Billing FAQs

Why are there duplicate charges for Surveys and Labs on superbills?

Duplicate charges typically occur for Surveys and Diagnostic Tests because a CPT code has been associated with the item in the Order/Workflow tab in the Encounter or Well Visit Templates. To avoid these duplicate charges, it is recommended to associate the CPT code in the respective setup area of OP for Surveys and Diagnostic Tests and not in the template. Within Encounter Templates, only Procedures should have CPT codes associated. Further, no E/M Codes should be attached to Encounter Templates.

Tip: Applying a Procedure Template more than once will cause duplicate CPT codes to appear under Coding within the template. Remember to remove any duplicate codes prior to saving the Note. Saving the Note will cause these duplicates to automatically push to the superbill.

  1. Review your templates to see if a CPT code has been associated with a Survey or Diagnostic Test in the template. 
  1. Navigate to Clinical tab > Encounter Templates or Well Visit Templates and select a template.
  2. Click the Orders/Workflow tab.
  3. Click the Surveys tab, and confirm that the CPT field is blank.
  4. Click the Other Tasks tab, and confirm there are no CPT codes associated with Diagnostic Tests. Note: While Diagnostic Tests are typically tasked from the Diag tests tab and not the Other Tasks tab, it is still recommended to check Other Tasks for CPT codes that may be causing duplicate charges.

  1. Review Survey setup by navigating to Clinical tab > More button (Customize group) > Surveys. Once you open the Survey, you'll associate the CPT Code by entering it or selecting it in the Default CPT field.

  1. Review Diagnostic Test setup by navigating to Clinical tab > More button (Customize group) > Diagnostic Tests. Once you open the Test, you'll associate the CPT Code by entering it or selecting it in the CPT code field.

Tip: Rather than open up each Test to confirm the CPT code is associated, you can easily review the list of Tests to which Tests do not have a CPT code already associated.

How do I make collection fee automatically bill with lab?

You can utilize the Blocked and Substitute feature in OP so that each time the a test such as glucose or hgbA1c is ordered, it will add the collection code. You have the option of setting this up for individual payers or for all payers.

How do I change a diagnosis code after a note is finalized?

You cannot go back and add the diagnosis directly to the note, but you can create an addendum to indicate that you have changed the diagnosis.

To rebill the claim with a correct ICD code, edit the archived transaction by adding the new ICD on the Basic Info tab associated with appropriate CPT codes and then re-queue the claim. Add a claim note so that you know what has been done.

How do I see all charges for day's visit when in note?

If you are in an encounter, you do not have to close out of the note. Click on the Superbill button that is on the top toolbar, and it will show you what codes have been already added to the visit for a diagnostic test or an immunization. Once a diagnostic test or immunization has been documented the code will automatically be sent to the superbill, so if they are appearing in your summary there will be a charge on the superbill.

Another way to view all the charges for a visit is to go to the Schedule > Tracking and check Billing Reconciliation. From here, highlight the visit and you will see all charges associated with the visit.

On the Coding tab of the visit, you will only see codes that have been added directly to the Coding tab, such as the E&M code or a procedure code. Codes that have been added to the Procedure tab of a template will also appear on the coding tab.

How do I add more than 4 diagnosis codes to a claim?

You are able to add 4 diagnoses per CPT code with a total of 12 per claim. This is per 5010 guidelines. You are able to add as many diagnoses as you want to the note itself.

You also have the option to document and bill for a separate visit with the appropriate codes if you are seeing a patient for a well visit, and providing care for a separate identifiable service.

How do I run my statements?

Bulk statement batches are created from the Statements tab of the Billing Center. When bulk statements are created, the settings in Global Preferences are applied.

  1. Select Billing Center from the Billing tab.
  2. Click on the Statements tab.There may be statements already in the Statement Queue. They will remain under this tab until you delete or send/print them, so you can let them accumulate for the whole day, or even until the end of the week, before printing everything all at once. Statements may exist here already if:
  •  While posting payments, you selected the patient action, Create Statement.
  • Or, while in a patient account, you selected to Queue a Statement.
  1. Ensure the Unsent only checkbox is selected.

NoteThe Unsent only checkbox needs to be selected in order to create batch billing statements. If you have this box unchecked, you will see the history of all the statements that were previously transmitted.

