System Organization and Complete Lifecycle
In Brightree
The system is organized by tools. You pick a tool first, like a Billing Exceptions screen or a specific inventory function, and then search for patients, claims, or items inside that tool.
In NikoHealth
The system is organized by work. NikoHealth is designed around work queues and workspaces, not individual tools. You pick the work area/queue first, then work the records from there and open full workspaces when you need detail.
NikoHealth Lifecycle
At a high level, the lifecycle in NikoHealth looks like this:
Patient is prescribed equipment or supplies.
Intake creates or updates the patient in NikoHealth and adds/refines insurance.
An Order is created to represent the work you will do (items, prescriptions, documentation, scheduling).
The patient is scheduled and serviced (delivery, setup, pickup, etc.), often via the Niko mobile app.
The Order is completed when the work is done and documentation is in place.
A single Invoice is created for that order in the Billing module.
The Invoice is submitted to the primary payer via the clearinghouse.
The payer (and any secondary/tertiary) adjudicates the claim; payments and denials come back.
Payments (insurance and patient) are applied to the invoice until the balance is zero.
Optionally, Deposits are created to reconcile those payments against your bank deposits.
One Payer with Many Plans
In Brightree
Brightree databases often contain many Payer entries that are really variations of the same payer (for example, “Aetna TX,” “Aetna PPO,” “Aetna HMO,” and so on). That can make configuration and reporting harder to manage.
In NikoHealth
You are encouraged to create:
One Payer record per payer (for example, “Aetna”)
Multiple Plans under that Payer (PPO, HMO, Medicare, Medicaid, etc.)
The Payer holds shared information and IDs, and each Plan can inherit those settings or override them for specific products. This structure is important for both auto-posting ERAs and eligibility, because clearinghouses and payers expect clean ID mappings.
For more information, visit our help article on Adding and Configuring Payer Plans.
CMNs, PARs, and Clinical information
In Brightree
CMNs and other clinical requirements may be tied repeatedly to individual Orders. Physician and diagnosis information can be reused automatically in ways that sometimes lead to wrong combinations on new claims.
In NikoHealth
CMNs and similar documents are usually logged at the Patient level so that they can be reused across multiple Orders and Invoices when appropriate. Each Order explicitly asks you to choose the physician and the diagnosis relevant to that episode of care. This means a little more deliberate data entry up front, but it reduces avoidable denials related to incorrect provider or diagnosis information later.
For more information on the Order Workflow in NikoHealth, visit our collection of help articles on this topic.
Using Statuses for better Data Hygiene and Reporting
In Brightree
It is often difficult to delete records once certain actions have occurred. Over time, this can lead to duplicate Patient records and extra Invoices that users are told to ignore.
In NikoHealth
Patients, Orders, and Invoices have clear statuses that let you deactivate or put "on hold" different records. Many records can also be deleted by users if they have the appropriate permissions. These features allow you to:
Inactivate or delete duplicate and test data instead of living with it forever
Use “On hold” for incomplete records that you don't want included in lists and reports.
Fore more information on how statuses are defined in NikoHealth, visit our help articles on Patient Statues, Order Statuses, and Invoice Statuses.
Cost sharing Feature and Patient Responsibility
NikoHealth includes a Cost Sharing feature that helps you estimate what the Payer and the Patient will owe before submission. It uses:
The pricing associated with the items
The Payer’s rules
The benefit information (deductible, remaining deductible, coinsurance) stored on the Patient’s insurance
If this information is present, Cost Sharing can show an estimated Patient responsibility per line and for the Order as a whole. This can help with collections and communication at the time of setup.
For more information, visit our help article on Cost Sharing.