Patient Eligibility and Cases

What is the context?

Cases and Authorisation codes allow a series of appointments to be linked under a single treatment plan, regardless of the patient’s default payer. This ensures efficient management of appointment sequences, such as physiotherapy sessions covered by an insurer. Eligibility and Cases can be managed from the Patient Record.

What is the purpose of this article?

This article provides step-by-step guidance on setting up, using, and managing cases and authorisation codes for patient appointments, including how to allocate credits and track their usage.

Pre-Requisites

Before creating an authorisation code, ensure the patient’s record includes a linked company, such as an insurer or employer, with a charge band correctly assigned in their ‘Personal Details’ page. This is crucial, as the services provided will depend on the company’s charge band. If these details are missing, update them before proceeding. Note that authorisation codes cannot be used for self-paying patients

Note: This process will not work for self-paying patients.

Eligibility and Cases Page

In the Eligibility and Cases page you can:

• Edit the Layout
• View Open and Closed Cases
• Create a Case
• Create an Authorisation

How to Create a Case

Cases can be created in many different areas in the at the point of booking an appointment, within a consultation or from the Eligibility and Cases from the Patient Record. Cases can exist to link a series of appointments together.
To create a case in Eligibility and Cases:

1. Click New Case.
2. Set a Title for the Case (Required)
3. Set a Safe Title for the case (Required)
4. Provide a Diagnosis Code (Not required)
5. Click Create to save Case.

Whilst creating a new case, you have the option to also create and apply an authorisation at the same time. Following the above steps of 1-4, click New Authorisation on the top of the window, next to Create. In the New Authorisation window specify:

1. Code (Required).
2. Payer Type.
3. Notes.
4. Credit amount (number of appointments that can be authorised).
5. Set an expiry date for the credits.
6. Click Add to Case to save the authorisation.
7. Click Save.

Create an Authorisation

Creating a New authorisation 

Authorisations are applied to cases.

To create a new authorisation, click New Authorisation. This will bring up the New Authorisation Window where you can define:

1. Case Title - Give the new authorisation a descriptive name such as ‘Rehabilitation’. 
2. Case Safe Title
3. Diagnosis Code - A diagnosis can be used to string all the cases together and also sent to Healthcode if this is part of your system setup (See the Healthcode section in this manual for more). 
4. Authorisation Code - The ‘Code’ field defines the authorisation code (This can be any string of numbers or digits and will be supplied by the insurer or patient).
5. Payer Type -The payer can be set here to either employer or insurer (assuming the patient has both of these listed in their personal details).
6. Credit total - Credits section lets you define how many credits the patient is allowed ( and therefore how many appointments).
7. Expiry Date - After this date all authorisation codes shall become invalid.

Using Cases and Authorisations

With the case and authorisation now prepared, we can book an appointment (See ‘Appointments’ for more information regarding the booking processes). Upon reaching the service picker page as shown below you will notice the ‘Authorisation Code’ box - clicking here will bring up all the authorisation codes available to this patient.

Selecting the code will change the payer and the charge band allowing the patient to receive the treatment required.

Once a booking has been made and an authorisation code has been used, the consultation will contain a case ‘Rehabilitation’. All appointments made with this authorisation will appear under this case automatically. Return to the patient page and view the authorisation code.

You will find the remaining credits have fallen to 4 and the ‘Allocated’ section now links to the appointment in which this credit was used. Once all authorisations are used they will become hidden from the ‘Eligibility box on the patient home page. To view exhausted authorisation codes click the ‘Show All’ button within this box.

Review Date

This article was last updated on 11th December 2024.