demographic entry and update module 2 entry and... · 2020. 9. 30. · step by step to query an...

Demographic Entry and Update

Module 2

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Table of Contents

Master Menu ...........................................................................................................3

Create a New Patient Account ................................................................................4

Accessing the Batch Control Screen .......................................................................4

Create a New Batch ................................................................................................5

Querying for an Existing Batch ..............................................................................8

Accessing the Patient Registration Block ...............................................................9

Searching for an Existing Patient Record ...............................................................10

Entering a New Patient Record ...............................................................................11

Demographic Block ................................................................................................13

Insurance Block ......................................................................................................18

Guarantor Block ......................................................................................................23

Precertification Numbers ........................................................................................25

Account Comments Inquiry ....................................................................................27

Action Codes ...........................................................................................................28

Tagged Comment ....................................................................................................30

Updating an Existing Patient’s Demographic Account ..........................................31

Updating an Existing Patient’s Guarantor Information ..........................................35

Updating an Existing Patient Insurance Record .....................................................37

Archiving Insurance ................................................................................................40

Accessing the Insurance Master Record .................................................................43

Entering Insurance for an Existing Patient with No Insurance History ..................45

Miscellaneous Insurance Section ............................................................................48

Repricing and refiling claims after updating primary insurance ............................49

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Master Menu

Everything in ClinixPM begins at the Master Menu. The Master Menu is often referred to as MM throughout

this documentation.

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Create a New Patient Account

Purpose: Creating a new patient account record requires creation of a batch granting quick access to post

Charges, Payments and/or Adjustments from this screen.

If the user entering the demographics does not intend to post transactions, it is still beneficial to use this

method for creating a new patient account record because it is quick, efficient and easy to learn. The first

step is to create a batch.

Accessing the Batch Control Screen

At the Master Menu, select 9-Transaction Entry with a mouse click or by entering '9' in the Enter

Selection field.

Selecting the 9-Transaction Entry displays the Transaction Entry Menu.

Select 2 - Batch Control: Charge Entry/Update with a mouse click or by entering '2' in the Enter Selection

field.

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Create a New Batch

By selecting 2– Batch Control: Charge Entry/Update the Batch Control screen displays. The only fields

that are mandatory in this screen are the Group Code, Deposit Date and Batch Number. However, other

fields may be required operationally for the practice.

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The Batch Control form displays in ‘Insert’ mode with the cursor in the Group field.

Step by Step to create a new batch.

In the Group field, <tab> or <enter> through the field if the database code is set to default, or

manually enter the code. The user can use the mouse to skip to the Deposit Date field if entry in the

following field is not necessary.

Batch Number, <tab> or <enter> through the field to use a system generated number (populated

upon save), or manually enter a number.

Comments, a user can opt to enter a free texted comment about the batch or <tab> or, <enter>

through the field.

Deposit Date, insert the current date.

Lock Box ID, this field can be utilized to enter the bank lock box ID. If not needed <tab> or

<enter>.

Default DOS, optional, enter a date of service to default.

Select the ‘Save’ icon from the Task Bar or the <F4> Function key. Upon save, a batch

number will be assigned.

A user can work in the same batch every day as long as there are no charges, payments or adjustments to

post, see Query an Existing Batch. However, the user has the flexibility to create a new batch every day

based on workflow. When the batch is open, if there is no need to post charges, payments or adjustments, no

further action is required other than to enter the new patient demographics (i.e. no need to “release” the batch

or to take any further action).

The Batch Control Field Name and Description table is available below.

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Field

Name Field Description - Batch Control

Group Code This field is for the group number. It will automatically default IF the group default

(MM1.1) is set.

Batch Number

Enter a Batch number (up to 6 characters) or the system will automatically assign a

sequential number after the user ‘Saves’ by selecting the ‘Save’ icon or by pressing the

<F4> Function key. This is a unique number identifying the batch, transactions, and

creator.

Date This is the current system date. Note: This field will automatically populate.

Last Update This field will default to the date the batch was updated.

Time This field will ‘stamp’ the time the batch was opened or last updated.

User ID This field will auto-populate the user ID that opened the batch OR last updated the batch.

Comments This is a free text field that a user can enter a comment concerning this batch.

Deposit Date This is a required field. Depending on the practice, a user can either enter the current date

or if posting payments, a user may want to enter the date of the actual deposit.

Default DOS Enter a Date of Service if all transactions are generally for the same Date of Service. This

DOS will default on all transactions posted, but can still be overwritten.

Transaction

Total This field will reflect the number of transactions that are posted within a batch.

Number of

Accounts

This field will reflect the number of accounts that have had transactions posted to them

within a batch.

Lock Box ID Enter the Lock Box number, if posting payments.

Bank Batch ID Enter the Bank Batch ID, if posting payments.

Hash Total

This field can be used for additional reconciling of balancing charge entry batches. Hash

totals calculate the sum of all CPT codes posted in this batch during charge entry. Alpha

in a procedure code is a zero unless it comes at the end of a procedure code. Examples:

G0008 = 00008, for a total of 8. G0008G = 0000080 which is a total of 80.(More accurate

balancing)

Batch Balance This field can be used for additional reconciling. It is the sum of the variances within the

batch.

Control Totals There is a field for Payments, Adjustments, and Charges. Manually complete these fields

after the batch has been balanced and prior to releasing the batch.

Actual

Amounts

There is a field for Payments, Adjustments, and Charges. These fields will automatically

continue to calculate as transactions are being posted in a batch. Use the totals to balance.

Variance

There is a field for Payments, Adjustment, and Charges. These fields will automatically

populate as transactions are being posted in a batch. They will be the opposite of the

Actual Amounts. For example if the actual amount of the charges are 3,650.00, the

variance field for the charges will reflect -3,650.00. Note: All of the Variance fields will

have to be at 0.00, zero, before a batch can be released.

Batch Status

There are three (3) batch status – H-Hold, E-Release for Editing, and R-Release for

Posting. Note: When a batch is opened the status will automatically default to an ‘H’.

The batch has to be on an ‘H’ before transactions can be posted or changed within that

batch.

Batch Post

Month

Identifies the specific month when the transactions in the batch are posted, as well as the

Month End the batch will be finalized.

Batch Post

Year Identifies the reporting year of the batch and the year the transactions are finalized.

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Querying for an Existing Batch

If the user elects to work in the same batch every day or has the need to locate an existing batch follow the

steps below.

Step by step to query an existing batch: Go to the Master Menu, select ‘9’ Transaction Entry Menu

Select ‘2’ Batch Control Entry/Update, the screen will be in 'Insert' mode which means the user will

have to start a query.

Start the query/search by selecting the 'Enter Query' icon from the Task Bar or by using the <F1>

Function key on the keyboard

Enter any of the following information in order to search for an existing batch:

o Batch Number

o Deposit Date

o User ID

Select the 'Execute Query' icon from the Task Bar or the <F2> Function key on your

keyboard.

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Accessing the Patient Registration Block

When the existing batch is located, or a new batch created, the user continues to the Patient Registration

Block by selecting the ‘Fast Posting’ tab, as indicated by a red box as shown below in the screen shot, or by

using the <F12> Function key.

Once the tab or <F12>, is selected the Patient Registration Block displays as shown

below.

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Searching for an Existing Patient Record

The ‘Patient Registration Block’ automatically displays in ‘Query mode’. This will allow the user to search

for existing patients to confirm the patient is not already in the database.

Enter the appropriate data to query, and then select the 'Execute Query' icon from the Task Bar or

the <F2> Function key on your keyboard.

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If no patient records match the data entered, in the lower-left corner of the screen, the Help Message states

“No Patients found or selected”.

Entering a New Patient Record

This screen has three “blocks” of information; two are visible and the third is hidden.

