Create a New Patient with a Prospective Treatment Episode

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You can create a Prospective Treatment Episode to record patient information and run a preliminary eligibility check and record the patient's insurance benefit details prior to admission. 

Prospective patient treatment episodes can be converted to admitted patient treatment episodes if the patient admits, reducing the need for duplicate data entry. You can create prospective treatment episodes for both new and existing patients. 

Create a New Patient and Prospective Treatment Episode

Let's review how to create a prospective patient treatment episode for a new patient. If you need to add a new prospective treatment episode to an existing patient, please see the next section. 

  1. Select the Organization and Practice, then navigate to the Patients page.
  2. Click Add New Patient.
  3. The first section of the wizard allows you to collect Patient Details

    At minimum complete:

    • The patient's First Name and Last Name.
    • Gender is not required but will need to be added at some point to resolve the Patient must have a specified Gender TODO alert.
    • The patient's Birthday.
    • Select at least one Associated Practice

    Click the Next: Add Treatment Episode button to continue.

  4. The Add Episode section allows you to choose whether to create a Prospective Episode or an Admitted Episode. Choose Prospective Episode

    At minimum:

    • Select a Practice
    • Enter the Anticipated Admit Date. 
    • Add at least one Diagnosis Code. You can use the + button to add additional diagnosis codes. 

    Next, you have two options:

    • Choose Add Patient and Episode Only to finish creating the prospect without insurance details.
    • Choose Next: Add Insurance to move to the next step in the wizard and add the prospect's insurance details.
  5. You can include the patient's Medical, Home, and Behavioral payer from the Add Insurance window. 

    All fields on this page are optional. 

    • Enter the policy's Effective Date
    • Use the Payer field to select an insurance. By default, the first payer added is the patient's Medical payer. 
    • If you would like to add the Home Plan or Behavioral Payer, please use the related links. 
  6. Additionally, this new view makes it very simple to add new payers to the practice. Simply select the radio button for New Payer or New Paper Payer to add a missing payer to the practice.
  7. Next, you have two options:
    • Choose Add Patient, Episode, and Payer Only to finish creating the prospect without Policy information.
    • Choose Next: Add Policy Info to move to the next step in the wizard and add the prospect's insurance details.
  8. The last section allows you to add the patient's insurance policy details:

    At minimum:

    • Add the Insurance ID
    • Select the Patient Relationship to Insured
    • If the relationship is not Self, please complete the First Name and Last Name fields for the subscriber. 

    To run an eligibility check, toggle on Verify Eligibility on Save.

    Click Finish to create the prospective treatment episode and run the eligibility check, if enabled.

    Click Finish to create the prospective treatment episode.

Patient Billing

For clients who have purchased Patient Billing, as soon as the prospective treatment episode is created for the patient, you have access to the Patient Billing tab. The only tab that won't be available is Services. From here, you can collect payments prior to admission.

Run a Manual Eligibility Check

Use the following instructions to run a manual eligibility check.

  1. Open the patient's prospective treatment episode.
  2. Open the Insurance tab.
  3. Click on the Primary insurance set (you can also add the Primary payer by clicking [Create] if no insurance has been added, click here for instructions on adding insurance).
  4. Open the Eligibility tab and click Check Eligibility.
  5. Add plan benefit details in the Benefits tab.

For assistance creating and adding insurance please see How to Add Insurance.

Convert Prospective Treatment Episode to Admitted 

If the patient does admit to the Practice, you can convert the prospective treatment episode to an admitted treatment episode by clicking on the Admit button from the patient's Treatment Episodes tab. Please review the steps below.

  1. Locate the patient and click to open their chart.
  2. From the Treatment Episode, click Admit.
  3. This opens the Admit Episode window, which walks you through adding the missing treatment episode information, insurance, and policy information, if not already added.
  4. From the Admit Episode section:

    At minimum:

    • Select the A/R Classification for this patient. 
    • Add their Admit Date. This will prepopulate with their previously entered Anticipated Admit Date.
    • Enter the Patient's Street Address, City State, and Zip Code. While this field isn't required, you will need to add it at some point to resolve the To do: Treatment Episode must have a completed Patient Profile alert.
    • Add at least one Diagnosis Code. You can use the + button to add additional diagnosis codes. 

    To add insurance and/or policy information, click Next: Add Insurance.

    If you've previously entered the insurance and policy information, click Admit Episode Only.  

  5. Please see the Insurance and Policy information sections previously covered above for instructions on completing these sections. 
  6. Once you've completed adding the admitting information, you'll receive an Episode admitted successfully! alert.

Archive Patient

If the prospective patient does not choose to admit, you can archive their profile.

  1. Locate the patient and open their Profile tab.
  2. Click Archive Patient.
  3. You can locate Archived patient profiles using the Patient Status list.
  4. You can also unarchive a patient if they return to your facility later, which is why we recommend archiving prospective patient records rather than deleting them.

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