MANSOQ RCM & insurance
Follow an episode from registration to cash
Understand the front, middle and back office controls connecting patient, encounter, account, claim and payment.
Current source · source reviewed · 8 min read
Before you begin
- Access to the correct facility and the Revenue Cycle workspace.
- An encounter and financial account for the patient.
1. Open the episode
From Revenue Cycle, open the Episode worklist and select the patient/account row. Check the patient, encounter and account together before acting. One encounter can have several claims and local invoices; these are separate records.
2. Complete front office evidence
Verify eligibility, review the benefit and network information, and present the responsibility estimate. Use Submit pre-authorization when a draft authorization is available. A positive eligibility response is not a payment guarantee.
3. Complete the middle office checks
Review documentation and coding, audit performed charges, and address the Integrated lifecycle gates and Exceptions and work queues. Recalculate refreshes controls after the underlying facts have been corrected.
4. Build, review and queue the claim
Use Build claim, inspect validation findings and attachments, then use Queue NPHIES claim only when a ready claim exists. A queued exchange is an instruction awaiting processing; inspect the NPHIES transaction lifecycle for the subsequent result.
5. Reconcile the financial outcome
Work payer adjudication and any denial separately. Use the canonical RCM finance workflow for advice, bank receipts and settlement before interpreting posted payments as cash.
What the stages mean
Front Office, Middle Office and Back Office are operational groupings displayed on the case. Readiness summarizes recorded checks; it does not replace the evidence or constitute external certification.
Expected outcome
The episode retains its clinical identity while financial decisions, exchanges, claim versions and settlement records can be followed individually.
Troubleshooting
An episode is blocked
Open the named blocker and route it to its owner. Repair the source evidence, coverage, coding or configuration instead of forcing a financial transition.
Source evidence
References are pinned to the private MANSOQ source repository. Repository access is required to open these links.