The first block that starts with the Relation-Guar field and ends at the Comment field is considered the

‘Patient Demographic Entry’ block. The next block or ‘Insurance Block’ begins with the Ins Co and ends

after Misc. Insurance. The 'Guarantor Block', is the ‘hidden’ block of information will display if the relation

to patient is anything other than ‘1’ or Self.

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Patient Demographic Entry

Guarantor Block

Insurance Block

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Demographic Block

Follow the cursor path below to complete the information, use the <tab> or <enter> key to move to the next

field. For more detail on each field, see the Field Name and Field Description table following the step by step

instructions.

Step by step to enter new patient record demographic information:

Select the button once and the cursor is active in the ‘Relation-Guar’ field.

Select the button for a second time and the following appears in the help message:

. Follow the cursor path below to

complete the information on the form, use the <tab> or <enter> key to move to the next field. For

more detail on each field, see the Field Name and Field Description table following the step by step

instructions.

Relation to Guar, enter the numeric value that describes how the patient is related to the guarantor

as defined in the help message.

The cursor will complete the Group if set to default, and skip the Account field if set to

automatically assign, otherwise manually enter.

Account, this field will display the patient’s account number, at the time the information is saved

.

Medical Record is an optional field, user can <tab> or <enter> through if not necessary to record

for the practice.

PHI, Protected Health Information, if the patient has given any PHI information enter ‘Y’ to flag

also make a comment using the Comments tab or <F12> on the keyboard. A pop-up message will

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remind users to review comments for instructions each time the patient’s account is accessed in

MM7.

Exc Code- If an Exception Code is attached to the patient’s account, it will display in this field.

Race, use the mouse to select the LOV button , or <Ctl F> to access the options then use the

mouse to select race or down arrow and <enter> to expand section. To insert choice, activate the

‘sticky cursor’ (double click with the mouse, <F4> Function key on the keyboard, or select the

‘Save’ icon on the

taskbar).

Ethn, use the mouse to select the LOV button , or <Ctl F> to access the options then use the

mouse to select ethnicity or down arrow and <enter> to expand section. To insert choice, activate

the ‘sticky cursor’ (double click with the mouse, <F4> Function key on the keyboard, or select the

‘Save’ icon on the taskbar).

Lan, use the mouse to select the LOV button , or <Ctl F> to access the pop-up window,

activate the ‘sticky cursor’ to insert the choice.

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Enter the patient’s name, exactly as shown on the insurance card if patient is the subscriber, in the

Last, First and MI fields. As additional reference, such as a nickname or maiden name, access the

Maiden or Alt. field by selecting the field with the mouse.

Gender, (required) enter ‘M’ for male, or ‘F’ for female.

Marital St, (optional) use help message for numeric value to enter.

SSN, not required, if used must be nine (9) digits.

Addr1, (required) enter the address including apartment number, if applicable.

Addr2, use for additional address information or <tab>/<enter> if not needed.

Ctry, this field will default to USA. If entering a zip code for another country, select the country

from the LOV button. When another country is selected, the zip code field will default to the format

of that country’s zip code.

Zip, (required) upon entering the zip code the City and State fields will automatically populate, the

user can click in the field if a manual correction is necessary.

City, this field is where the patient’s city is entered. The city and state will default when the zip

code is entered.

ST, this field will default the state where the patient lives.

Home Phone, enter the home phone number (your client manager can set a (med)option to default

the area code if requested)

Cell Phone, enter the patient’s cell phone number.

E-Mail, this informational field must have a valid email address entered if used.

DOB, (required) enter the patient’s date of birth using the 8-digit date format (MMDDYYYY), this

will populate the next field with the age of the patient.

DOD, this field is for ‘Date of Death’.

Primary, enter the numeric doctor code for the attending provider or query by using the LOV button

or <Ctl F> on your keyboard for a list of values then activate the ‘sticky cursor’ to insert

the doctor code. The next field will populate with the attending providers name. If entered the

provider will default at charge entry.

Ref In, enter the numeric doctor code for the attending provider or query by using the LOV button

or <Ctl F> on your keyboard for a list of values then activate the ‘sticky cursor’ to insert

the doctor code. The next field will populate with the attending providers name. If entered the

referring doctor will default at charge entry.

Emp Status, see help message for numeric value to enter. Only if ‘1-Employed’ is entered will the

cursor access to the work phone fields.

Employer, enter the patient’s ‘Employer Name’.

Work Phone, enter patient’s work number.

Msg Code, this field will display a patient statement message code, if applicable.

Msg Cnt, this field will diplay the numeric value of how many statement messages should print on

the patient’s account, if applicable.

Initials, this field can be utlizied to enter a users initials.

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Comment, this field will display a patient’s comment.

Admit Date, if applicable, enter the hospital admission date.

Emer, enter the patient’s emergency contact person’s name.

Hospital #, This field will display a hospital identification number when an interface is active.

Log Date, if applicable, enter the date of log

Scan Index, if applicable, enter the number.

Injury Type, use drop down to select Emp Related, Automobile or Other.

Injury Date, if applicable, enter the date of injury.

Contact Rel., use drop down to identify relation of emergency contact to patient 1-spouse, 2-child,

3-parent, 4- sibling, 5- other.

Ph, enter the emergency contact phone number

X, enter the emergency contact phone extension number

Below is a table containing the Field Name and Field Descriptions.

Field Name Field Description – Patient Registration Block (Demographic)

Relation-Guar This field is referring to ‘how is the patient related to the guarantor?’

1 = Self, 2 = Spouse, 3 = Child, 4 = Other

Group Group number. It will automatically default IF the group default is set.

Account Patient’s account number. Based on how the database is set up, the system can assign the

account number at the time the information is saved OR one can be entered manually.

Medical Record If the Medical Record or chart # is different from the patient account #, and it is important to

the practice, it is entered in this field.

PHI

Protected Health Information, if the patient has given any PHI information enter ‘Y’ to flag

also make a comment using the Comments tab. A pop-up message will remind users to

review comments for instructions each time the patient’s account is accessed in MM7.

Exc Code

Exception Code – Decided on and set up in Master Files by practice management. This

field indicates an ‘exception to the norm’ or to note specific info regarding a patient’s

account. Can be used to prevent a statement or claim from generating, can cause an

appointment schedule override, indicating to that user that the patient may need to speak to

someone in the office, depending upon the code. ClinixPM automatically loads the

following four exception codes:

BA – Bad Account, PD – Past Due;

CA – Collection Account, CP – Collection Pending

Race This field is for one of the three ‘Meaningful Use’ fields.

Ethn This field is for one of the three ‘ Meaningful Use’ fields.

Lan This field is for one of the three’ Meaningful Use’ fields.

Last Patient’s last name. If the patient is the subscriber of the insurance, this name must match

exactly, the name on the insurance card to prevent denial of the claim.

First Patient’s first name – must match insurance card.

MI Patient’s middle initial.

Maiden or Alt. Maiden or Alternate Name. This is useful if patient goes by a different first name than what

is on the insurance card and/or reflected in the First name field; such as 'Bill' for 'William'.

Gender Patient’s gender: M – Male, F – Female. Required field.

Marital St Patient’s Marital Status:

1-Single, 2-Married, 3-Unknown, 4-Divorced, 5-Widowed, 6-Legally Separated

SSN Patient’s Social Security Number – the practice management decides whether this field is

required or not. If used it must be in nine-digit format.

Addr1 Patient’s address. Required field.

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Addr2 The post office reads an address from the bottom up therefore try to keep all address info on

line 1 and only use this row if absolutely necessary (e.g. “In Care Of”).

Ctry

USA will default. To select a foreign country, the user activates the cursor in the Country

field and selects <Ctl F> or clicks on the LOV. The <F2> Function key or the

‘Execute Query’ icon from the Task Bar displays the list of countries. By

selecting <F1> Function key or the ‘Enter Query’ icon from the Task Bar, the

user can enter the name of the country in the Country field and select <F2> Function key or

the ‘Execute Query’ icon from the Task Bar to display the queried country.

