Overview
This guide offers step-by-step instructions for processing a personal injury (PI) case from start to finish. While PI cases can vary significantly based on payer and state-specific requirements, this guide and accompanying video focus on the most common and generic approach to managing a PI case.
Please note that this guide may not address every possible scenario. If you encounter unique circumstances or need assistance with a case outside the example provided, don't hesitate to reach out for additional support.
Step 1: Add the Third-Party Payer
A third-party payer (e.g., attorney, law firm, or insurance company) must be added to the system to manage the PI case.
Navigate to either System-level or Location-level, depending on where the payer needs to be set up -
System-level: System Dashboard > Insurance > Insurance/Third Party Payers
Location-level: Live location > Insurance > Settings > Payers
Click Add Third Party Payer.
Enter the required information:
Name: Attorney, law firm, or insurance company name (e.g., Test Law Firm).
Contact Information: Add contact details, including phone and fax numbers.
Address: Provide the payer’s mailing address.
Check the Paper Bill option to categorize PI claims separately and avoid electronic claim submission issues.
Click Create Payer to save.
Step 2: Create a PI Case for the Patient
Open the patient’s profile and go to the Cases tab.
Click Create New Case.
Select Personal Injury under Type.
(Optional) Rename the case under Case Name.
Set Billing to Suspended to hold all dates of service until the end of the case.
Save the case and set it as the Default Case.
Step 3: Link Insurance Coverage to the PI Case
In the patient’s profile, go to Insurance Coverage and click Add New Insurance Coverage.
Select the third-party payer from the drop-down menu (e.g., Test Law Firm).
Set the Coverage Start Date (typically the patient’s first appointment pertaining to the PI case).
Leave the Coverage End Date blank for open-ended cases.
ID/Claim Number
Enter the provided claim number or "LIEN" if working with a lien.
Claims Related To: Select Auto Accident from the drop-down.
State of Incident: Specify the state where the accident occurred.
Date of Current Illness or Injury: Enter the accident date.
Onset Qualifier: Select 439 - Accident
Add any relevant details:
Notes: Include any important details such as adjuster or attorney contact information.
Save the insurance coverage.
Step 4: Manage Patient Visits and Documentation
For each appointment, ensure you:
Add charges to the patient’s ledger.
Complete SOAP notes.
At the conclusion of the patient’s care, generate the required documentation to send to the third-party payer.
Step 5: Generate Required Documentation
Most attorneys and insurance companies typically request a Statement of Account and SOAP notes for personal injury cases.
However, requirements can vary depending on the third-party payer. For instance, some auto insurance companies may require HCFA forms. It’s important to communicate directly with the third-party payer to understand and meet their specific documentation and claim submission needs.
To Generate a Statement of Account:
Navigate to the Patient's Profile.
Statement of Account > Beta
Select the PI case and leave the start and end dates blank to include all services.
Enable Include Case Details to display NPI, EIN, DX codes, and other case-specific details.
Click Submit to generate a PDF.
To Generate SOAP Notes:
Navigate to the Patient's Profile.
Care History.
Select the PI case and leave the start and end dates blank.
Click Generate to create a PDF of all SOAP notes.
If the third-party payer requests claims on a HCFA form, follow their specific instructions.
Step 6: Process Claims Internally
All PI case services must be processed through the system to enable proper check posting later.
Navigate to Insurance > Create Claims and toggle to Standard Paper.
The Standard Paper option is used because the third-party payer was set up for paper billing. This ensures that claims are directed to a separate billing queue, keeping them distinct from the electronic batch billing process.
If the patient doesn’t appear in the claims queue, unsuspend billing:
Go to the patient’s case settings and set billing to Bill Normally.
Process the claims but do not send them externally unless requested.
Step 7: Post the PI Payment
When you receive the payment, post it as an insurance check to ensure proper reporting.
Go to Insurance > Process EOB and select Personal Injury Check.
Enter the check details, including:
Check Number (recommended).
Check Amount (e.g., $750).
Memo
Choose a posting option:
Allocate and Write Off Differences: Applies payments to services and writes off remaining balances.
Allocate and Set to Patient: Assigns the remaining balance to patient responsibility.
Click Submit to save the payment.
The payment will now be categorized as an Insurance Payment in your reports.