Additional Actions before Posting a Pending Adjudication

Version 14.8
Path: Smart Toolbar > Billing button > Adjudications tab

Overview

When processing pending adjudications, you can request OP take further action on any unpaid balance by clicking on the dropdown in the Patient Action or Insurance Action fields, prior to posting the adjudication(s),  as listed below:

  • Insurance Action - In all selections below, the insurance balance (as identified in the Ins Bal column) will be listed as due by the insurance and the next action will depend on your choice of the following options:
  • Hold on Account - No further action will be taken at this time. You would select this option if the insurance balance is to be held as outstanding pending claim appeal, review, or reprocessing.
  • Xfr Sec - The referenced insurance balance will be transferred to the insurance you select for submission as a secondary claim. Once selected, the corresponding claim will be automatically sent to the Claims Queue with its stage set to Secondary.

You will be given two options based on the insurance IDs listed on the patient account. Be sure to select the correct ID.
  • Xfr Prim - The referenced insurance balance will be transferred to the insurance you select for submission as a primary claim.
    Once selected, the corresponding claim will be automatically sent to the Claims Queue with its stage set to Primary.

You will be given two options based on the insurance IDs listed on the patient account. Be sure to select the correct ID.
  • Patient Action - In all selections below, the patient balance (as identified in the Pat Bal column) will be transferred to the patient and the next action will depend on your choice of the following options:
  • Hold on Account - No further action will be taken at this time. You would select this option if the patient responsibility is a significantly small amount and you do not want to generate a patient statement at this time.
  • Create Statement - The referenced patient balance will be sent to the Statement queue awaiting printing by your office.
  • Autopay with PC ($x.xx) - The referenced patient balance will be paid with the patient's available credit. If there is an available credit, this selection will identify the amount of the available credit.
  • Autopay with CC only - OP will attempt to utilize a pending credit card on file to pay the referenced patient balance.

Saving Credit Cards on file is only applicable if user is signed up for Instamed merchant services.
  • Autopay with PC + CC - OP will attempt to pay the balance with any available Patient Credits first then proceed to pay any remaining balance with a saved Credit Card on file´╗┐.

 Adjudications tab