Zip Patient’s zip code; Note: format will adjust with Country choice. Required field.

Plus Patient’s plus four zip code.

City Patient’s city of residence (will auto-populate after zip code is entered).

ST Patient’s state of residence (will auto-populate after zip code is entered).

Home Phone Patient’s phone number.

Cell Phone Patient’s cell phone #, if applicable.

E-Mail Patient’s email address, if applicable. This field is informational only.

DOB Patient’s Date of Birth (MMDDYYYY). This field is required. The patient’s age will

populate in the next field

DOD No entry is required in this field to create a new patient account. It represents the patient’s

Date of Death and can be updated as necessary by the user.

Primary The attending physician or the doctor who is seeing the patient; when entered here, it will

default during charge entry. LOV available.

Ref In Patient’s referring doctor; when entered here, it will default during charge entry.

LOV available.

Emp Status Patient’s employment status: 1-Employed, 2-Part Time, 3-Full-Time student

Employer Patient’s place of employment.

Work Phone Patient’s work phone #, if applicable.

Msg Code This field will display a patient statement message code, if applicable.

Msg Cnt This field will display the number of cycles the message should appear.

Initials User can enter initials for account follow up.

Comment Displays the most recent comment on the account unless a tagged comment is checked on

the Comments screen.

Admit Date Date the patient was admitted to the hospital, if applicable.

Emer Emergency contact person for patient

Hospital # This field will display a hospital identification number when an interface is active.

Log Date

The log date pulls from the activity log record. The activity log record is accessed through a

batch in MM13.8 and selecting <F12> or the F12 Demo/Charge Entry Tab from the saved

batch.

Scan Index This field identifies the number associated with document imaging of patient demographic

and/or insurance information.

Injury Type Use drop-down menu: Employment-related, Automobile, or Other – if applicable.

Injury Date Date the patient was injured, if applicable.

Contact Rel use drop down to identify relation of emergency contact to patient 1-spouse, 2-child, 3-

parent, 4- sibling, 5- other.

Ph Emergency contact phone number

x Emergency contact phone number extension number

When all information is complete in the first block, the user selects either the next block icon on the Task

Bar, the <F8> Function key, clicks the ‘Change Blocks’ tab, or uses the mouse to click into the Ins Co field.

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This moves the cursor to the Insurance Block if the Relation-Guar is a ‘1’, as shown on the next page. If the

Relation-Guar is not ‘1’, then the Guarantor block will be presented next as explained below.

Insurance Block

Step by step to complete a new patient record insurance block:

Ins Co, enter the Insurance Company key code. See section ‘Query Insurance Company Code’ for

step by step instructions to look up a key code from the LOV button available.

o The IT, Ins Seq, and Name fields will auto-populate.

Effective, enter the effective date of the policy 8-digit format (MMDD YYYY).

Expiration, enter the expiration date of the policy 8-digit format (MMDDYYYY) if unknown

<tab> past field.

Eligibility - This field will contain the date eligibility was checked

Policy, this is a required field, enter the Policy ID number.

Group, enter the group number if applicable.

MSP, Medicare Secondary Payer Indicator, use LOV button or <Ctl F> on the keyboard to

select reason as required when Medicare is secondary.

Rel to Insured, use help message for numeric value to enter. If entry is not ‘1-Self’, then entry in

the Insured section is required.

o Name, enter the last name <comma> first name of the Insured.

o Address1, Address2, Country, Zip, St, City, Tel, will all copy from the patient record if

‘Rel to Insured’ is not ‘4-Other’, which requires entry of all fields.

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Address1, Address2 ,enter address.

Zip, upon entering the zip the City and ST will auto-populate.

DOB, Date of Birth of the Insured is required.

Tel, enter the phone number.

Sex, required to enter ‘M’ for male or ‘F’ for female.

Employer, enter Insured’s Employer name.

o DOB, Date of Birth of the Insured is required.

o Tel, telephone number for Insured

o Gender, required to enter ‘M’ for male or ‘F’ for female.

o Employer, enter the Insured’s Employer name.

To enter a additional insurances, down arrow and repeat above steps.

Below is a table containing the Field Name and Field Descriptions. Field Name Field Description – Patient Registration Block (Insurance)

Ins Co

Enter the key code for the patient’s insurance carrier by clicking on the LOV button or by

typing the insurance key code of the specific insurance company loaded in the Master

Table. See ‘Query Insurance Company’ section for more detailed instructions below.

IT Type of Insurance, which is set up in the Insurance Company master record, and therefore

auto-populates after Ins Co code entry.

Ins Seq System auto-populates: 1-Primary Insurance, 2-Secondary Insurance, 3-Tertiary, etc.

Upd Seq Use the LOV if the sequence of the insurance needs to be switched.

Name Name of Insurance Company; auto-populates after the Insurance Company key code entry.

Effective Effective date of the policy, this field requires 8-digit format (MMDDYYYY).

Expiration Termination date of the policy if known, this field requires 8-digit format (MMDDYYYY).

Eligibility This field will contain the date eligibility was checked.

Policy Policy ID number in this required field.

Group Policy Group number if applicable.

Return

This field indicates how the user would like the claim handled for this insurance company.

‘1’ will drop the claim to paper once, ‘R’ prints claim to paper every time, the word Return

and the initials, if entered, will appear at the top of the claim. An ‘S’ in this field prints the

claim on the office printer for investigation as to why it could not process electronically.

'S' can also print the claim at the client office for the doctor’s signature.

Initials Enter user initials to print on the top of the paper claim as identification.

Copay

Enter the patient’s copay dollar amount for this insurance company. When entered here, the

copay amount field will be auto-populated at the time the copay is posted and prompts the

user of the patient copay at the time of check-in/registration. If signed up for Passport, this

will update automatically, otherwise the field can be updated manually when eligibility is

checked.

MSP Medicare Secondary Payer Indicator – click on LOV button for options, this is a required

field if the patient has Medicare as secondary insurance.

INS2 Displays the secondary insurance key code, if applicable.

INS3 Displays the tertiary insurance key code, if applicable.

Rel to Insured This field requires the patient relationship to the subscriber or policyholder of the

insurance. 1-Self, 2-Spouse, 3-Child, 4-Other

Field Name Field Description – Patient Registration (Insured Section)

Name

Subscriber/Policy Holder’s Name. If the relationship to Insured was entered as 1-Self,

ClinixPM will auto-populate this field; if 2-Spouse, ClinixPM will populate the block with

address information but not the name; if any other relationship, the user will have to

complete. Use ‘LastName,FirstName’ format with no spaces, separated by a comma.

Address1 Subscriber/Policy Holder’s Address. If the Relationship to Insured was entered as 1-Self,

2-Spouse, or 3-Child ClinixPM will auto-populate this field; otherwise, the user will have

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to enter the policyholder's address.

Address2 The post office reads an address from the bottom up therefore try to keep all address info

on line 1 and only use this row if absolutely necessary (e.g. “In Care Of”).

Country







Zip Subscriber/Policy Holder’s Zip Code; Note: format will adjust with Country choice.

ST Subscriber/Policy Holder’s State (will auto-populate after zip is entered.)

City Subscriber/Policy Holder’s City (will auto-populate after zip is entered.)

DOB Subscriber/Policy Holder’s date of birth (8-digit, MMDDYYYY format) required when

Rel to Insd is not 1-Self and (med)option is set.

Tel Subscriber/Policy Holder’s phone number.

Gender Subscriber/Policy Holder’s gender required when Rel to Insd is not 1-Self and (med)option

is set.

Employer Subscriber/Policy Holder’s employer name.

