Patient Responsibility & Invoicing

What this solves: Billing clients for deductibles, co-pays, and co-insurance, plus any self-pay charges.
Who it's for: Anyone in your agency who works in Billing — billers, practice admins, and front-desk staff who manage client charges.
Outcome: Accurate client invoices generated from claims or events, tracked through to payment.

Key terms

Insurance does not always cover 100% of a service. The part the client owes is called Patient Responsibility, and it can be made up of:

Term	What it means
Deductible	The amount a client pays before their insurance begins to pay.
Co-Pay	A fixed amount the client pays for a service (e.g., $25 per visit).
Co-Insurance	A percentage of the billable amount the client pays (e.g., 20%).
Self Pay	Billing the client directly — used when a client has no insurance, or for extra charges the agency bills to the client.
ERA	Electronic Remittance Advice. The electronic statement from a payer showing what was paid and what the patient owes.

A single claim's patient responsibility can be any one of these, or a combination.

Requirements

Before you start, make sure:

You have access to the Billing module.
For invoicing from claims: an ERA has been imported and contains a patient responsibility amount. You can only create an invoice when there is an amount to bill.
For self-pay invoicing: at least one rate has been configured for the client's insurance.

Where to find it

Everything lives under Billing. The tabs you'll use most:

Tab	Use it to
Remittance Advices (ERA)	Import and review ERAs from payers.
Standalone Claims	View individual claims and their patient responsibility.
Batch Claims	View claims grouped in a batch and their patient responsibility.
Invoices	Create, view, print, and manage client invoices.

View patient responsibility on a claim

When an ERA is imported, Office Puzzle automatically calculates the patient responsibility and displays it on the related claim.

Step 1: Go to Billing.

Step 2: Open Standalone Claims to see an individual claim, or Batch Claims to see claims grouped in a batch.

Step 3: Look for the Patient Responsibility column, this shows the amount owed by the patient. If there's an amount greater than $0, you can create an invoice

Expected outcome: You can see exactly how much the client owes, so you know what to invoice.

Generate an invoice from patient responsibility

This is the core workflow: turn the amount a client owes into an invoice.

Step 1: Go to Billing → Standalone Claims (or Batch Claims).

Step 2: Select the claim(s) you want to bill, by marking the checkboxess on each row. You can:

Select multiple claims for the same client to combine them onto one invoice.
Select claims for several clients at once — Office Puzzle generates a separate invoice per client in a single process.

Step 3: Select Create Invoices > Click on the green arrow > For Client to conform the invoices.

Step 4: Confirm to generate. Office Puzzle creates the invoice(s) and assigns each an auto-generated reference number.

Step 5: Open the new invoice from the Invoices tab to review it.

What's on the invoice: Each invoice is built from the claim and includes:

The client
The patient responsibility as a line item, broken down into co-pay, co-insurance, and deductible
Date of service
Service description
Payer name
Payer reference #

Expected outcome: A new invoice appears in the Invoices list, and the originating claim now shows in-app that the amount has been invoiced — so you won't accidentally bill it twice.

Note: If a claim has no patient responsibility, you can't create an invoice from it. The option will be unavailable.

View and manage invoices

Go to Billing → Invoices to see all client invoices.

The list shows each invoice's creation date, reference, client, amount, and status.

From this list you can:

Action	What it does
Update status	Manually set an invoice's status (see statuses below).
Bulk update status	Select multiple invoices and update them all at once.
Change date	Change the date on an invoice.
Delete	Remove an invoice. The link between the claim and the invoice is updated, so the claim is no longer marked as invoiced.
Export	Select invoices and export them to an Excel spreadsheet.
Print	Print one or more invoices at once.

Invoice statuses

You control the status of each invoice manually. Available statuses:

Status	Code
Created	10000
Confirmed	20000
Rejected	30000
Cancelled	40000
Submitted	50000
Pending	60000
Paid	70000
Partially Paid	70100
Overpaid	70200
Declined	90000

Print or download an invoice

Step 1: In the Invoices list, select one or more invoices.

Step 2: Click Print. Each invoice opens as a printable PDF.

Each printed invoice shows:

Invoice status
Invoice date
Client name
A table of line items

Expected outcome: A clean PDF you can save, print, or send to the client.

Configure self-pay rates (Advanced)

Self-pay rates let you bill clients directly — for clients without insurance, or for extra charges the agency handles itself.

Add a rate

Rates are set at the client insurance level.

Step 1: Go to Clients and select a Client

Step 2: Navigate to Manage > Insurance tab

Step 3Click on the Insurance > Rate tab

Step 4: Add a new rate. Set the:

Rate amount
Currency
Interval
Start date and end date
Billing code(s) the rate applies to

Step 5: Save. You can add multiple rates per client insurance (for example, different rates for different billing codes or date ranges).

Expected outcome: When you invoice a self-pay service for this client, Office Puzzle automatically applies the matching rate.

Create an invoice from events (Self Pay) (Advanced)

Use this to bill a client directly for scheduled events, instead of from an ERA claim.

Step 1: Go to Billing → Invoices.

Step 2: Start a new invoice and set the source. In Select Source, choose Events.

Step 3: Search for and select the event(s) you want to invoice.

Step 4: Generate the invoice. Office Puzzle applies the rate linked to the client for that event and billing code.

Expected outcome: A client invoice based on your configured self-pay rates, ready to manage and print like any other invoice.

Troubleshooting

Problem	Likely cause	What to do
Can't create an invoice from a claim	The claim has no patient responsibility amount.	Confirm the ERA was imported and that the payer left an amount for the client to pay.
Patient responsibility isn't showing	The ERA hasn't been imported, or it contained no patient responsibility.	Check Remittance Advices (ERA) to confirm the ERA imported successfully.
A claim looks like it was billed twice	Two invoices were generated from the same claim.	Open the claim to see its invoiced status; delete the duplicate invoice to restore the link.
An event invoice has the wrong amount	No rate, or the wrong rate, is linked to the client insurance and billing code.	Review the client's self-pay rates and check the billing code and date range.
Deleted an invoice mistakenly	Deletion also unlinks the claim.	Re-generate the invoice from the claim in Standalone Claims or Batch Claims.