Batch Billing Statements

  1. Click on the Bulk Stmts button in the Statement Queue. The Batch Billing Statement window is displayed.

  1. Identify your statement parameters.
  1. Transaction dates: The system defaults to All, to include a specific range of transactions enter the begin and end date range.
  2. Exclude older than: Click the checkbox and enter a date to exclude claims older than the specified date. This is pre-populated based on the number of days selected in Global Preferences, but may be changed during statement batching. A change here will not change the Global Preference.
  3. Last name of guarantor: This is only available when more than ONE guarantor's last name group is selected in Global Preferences. 
  4. Medical home: The system defaults to All, allowing you to print statements for patient balances regardless of the Medical home listed in the chart. Deselecting All and selecting a location for the dropdown generates statements for the specified location ONLY.
  5. Custom messages: Enter a custom message to appear on your statements to add onto your dunning message or replace your dunning message. 

Tip: After all statement parameters have been addressed, you may want to click the Save Preferences button and confirm the saving of the preferences in the Batch Billing Statements window. The saving of your preferences will lock in your selections so that they are defaulted the next time you launch the Batch Billing Statements window.

  1. Click the Begin Batch button to to begin to generate statements for patients with balances based on criteria set. A confirmation window will display the statements that match the criteria you identified. Click Yes to continue.    

  1. The system will generate batch statements for all patients matching the criteria identified above. Once the process is complete, the dialog box closes and you are returned to the Statements window.

NoteIf the intention is to create "batches" of statements meeting different criteria and using different custom messages, you can repeat the steps listed above to set new parameters to identify another range/batch of patient statements.

Back in the Statement Queue, the user will see all statements generated to be printed or sent via electronic statement file.   

  • If mailing statements from your office, select the Stmts button and select Yes to print statements.
  • If sending an electronic statement file to the clearinghouse, click the Create Files button and select Yes to create a file for transmission to the mailing house.
    • A progress window will appear, and when complete, will prompt you to send the file.

How do I put a patient in collections for bad debt?

While there is currently not a Collections module in OP, you can still set the patient's status to indicate their financial standing with the practice. To change a patient's status to In Collection:

  1. Navigate to the patient's chart.
  2. Click Basic Information.
  3. Use the Status drop-down to select In Collection.
  4. Click the Save button.

You may also consider adding a Billing Note or a Misc. Note to the chart.

How do I post a patient adjustment?

To post a patient adjustment, follow the steps below:

  1. Navigate to the Patient Chart.
  2. Click Payments in the window navigation panel.
  3. Click the New Payment button.
  4. Ensure you are in the Patient tab (indicated with a pink background).
  5. Select AD Adjustment Only from the Pay Method drop-down menu.
  6. Enter the Adjustment Amount in the Adjustment column for the appropriate procedure code.
  7. Select an Adjustment Reason in the Adj Reason column for the same procedure code.
  8. Click the Save + Close button.

How do I post patient balances and credits to OP from prior system?

To post patient balances to OP from a prior (legacy) system, follow the steps below:

  1. Navigate to the patient's chart.
  2. Click Charges in the Window Navigation Panel.
  3. Click the New Claim button. The Add/Edit Charges window is displayed.
  4. Click the SP button in the Payer(s) section of the window to clear the patient's insurance for the claim.
  5. Select the Rendering Provider.
  6. In the Diagnosis section of the window, search for and select a 'balance forward' diagnosis or another miscellaneous/administrative diagnosis code.
  7. In the Add CPT field, search for and select BEGBAL (or another CPT code set up by the practice). 
  8. In the Unit Chart and Charge amount fields, enter the amount of the patient's balance to be moved to OP. 
  9. Click Save. If you click Save + Queue, the claim will be added to the transmit queue and will have to be removed.

To post patient credits to OP from a prior (legacy) system, follow the steps below:

  1. Navigate to the patient's chart.
  2. Click Credits in the Window Navigation Panel.
  3. Click the New Credit button.
  4. From the Pay Method drop-down, select Transfer (general). Selecting this method prevents the credit from looking like new revenue.
  5. In the Patient Credit Amount field, enter the amount of the credit from the prior system.
  6. Click Save. The credit is now available in OP for allocation to a patient balance.

Can I daysheet if I am not done with charges from day before?

Yes, you can daysheet even if you are not done with charges from previous day. The importance of running a daysheet is to lock in the payments and prevent them from being deleted. If a payment is deleted/voided prior to posting the daysheet, it will not show in the audit log, reports, or the Patient's Account. As for charges, you are able to run reports based on the DOS, therefore you will still be able to filter for them regardless of what daysheet(s) they were posted on.

How do I align HCFA form?

Due to various printer setup and configurations, you may find that when printed, HCFAs are misaligned. To correct this, try some of the following options as they apply in the Print Settings window:

  • Select Actual Size instead of Shrink to Fit or Fit to Width
  • Change the Custom Fit Percentage to a different value (for example, change from 100% to 102%)

How do I process and reconcile Instamed Portal payments?