Field Name Field Description-Patient Registration Block (Misc. Insurance Section)

Name Insurance Company Name.

Address1 Insurance Company Address.

Address2 If user must use this second address line, add the street # and street name here and the Suite

or other info on Address Line 1. (Previous field)

City Insurance Company’s City (will auto-populate after zip is entered.)

ST Insurance Company’s State (will auto-populate after zip is entered.)

Country







Zip Insurance Company’s Zip Code; Note: format will adjust with Country choice.

Phone # Insurance Company’s phone number.

Ext Insurance Company’s phone extension, if applicable.

When all the information is entered, the user selects the ‘Save’ icon or the < F4> Function key.

Misc. Insurance Section

Use only if Insurance will not be added to the Insurance Company Master Table or if claim needs to go to a

different address or department other than what is in the Master Table. Miscellaneous Insurance claims will

always print to paper. Entry in the below fields will only occur when the key is identified with a ‘Y’ in the

Miscellaneous field of the Insurance Master (MM1.4, page 2).

Step by Step to enter the Miscellaneous Insurance Information:

Name, enter the Miscellaneous Insurance Company name.

Address1, enter the address to mail the paper claim.

Address2, additional mail handling.

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Country, enter the Country.

Zip, upon entering the zip code the City and ST fields will populate.

Phone #, enter the telephone number.

Query Insurance Company in Patient Registration Block screen

Step by step to query an insurance company code while entering a new patient on the ‘Patient

Registration Block’ screen:

Select the LOV button or <Ctl F> on the keyboard and a pop-up window will display.

o <Tab> once to the name column,

o enter the name and the ‘Clinix Wildcard’ (%), the application will search for all entries entered

before, between, or after the ‘Clinix Wildcard’, the percent sign (%) as shown above.

o use <F2> or the ‘Execute Query’ icon to search,

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o Find the code then activate the ‘sticky cursor’ to return the code by double clicking, <F4> on

the keyboard or the ‘Save’ icon in the taskbar.

o The key code will pull back into the Ins Co field, the user will <tab> or <enter> then the

‘Name’ field will populate.

A user can also search using the insurance company’s address.

Select the LOV button or <Ctl F> on the keyboard and a pop-up window will display.

o <Tab> five (5) times or click in the address column,

o enter the address or partial address and the ‘Clinix Wildcard’ (%), the application will search for

all entries entered before, between, or after the ‘Clinix Wildcard’, the percent sign (%) as

shown above.

o use <F2> or the ‘Execute Query’ icon to search,

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o Find the code then activate the ‘sticky cursor’ to return the code by double clicking, <F4> on

the keyboard or the ‘Save’ icon in the taskbar.

Guarantor Block

Depending upon the Patient’s Relationship to the Guarantor as entered when completing the patient

information, (see red arrow in upper left corner of screen shot below), ClinixPM will automatically complete

certain fields in the Guarantor Block.

The user can access this block by pressing the <F8 > Function key or by selecting the

tab at the top of the ‘Patient Registration Block’ screen.

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If the answer to Relation-Guar is '1' – 'Self', the patient information is copied over to the Guarantor block. If

there is any number other than, '1', in the patient relationship to guarantor field the Guarantor Block appears

at the bottom of the Patient Registration Block screen overlaying the Insurance Block until completed by the

user. Detailed explanations of the various ‘Relation-Guar’ are shown below. Entry of First and Last Name of

Guarantor is required, all other fields are optional.

If the answer to Relation-Guar is '2' – 'Spouse', everything except the Guarantor Name, SSN, DOB,

Marital Status, Emp Status, Employer, Work Phone and Cell Phone is copied over to the Guarantor

block.

If the answer to Relation-Guar is '3' – 'Child', everything except the Guarantor Name, SSN, DOB,

Marital Status, Emp Status, Employer, Work Phone and Cell Phone is copied over to the Guarantor

block.

If the answer to Relation-Guar is '4' – 'Other', nothing is copied over to the Guarantor block, so all fields

will need to be completed.

After all blocks are complete, the user ‘Saves’ by selecting the ‘Save’ icon or by using the <F4> Function

key. The system will automatically assign the Account number.

To enter another patient, select the button, use the ‘Enter a Query’ icon , or <F1> from

the keyboard to enter the next patient to search.

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Precertification Numbers

Purpose: To ensure authorization and/or precertification numbers are in the patient record and for inclusion

on the claim(s). The ClinixPM application manages the number of authorized visits used, as well as, how

many visits remain. It is important to note that when specifying how the precertification can be utilized by

Specialty or by Doctor, the user can choose either but not both.

Once the user has completed the Patient Registration Block screen, they have the choice of selecting the

<F11> Function key or the ‘Precertification’ tab at the top of the screen.

The Group, Account, Insured Name and insurance information all carry over into the precertification screen

from the Demographics screen, therefore the user only has to enter one line of information per precert/auth.

Step by step to enter a precertification number: Ins Company, Enter the insurance key for the carrier

Effective Date, (required) complete the effective date.

Expiration Date, (required) complete and expiration date.

Visit Authorized, (required) enter the number of visits authorized.

Certification ID, (required) enter the Certification ID provided.

Specialty, If the pre-cert states that the patient can see any provider within the practice then

complete the Specialty field.

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Doctor, if the pre-cert states a specific doctor within the practice then enter the doctor number.

Note: it is required to use either Specialty or Doctor field, however, not both.

The last two fields, Available and Pending Visits, will auto-populate.

Contact, The contact name and number can be documented for any future need.

Field Name Field Description – Precertification Numbers

Ins Company The Insurance Key Code from the applicable insurance providing the

precertification/authorization number in this required field.

Effective Date First day the precertification/authorization number is effective in this required field.

Expiration Date Last day the precertification/authorization number is effective in this required field.

Visits Authorized The total number of visits the insurance company approved in this required field.

Certification ID Precertification/authorization # obtained from the insurance in this required field.

Specialty

If the pre-cert allows the patient to see any provider within the practice Users can

manually enter or click the ‘Specialty’ LOV to assign the specialty that is applicable.

Note: only use Specialty OR Doctor and not both.

Doctor

If the pre-cert states that the patient may see only a specific provider, Users can

manually enter or click ‘Doc’ LOV to assign the correct doctor that is applicable. Note:

only use Specialty OR Doctor and not both.

Available Visits Once saved, this field will auto-populate the number of available visits the insurance has

approved.

Pending Visits

The number of visits that are designated for any upcoming appointments for this

specific precertification/authorization #, this number will auto-adjust after each

precertification use or if certification is not used or the appointment was cancelled the

count will increase the available visit count.

Contact Enter the insurance contact name.

Phone Number Enter the insurance contact phone number.

The user saves the precertification/authorization record by selecting the ‘Save’ icon or by selecting the

<F4> Function key.

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Account Comments Inquiry

Purpose: To add/view comments entered by users.

If the user would like to enter comment(s) specific to this patient, use the <F12> Function key or click on the

‘Comments’ tab from the ‘Patient Registration Block’. This will take the user to the ‘Account Comments

Inquiry’ screen.

When the application displays the form, the ‘Group’, ‘Account’, ‘Patient Name’ and ‘Financial Class’ fields

will auto-populate from the Patient Account screen. The ‘Date’ and ‘Userid’ display after a comment is

entered and saved based on system date and the credentials of the user logged into the application.

The user can read all comments at this time and/or add new comments. The cursor is in the ‘Initial’ field,

which refers to the user’s initials, but is not a required field, however if the user chooses to enter their initials

they can later query for just their comments.

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Action Codes

Purpose: To comment in a standardized fashion and allow reporting on frequent actions at an account level.

