: Click the button to close the Case Management popup.
RESET button: Click the button to reset the recently entered changes in the record before it was saved.
DELETE button: Click the button to delete the case details from PrognoCIS. On clicking this button, a prompt confirming the delete action is displayed.
HISTORY button: Clicking the button to invoke the Patient Case Management History popup. When a new case is added, the Patient’s Case details are captured in this popup. This popup has 3 columns: Modified By, Date and Modified Notes.
LEDGER button: Click on this button to display all Billing transactions for selected Case in the sequence in which they occurred. This button is enabled only if the following two conditions are satisfied:
- PrognoCIS Billing module is turned On.
- Patient has atleast one Billed claim with the selected Case Number associated.
- PrognoCIS Billing module is turned On.
- Patient has atleast one Billed claim with the selected Case Number associated.
PRINT button: Click on this button to invoke the Case Info popup displaying details saved on the Case Management popup. Click on the PRINT button on the Case Info popup and select the appropriate settings from the Print popup and print the details.