The user can <Tab> or <Enter> to the ‘Action Codephiphi.’ field which represents ‘Action Code’. If the

client uses ‘Action Codes’, (added during Master Tables training), the user can manually enter an ‘Action

Code’, pulling a partial comment that is already added to the ‘Action Codes’ Master Table. There are two

ways to add an action code.

If the ‘Action Code’ is unknown, the user can click the LOV button. A blank window opens in

‘query’ mode.

The user selects <F2> Function key from the keyboard or the ‘Execute Query’ icon on the task bar

and all ‘Action Codes’ will be listed.

The user can scroll through the available codes and description or conduct a query by selecting <F1>

Function key on the keyboard or the ‘Enter Query’ icon on the task bar to clear the window. The

user selects <tab> to move to the ‘Description’ field and enters search parameters with the Clinix Wildcard,

the '%’ sign as shown here:

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The user selects <F2> Function key from the keyboard or the ‘Execute Query’ icon on the task

bar and the query displays the following:

The user highlights the desired ‘Action Code’ and can activate the ‘Sticky Cursor’ feature. This is

accomplished by double clicking on the code or selecting the ‘Save’ icon or by using the <F4>

Function key from the keyboard to bring the ‘Action Code’ back to the comment record. The user can

click at the end of the comment that auto populated and complete the comment.

If the user wants to enter a unique comment, <tab> past the ‘Action Code’ column and start typing the

comment. If more than one line is needed, the comment will continue on the next line or the user can

press <enter> and the cursor will go to the next line.

When the new comment is complete, the user ‘Saves’ by selecting the ‘Save’ icon or the <F4>

Function key, the system will automatically stamp the current date and the userid. Then select from

the Task Bar or <Ctrl Q> from the keyboard to return to the ‘Patient Registration Block’. When the user

refreshes the account, the last comment entered will populate in the comment field or a tagged comment

as explained below.

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Tagged Comment

Purpose: To display a preferred comment on multiple screens throughout the application.

ClinixPM also has a feature that will give users the ability to ‘tag’ a comment, as the preferred comment to

always display on that account. When a comment on the ‘Account Comments Inquiry’ screen is ‘tagged’ or

checked, it will display instead of the standard last comment entered. The user selects the appropriate

comment on the ‘Account Comments Inquiry’ screen to tag by clicking the box to the left of the comment in

the ‘Tag’ column as shown here:

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Updating an Existing Patient’s Demographic Account

Purpose: To change or edit an existing patient’s demographic or insurance information.

From the Master Menu, select 7 ‘Patient Account’. User is in ‘Query’ mode at screen entry. Search for the

patient by account number or last name and first name or any other known value. Select the <F2> Function

key or select ‘Execute Query’ icon from the Task Bar to search for the patient.

Once the screen is populated the user can <tab>, <enter> or click in the applicable field(s) to change.

The following is a table of Field Name and Field Descriptions.

Field Name Field Description – Patient Account

Comment Displays the last comment recorded on <F12> Comment Rec. or the ‘tagged’ comment

if applicable.

Date Cmnt. Displays the date of the comment showing in the comment field.

Other Allows entry of a single character for custom use.

General This field will display additional comments.

Group This field will display the Group code as set in the master table. The group code will

automatically default if set on MM1.1.

Guar This field will display the guarantor number.

Relation

This field is referring to ‘how is the patient related to the guarantor?’ 1 = Self, 2 =

Spouse, 3 = Child, 4 = Other, which is displayed at the Help Message Section help

bar in the bottom left corner of the screen.

Account This field will display the patient’s account number.

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Active This field will display the status of the patient’s account. Options are ‘Y’ for active or

‘N’ if the account is deactivated.

Type This field will display the type of account. Options are Patient, Temporary, Z-

Company or Unknown.

Medical Record

If the Medical Record or chart # is different from the patient account #, and it is

important to the practice, it is entered in this field. For conversions, if the account

number is different in the previous PM system, that account number can be entered

here as a search field.

NPP

Notice of Privacy Practice – Valid entries are either 'Y' or 'N'. Use this field to show

that notice has been given. If the practice has a policy of only giving a patient the

Notice of Privacy Practice one time then the user that hands the notice to the patient

can enter a ‘Y’ in this field and then the next time this patient’s account is pulled up,

they know that they do not have to offer it to them again.

PHI

Protected Health Information field. This reflects if patient (or the patient’s parent or

guarantor, if patient is a minor) forbids sharing of their info to anyone else valid

entries are Y-Yes or N-No. A pop-up will display advising the user to review PHI

notes on the F-12 comment screen if this field is flagged with ‘Y’.

Last Patient's last name - If the patient is the subscriber of the insurance, this name must

match exactly, the name on the insurance card to prevent denial of the claim.

First Patient’s first name - If the patient is the subscriber of the insurance, this name must

match exactly, the name on the insurance card to prevent denial of the claim.

MI Patient’s middle initial.

Maiden or Alt.

Maiden or Alternate Name. This is useful if patient goes by a different first name than

what is on the insurance card and/or reflected in the First name field; such as 'Bill' for

'William'.

Gender The options are M for ‘Male’ , F for ‘Female’ or U for ‘Unknown’ in this required

field.

Marital

Valid entries for the Patient’s Marital Status: 1-Single, 2-Married, 3-Unknown, 4-

Divorced, 5-Widowed, 6-Legally Separated. Select the option by clicking on the down

arrow to the right of the field.

SSN Patient’s Social Security Number – Management for the practice decides whether this

field is required or not. If used it must be entered in a nine-digit format.

Addr1

Patient’s address will auto-populate if the relationship to the guarantor is 1 = Self, 2 =

Spouse, 3 = Child. Enter the correct information if patient's address is different from

the guarantor's. If two lines are needed, keep in mind that the post office reads an

address from the bottom up therefore try to keep all address info on this line.

Addr2

The post office reads an address from the bottom up, therefore try to keep all address

info on line 1 and only use this row if absolutely necessary. This field can be used for

‘In Care of’, if needed.

Zip This is for the patient’s zip code. Enter the correct information if patient's address is

different from the guarantor's; Note: format will adjust with Country choice.

City Patient’s city of residence (will auto-populate after zip code is entered) Enter correct

information if patient's address is different from the guarantor's.

ST Patient’s state of residence (will auto-populate after zip code is entered) Enter correct

information if patient's address is different from the guarantor's.

Country

USA will default. To select a foreign country, the user activates the cursor in the

Country field and selects <Ctl f> or clicks on the LOV. The <F2> Function key

or the ‘Execute Query’ icon from the Task Bar displays the list of countries.

By selecting <F1> Function key or the ‘Enter Query’ icon from the Task Bar,

the user can enter the name of the country in the Country field and select <F2>

Function key or the ‘Execute Query’ icon from the Task Bar to display the

queried country.

Home Phone This is for the patient’s phone number. Enter correct information if patient's phone

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number is different from the guarantor's.

Cell Phone Patient’s cell phone #, if applicable.

E-Mail Patient’s email address, if applicable. This field is informational only.

Opt Out Check box to indicate if a patient declines providing an email address

DOB Date of Birth requires an 8-digit format (MMDDYYYY). When entered, the system

will auto-populate the Age field above the DOB field.

DOD Date of Death requires an 8-digit format (MMDDYYYY).

Red Flag

Alerts the provider of any reported identity theft regarding the patient. Valid entries

are numeric, use the LOV or List Of Values to locate appropriate value, the “sticky

cursor” feature will pull code back to field.

Exc Code

Exception Codes are user defined and set up in the Master Files by the client. This

field indicates an ‘exception to the norm’ or to note specific info regarding a patient’s

account. Exception Codes can be used to prevent a statement or claim from generating

and can cause an appointment schedule override, indicating to that user that the patient

may need to speak to someone in the office, depending upon the code. ClinixPM

automatically loads the following four exception codes:

BA – Bad Account; PD – Past Due

CA – Collection Account; CP – Collection Pending

Race

Race of the patient. Select the LOV or List of Values button, a window populates with

possible entries. Each entry with this symbol beside it can be opened by a mouse

click to view additional valid entries. Locate the correct entry then use the ‘Sticky

Cursor’ feature to pull the code back into the field. This data pushes to an interfaced

EHR validating one requirement of meaningful use.

Ethn

Ethnicity of the patient. Select the LOV or List of Values button, a window populates

with possible entries. Each entry with this symbol beside it can be opened by a

mouse click to view additional valid entries. Locate the correct entry then use the

‘Sticky Cursor’ feature to pull the code back into the field. This data pushes to an

interfaced EHR validating one requirement of meaningful use.

Lan

Language of the patient. Select the LOV or List of Values, a window opens, locate the

correct entry, use the ‘Sticky Cursor’ feature to pull the code back into the field. This

data pushes to an interfaced EHR validating one requirement of meaningful use.

Referred This field will display the Referred options that are entered in MM2.20 as to how the

patient was informed about a practice.

Set up This is the date the account was established. ClinixPM will auto-populate the date

when the record is saved.

Follow up Used to create a tickler for follow up on this patient's account requires 8-digit date

format (MMDDYYYY).

Ins1: Key Code Displays the primary insurance key code.

Ins2: Key Code Displays the secondary insurance key code.

Ins3: Key Code Displays the tertiary insurance key code.

Group # These fields will display the insurance group number for any primary, secondary, and

tertiary insurance a patient might have.

Policy # These fields will display the insurance policy number for any primary, secondary and

tertiary insurance a patient might have.

Eligibility Reflects last date the eligibility was checked.

Fin Class This reflects the Financial Class of the primary insurance on the account.

Price Cd This two character code reflects the Price Code for the fee schedule to be used.

Hosp# This field will display a hospital identification number when an interface is active.

Log Date

The log date pulls from the activity log record. The activity log record is accessed

through a batch in MM13.8 and selecting <F12> or the F12 Demo/Charge Entry Tab

from the saved batch.

Scan Index This field identifies the number associated with document imaging of patient

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demographic and/or insurance information.

Injury If the visit is due to an injury, select from the drop down box. Selections are: Emp

Related, Automobile, Other. If utilized, this information will print on the claim.

Injury Date Date the patient was injured, if applicable. If utilized, this information will print on

the claim.

Primary This is the attending physician or the doctor who is seeing the patient; when entered

here, it will default during charge entry.

Ref In This is the patient’s referring doctor; when entered here, it will default during charge

entry.

Emer. Contact Enter the patient emergency contact person’s name in this field.

Contact Rel. From the drop down box, select the patient's emergency contact relation. 1 = Spouse, 2

=Child, 3 = Parent, 4 = Sibling, 5 = Other

Contact Ph Enter the patient's emergency contact person’s phone number.

Ext Extension number, if applicable

Emp St Patient’s employment status: 1-Employed, 2-Part Time, 3-Full-Time student.

Employer Patient’s place of employment (Free text format).

Work Phone Patient’s work phone #, if applicable.

Ext Extension number, if applicable.

Balance Account Balance not including pending transactions.

Pat. Balance Patient responsibility balance not including pending transactions.

PIN This field is associated with the Patient Portal feature.

Last Charge Date of the last processed charge, not including pending transactions.

Hold Stm

'N' defaults. If ‘Y’ is entered the patient balance ages and must be manually

removed. Use a Numeric value, the system will count down the number of

statement cycles to hold this also prevents the account from aging.

Initials Enter user initial’s to create a tickler for follow up on this patient's account.

Cycle This is the statement cycle count.

Msg Cd Enter a Statement Message Code for a specific message to appear on the

patient’s statement.

For # of stmts Enter the number of statement cycles a statement message needs to print on a

specific patient’s account.

Minimum Pay Enter a minimum payment amount when the patient is on a payment plan.

Co Pay Populated from the Pt Insurance record, the patient’s copay amount

Family Balance Family Balance, balance of all linked accounts not including pending transactions.

Last Visit Often inserted during a conversion, this optional field requires an 8-digit date format

(MMDDYYYY).

Acct. Age This is the age of the account.

Collection Flag

After charges are posted enter ‘F’ for ‘Force’ or ‘S’ to ‘Suspend’.

• For accounts with ‘F’, the application will force an account to be written off

and turned over to the collections agency regardless of what criteria is set on

MM1.22. Once the collection edit process is completed, the ‘Exception Code’ will

automatically update to a ‘CP’ to indicate that the account will be with a

collection agency, and the ‘Collection Flag’ field will be reset to null.

• For accounts with ‘S’, the application will suspend an account from being

written off and turned over to the collection agency. When the collections edit runs,

the application will bypass accounts that have the ‘Collection Flag’ set to ‘S’

regardless of the balance or the collection parameters. The program will leave the

‘Collection Flag’ set to ‘S’, which will keep the account from being sent to collections,

until the ‘S’ is manually removed.

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The user saves the new demographic information for the patient by selecting the ‘Save’ icon or by using

the <F4> Function key.

If the user attempts to exit without saving the following pop-up will display.

Updating an Existing Patient’s Guarantor Information

Users only have to update the guarantor’s address if the Relation is something other than a ‘1’ in the ‘Patient

Account’ screen. If the patient is the guarantor any information updated on the ‘Patient Account’ screen will

automatically update on the guarantor screen.

Step by step to update existing patient’s guarantor information: The user selects the patient to update the guarantor information.

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The user selects the LOV.

The application displays the ‘Guarantor Setup &Maintenance’ form.

The user updates the pertinent Guarantor information in this screen. The record is then saved by selecting the

‘Save’ icon or the <F4> Function key.

Field Name Field Description – Guarantor Setup & Maintenance

Group Group code

Guarantor # Guarantor Number

Guar Name Guarantor Name

Address 1 Street Address

Address 2

The post office reads an address from the bottom up, therefore try to keep all address info on

line 1 and only use this row if absolutely necessary. This field can be used for ‘In Care of’, if

needed.

E-mail Email address (must include @ symbol)

Zip Zip Code Note: format will adjust with Country choice.

City City of residence (will auto-populate after zip code is entered) Enter correct information if

patient's address is different from the guarantor's.

ST State of residence (will auto-populate after zip code is entered)

Country



‘Execute Query’ icon from the Task Bar displays the list of countries. By selecting

<F1> Function key or the ‘Enter Query’ icon from the Task Bar, the user can enter

the name of the country in the Country field and select <F2> Function key or the ‘Execute

Query’ icon from the Task Bar to display the queried country.

Home Phone Home phone number

Cell Phone Cell phone number

Birthdate Date of Birth requires an 8-digit format (MMDDYYYY).

SSN Social Security Number – Management for the practice decides whether this field is required

or not. If used it must be entered in a nine-digit format.

Marital Status

Valid entries for the Patient’s Marital Status: 1-Single, 2-Married, 3-Unknown, 4-Divorced,

5-Widowed, 6-Legally Separated (as displayed on the Help Message Section in the lower

left corner of the screen)

Race

Race of the guarantor. Select the LOV or List of Values button, a window populates with

possible entries. Each entry with this symbol beside it can be opened by a mouse click

to view additional valid entries. Locate the correct entry then use the ‘Sticky Cursor’ feature

to pull the code back into the field. This data pushes to an interfaced EHR validating one

requirement of meaningful use.

Ethn

Ethnicity of the guarantor. Select the LOV or List of Values button, a window populates with

possible entries. Each entry with this symbol beside it can be opened by a mouse click

to view additional valid entries. Locate the correct entry then use the ‘Sticky Cursor’ feature

to pull the code back into the field. This data pushes to an interfaced EHR validating one

requirement of meaningful use.

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Lan

Language of the guarantor. Select the LOV or List of Values, locate the correct entry, use the

‘Sticky Cursor’ feature to pull the code back into the field. This data pushes to an interfaced

EHR validating one requirement of meaningful use.

Comments Free text field for comments

Emp Status Employment status: 1-Employed, 2-Part Time, 3-Full-Time student

Employer Place of Employment

Employer

Phone # Work phone number

Ext. Work phone extension

Stmt Cycle Statement Cycle is auto populated

Current Cycle Current Cycle is auto populated

Return Stmt If statement is to be returned to office instead of directly to patient, enter ‘R’.

Hold

Statements Used to hold Guarantor statements with ‘H’

Billing Message Displays ‘Y’ if billing message will print, default ‘N’

Max Pat

Billings Auto populates numeric value in master table

Patient Billings Free text field

Updating an Existing Patient Insurance Record

The user selects the patient to update the insurance information.

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The user selects the tab or <F8> Function key on the keyboard.

The application displays the ‘Patient Insurance Record’.

Updating a patient insurance record When the Patient Insurance Record screen launches, the primary insurance displays as '1' in the

Filing Sequence field. The user can change the filing sequence view by selecting the <down

arrow> key on the keyboard until the insurance to be updated is displayed. The user can also use

the <up arrow> key to display a previous insurance record.

When the insurance to be updated is displayed, the user updates any pertinent information regarding

the effective/expiration dates, insurance company and/or the Insured Information.

If the patient has new primary insurance, make sure that an effective date and expiration date is

entered for the old insurance. Then <down arrow> until the sequence ‘1’ is displayed, enter the

new primary insurance ensuring that the effective date is after the old primary expiration date. After

save, the user will see an asterisk on the patient account screen identifying there are multiple

insurance records in the sequence as shown here.

The user saves the new information by selecting the ‘Save’ icon or <F4> Function key on the

keyboard.

Changing a current primary insurance to secondary to add a new primary when

there is no other insurance listed

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If a current primary insurance should now be secondary, and there is no other insurance listed, the

user changes the filing sequence to ‘2’ and saves by selecting the ‘Save’ icon or <F4> Function

key on the keyboard.

The user then selects the down arrow key on the keyboard to populate a blank screen for entering the

new primary insurance and the filing sequence will display as ‘1’.

The user enters the new insurance information as well as the Insured Information and saves by

selecting the ‘Save’ icon or <F4> Function key on the keyboard.

Changing a current secondary insurance to tertiary and a current primary to

secondary to add a new primary If there is already a secondary insurance that will become tertiary with the addition of the new

primary insurance, the user changes the filing sequence of the current secondary insurance to ‘3’ and

saves by selecting the ‘Save’ icon or <F4> Function key on the keyboard.

The user then selects the up arrow key to locate the current primary insurance and changes the filing

sequence to ‘2’ and saves by selecting the ‘Save’ icon or <F4> Function key on the keyboard.

The user then selects the down arrow key on the keyboard until a blank screen displays with the

filing sequence as ‘1’.

The user enters the new insurance information as well as the Insured Information and saves by

selecting the ‘Save’ icon or <F4> Function key on the keyboard.

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While adding a new insurance, the ‘Relation to Insured field’ will default to a ‘1’, click in the field and the

Help Message displays: If the relationship to the insured is any

number other than a ‘1’, which is the patient, the Insured Information will need to be completed by the user.

Archiving Insurance

Purpose: To preserve expired insurance information.

Users should never delete a patient’s insurance record.

If the patient’s primary insurance is replaced by a new primary, make sure that the effective date

and expiration date fields are completed on the record with filing sequence ‘1’.

Then down arrow until the sequence ‘1’ is displayed, enter the new primary insurance ensuring that

the effective date is after the old primary expiration date. After save, the user will see an asterisk

on the patient account screen identifying there are multiple insurance records in the sequence as

shown here.

The user saves by selecting the ‘Save’ icon or <F4> Function key from the keyboard. If any

previous dates of service should ever need to be refilled to an old insurance, it will now be possible

to do so. The user will be prompted with a pop-up window for direction on resubmitting closed

claims.

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If the user selects ‘Yes’ then the below pop-up window will present with the effective date entered as the

starting date, however the user may manually edit if applicable. Select ‘No’ or ‘Cancel’ if closed claims do

not need to be resubmitted.

The user then enters the new primary insurance using filing sequence ‘1’

Choose the Insurance key by entering the code if known, or by querying the ‘Insurance Master

Record’ screen. Refer to ‘Accessing the Insurance Master Record’ Section below.

The application will not allow two insurances in the same sequence with the overlapping effective dates,

users will see the following pop-up alerting that the dates are overlapping.

The ‘Patient Account’ screen will show an asterisk (*) by the INS field indicating there is more than one

insurance for the specific sequence.

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Accessing the Insurance Master Record

Purpose: To obtain Insurance information referenced on the ‘Insurance Master’ from the ‘Patient Insurance

Record’ screen.

If the company Insurance key code is unknown, the user can select the LOV button from the

‘Patient Insurance Record’ to open the ‘Insurance Master Record’. This screen displays initially in ‘Insert’

mode so the user will always have to start a query by selecting the ‘Enter Query’ icon on the taskbar or <F1>

on the keyboard.

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Step by step to look up an insurance key on the Insurance Master Record:

Select <F1> from the keyboard or the ‘Enter Query’ icon from the Task Bar.

Select <tab> or <enter> or use the mouse to click into any searchable field across in the left box

using partial or complete information such as company name, address, city, zip, etc.

The ‘Clinix Wildcard’, the percent sign (%) can be used for conducting the query. When search

criteria are entered, the user selects <F2> from the keyboard or the ‘Execute Query’ icon from the

Task Bar. The application will search for all entries entered before, between, or after the ‘Clinix

Wildcard’, the percent sign (%).

The user can select the icon from the Task Bar or the <down arrow> key on the keyboard to

review all query results if there is more than one record retrieved.

When the correct insurance is located, the user selects the from the Task Bar or <Ctrl Q> from

the keyboard to exit back to the ‘Patient Insurance Record’.

This action displays the ‘Insurance Key Code’ in the Company field.

The user selects <tab> or <enter> and the Name of the Insurance Company and the Insurance

Type displays.

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Entering Insurance for an Existing Patient with No Insurance History

In MM7, the user selects the patient in order to update the insurance information. The user selects the

tab or <F8> Function key from the keyboard. The application displays the Patient Insurance

Record.

When the Patient Insurance Record launches the user will view a blank screen except for the ‘Group Code’

and ‘Account Code’ which both copy over from the Patient Account screen. The number ‘1’ will display in

the ‘Filing Sequence’ field since the user is entering insurance for this patient for the first time.

The table below gives further information for the Field Name and Field Descriptions.

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Field Name Field Description – Patient Insurance Record

Group Code Group number. It will automatically default IF the group default is set.

Account Code Patient’s account number will automatically populate.

Filing

Sequence System auto-populates the '1'-Primary Insurance.

Company

Select patient’s insurance carrier by clicking on the LOV button or by typing the insurance

key code of the specific insurance company stored in the Master Table. As explained in the

‘Accessing the Insurance Master Record’ section.

Name Insurance Company Name will automatically populate according to the Company code

selected.

Insurance

Type

Type of Insurance, which is set up in the Insurance Company master record, and therefore

auto-populates after the Insurance Company code is entered

Policy Policy ID# , required field.

Group Policy Group #, if applicable.

MSP Use this LOV button to look up the scenario that determined the patient’s Medicare to be

secondary, when applicable, this is required.

Copay

Enter the patient’s copay dollar amount for this insurance company here, then the copay

amount field will be auto-populated at the time a copay is being posted and also prompt the

user that the patient has a copay at the time of check-in/registration.

Effective

Date Effective Date of the policy requires 8-digit date format (MMDDYYYY).

Expiration

Date

Expiration Date or termination date of the policy, requires 8- digit date format

(MMDDYYYY).

Return

This field indicates how the user would like the claim handled for this insurance company

on this patient. A ‘1’ in this field, will drop the claim to paper once. An ‘R’ prints claim to

paper every time. An ‘S’ prints the claim to paper: this is the ClinixPM ‘safety catch’ for

any claims that should have gone electronic but for some reason would not. The claims also

drop to paper for a doctor’s signature, if needed, prior to mailing.

Initials Enter the user’s initials to print on the paper claim when entering a ‘1’,’R’ or ‘S’ in the

“Return Field” above.

Network If applicable, select Network by clicking on the LOV button for options.

PCP Primary Care Physician record number.

First Primary Care Physician’s first name.

Last Primary Care Physician’s last name

Member ID Member ID# to process claims, if applicable.

Well

Coverage

‘Y’ or ‘N’ to indicate if this insurance pays for Well Visits, such as physicals and other

preventative services. If signed up for Passport, this will update automatically, otherwise

the field can be updated manually when eligibility is checked.

Deductible

Remaining

Dollar amount representing the remainder of the deductible that the patient/subscriber has

yet to meet before the insurance will pay. If signed up for Passport, this will update

automatically, otherwise the field can be updated manually when eligibility is checked.

Co-Insurance

Dollar amount representing the percentage of the allowed amount of the claim that the

patient or other insurance will be billed. If signed up for Passport, this will update

automatically, otherwise the field can be updated manually when eligibility is checked.

Co-Ins %

Percentage representing patient/subscriber’s out-of-pocket expense. If signed up for

Passport, this will update automatically, otherwise the field can be updated manually when

eligibility is checked.

Last This will display the last date of eligibility check if through Passport.

Eligibility Will identify results of eligibility checking.

Accept ‘Y’ or ‘N’ to indicate if the practice will write off non-allowed charges or hold the patient

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Assignment responsible. This required field will auto populate from MM1.4.

Auto Print

Insurance

This field defaults to a ‘Y’. ‘N’ indicates the user does not want an insurance claim to

generate.

Signature Status Defaults from Signature Master File.

Relation to

Insured

This field indicates how the patient is related to the subscriber or insured. Default is‘1’-

Patient. Must choose appropriate relation as follows: 1=Patient, 2=Spouse, 3=Child,

4=Other

Insured Name Last Name, First Name, and Middle Initial of subscriber or insured, If relation is 1-Patient,

this is automatically populated.

Address 1 Insured’s address .

Address 2 The post office reads an address from the bottom up therefore try to keep all address info on


City/State Insured’s city of residence (will auto-populate after zip code is entered).

Country







Zip Code Insured’s zip code; Note: format will adjust with Country choice.

Telephone Insured’s phone number.

Birthday Insured birthdate (8-digit date format MMDD YYYY). If (med)option set, this can be

required.

Sex Gender select ‘M’ for Male, or “F” for Female. If (med) option set this can be required.

Employer Insured’s employer.

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Miscellaneous Insurance Section

Use only if the insurance of the patient will not be added to Insurance Company Master Table or if the claim

needs to go to a different address or department other than what is in the Master Table. Insurance key code

must be identified with a ‘Y’ on the insurance master to access this section.

Field Name Field Description –Patient Insurance Record (Miscellaneous Insurance)

Name Insurance Company Name.

Address 1 Insurance Company’s Address .

Address 2 The post office reads an address from the bottom up therefore try to keep all address info on


City Insurance Company’s City (will auto-populate after zip is entered).

ST Insurance Company’s State (will auto-populate after zip is entered).

Country USA will default. To select a foreign country, the user activates the cursor in the Country






Zip Code Insurance Company’s Zip Code; Note: format will adjust with Country choice.

Telephone Insurance Company’s phone number.

Ext Insurance Company’s phone extension, if applicable.

Once all information is complete, the user should save by selecting the ‘Save’ icon or by selecting the

<F4> Function key.

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Repricing and refiling claims after updating primary insurance

For multiple fee schedules, if the user changes the primary insurance from one 'Insurance Type' to another

that will affect the price of the CPT codes the user will see the screen below:

By answering 'Yes' to the question above, the application will reprice the CPT codes based on the fee

schedule of the new primary insurance.

If known enter the date when the insurance change is effective in the start date field. This tells the

system how far back to go and refile or resubmit claims. If the effective date is not known enter

'today's' date so nothing gets refiled or resubmitted.

When the user enters the starting date the pop-up below displays. Based on the starting date of the

new primary insurance and the repriced CPT codes of the fee schedule there might be charges to bill to

the new primary. The user answers 'Yes' or 'No' to 'Close and Refile' the claims appropriately.

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Exercise

** Use your own last name when creating these patients BUT don't use your SS#**

1. What is the path to create a batch? __________________________

2. What three fields are mandatory to create a batch on the Batch Control screen?

__________________________________________________

3. After creating a batch, which tab is selected to display the Patient Registration Block?

________________________________________

4. How many blocks of information can be on the Patient Registration Block?

1 2 3 4 5 (Circle one)

5. Forms in ClinixPM open in either insert or query mode. How does the Patient Registration

Block open? Insert or Query

6. Name the blocks of information and circle the block considered ‘hidden’.

7. Register yourself as a patient with yourself as the guarantor.

Insurance: Cigna Healthcare HMO insurance

P.O. Box 8915, Bristol, TN 37621-8915

Referring Doctor: Dr. Welby, #100.

Copay: $20

Policy number: 12345602

Group number: ABC123

What is the patient’s account number?______________

8. Register a new patient with the first name Dublin with your last name.

Insurance: United Healthcare Insurance, Utica, NY 13504-3041

Referring: Dr. Welby #100.

Policy: 23456789.

Copay: $15.

Secondary ins: Accordia of Central Indiana

commercial insurance under his wife, Hera’s policy

Sec. Policy: 678901.

What is the patient’s account number?__________________

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9. Register a new patient with the first name Rome with your last name.

Insurance: Accordia Central of Indiana Commercial Insurance

Policy number: 4561240.

What is the patient’s account number? _______________

10. Register a new patient with the first name Athens and your last name.

Insurance: Medicaid P.O. Box 460

Policy #: 43676572

Secondary Ins: AARP coverage

Sec. Policy #: 43676572.

What is the patient’s account number? ______

11. Register a new patient with the first name London and your last name.

Insurance: Aetna US Healthcare

P.O. Box 3925

Referring Dr: Ben Casey, #101.

Policy number: 2587613.

Copay: $6.

Secondary Ins: BCBS, PO Box 2300

Louisville, KY 40223.

Comment: “Get copy of Ins card on pt’s next visit.”

What is the patient’s account number?_________________

12. Update patient Dublin’s address and phone number

13. Update the guarantor’s address and date of birth on patient Rome.

14. Update the policy number on patient Athens.

15. Name the path from the Patient Registration Block to add a Precertification Number.

___________________________________________________________

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ClinixPM Training Signoff

NAME: _______________________________________________

DATE TRAINING COMPLETED _________________________

Demographic Entry and Update - Module 2

Review the Module 2 Signoff topics and tell me if we need to go over something again.

Check

mark Subject

User’s

Initials

The Master Menu

The Batch Control Screen

Patient Demographic Block

Patient Insurance Block

Guarantor Block

Precertification Numbers

Account Comments Entry and Inquiry

Updating an Existing Patient Demographic Account

Updating Guarantor Information

Miscellaneous Insurance

Archiving an insurance record

New Insurance for an Existing Patient with no Insurance History

Repricing and refiling claims after updating the primary insurance

demographic entry and update module 2 entry and... · 2020. 9. 30. · step by step to query an...

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