Integrating with Instamed Merchant Services for payment processing services allows for payments to be made securely, simply, and conveniently. Credit cards can be saved on file directly in OP for easy application to patient balances.

Posting Credit Card Payments (Copays)

  1. Click the Schedule button located in the Billing, Clinical, or Practice Management tab. 
  2. If not already selected, select the Calendar radio button. 
  3. Locate and double-click on the patient's appointment. The Add/Edit Appointment window opens.
  4. Click the Copay button. The Patient's Credit Account window opens with the current date defaulted in the Date field.  

Note: Do not click the Activate Card Reader button.

  1. From the Pay Method dropdown, select Credit card (present).
  2. Click in the Name on card field.
  3. Swipe the credit card. The card information will populate in the fields.
  4. In the Patient Credit Amount field, enter the payment amount.
  5. Click the Save / Post button. A status bar will appear as the transaction is processed through Instamed.
  6. A popup window will display the message that the transaction was either approved or denied.
  7. If the transaction is approved, another popup message will ask if you would like to print a receipt.

Tip: It is important to follow the instructions above step-by-step to minimize errors. If the steps are done out of order, you can close the credit window and retry the steps in the exact order listed above.

Tip: Credits card payments that are taken for patients that do not have a scheduled appointment are entered following the same process as above, but from the Credits section of the patient chart.

Reprinting a Credit Card Transaction Receipt

  1. Navigate to the patient's Chart.
  2. Click Credits.
  3. Select the transaction.
  4. Click the Receipt button.
  5. Print receipt.

Keeping a Credit Card on File if Contracted for Credit Card Services

  1. Navigate to the patient's Chart.
  2. Click Credits.
  3. Click the New Credit button.
  4. From the Pay Method dropdown, select Credit Card (present).
  5. Place your cursor in the Name on Card field.
  6. Swipe the credit card. The card information will populate in the fields.
  7. Click the Save on File button.

NoteThis process may be done during the entry of a credit card payment. However, clicking the Save on File button does not process the payment if a payment amount has been entered. The payment will not be processed until the user clicks Save / Post.

Using Auto-Pay with Credit Card on File

Users are able to use a patient's credit card that has been saved on file while posting Insurance payments.

  1. Navigate to the area in which you are posting the Insurance payment. Some examples include:
  • Billing tab > Bulk Payments button
  • Patient Chart button > Payments > New Payment button
  • Billing tab > Billing Center button > Adjudications button.
  1. Indicate the Patient Responsibility amount and Reason of 1: Deductible Amount, 2: Coinsurance Amount, or 3: Copayment Amount.
  2. In the Patient Action field, use the dropdown to select Autopay PC+CC or Autopay CC only.

Removing Saved Credit Card on File from Patient Account

  1. Navigate to the patient's chart.
  2. Click Summary.
  3. Click the Delete button located in the Credit Card on file section of the Account Summary.

Keeping a Credit Card on File if not Contracted for Credit Card Services

For HIPAA purposes, this can not be stored securely in OP.

Why are my CC Payments Showing up as PC?

When using Instamed Merchant for Credit Card Payments, if there is more than one transaction, the first transaction will show up as CC Payment, and the other transactions will show up as PC. Balancing of the payments should be done in the Receipts tab of the Billing Center

Processing Credit Card Refunds in OP

It is an option to do a credit card refund the next business day after the transaction was originally processed.

  1. Navigate to the patient's chart.
  2. Click Credits.
  3. Click the Refund button.
  4. Use the Refund Method dropdown to select how you are removing this credit from the patient. If selecting the Refund Method of Refund credit card, you must have the credit card information available for entry.
  5. In the Refund from Patient Credit field, enter the amount of the credit being refunded.
  6. (Optional) In the Note field, enter a note indicating why this refund is being performed.
  7. ´╗┐Click Save/Post.

Voiding Credit Card Transaction in OP

When credit card transactions need to be voided the same day that they were processed, follow the steps below:

  1. Navigate to the patient's chart.
  2. Click Credits.
  3. Click the New Credit button.
  4. Click the Ledger tab.
  5. Select the transaction that needs to be voided.
  6. Click the ´╗┐Void button to refund the transaction. A confirmation window confirms you would like to void the transaction.
  7. Select Yes or No in the confirmation window to confirm you would like to void the transaction.
  8. Print the receipt or close the Print Preview.

Pulling Payments Made on the Instamed Portal into OP

Practices must process the payment reports (DPA files) from Instamed into OP. DPA payment files can be brought into Office Practicum the next business day. Users can log into the Instamed site throughout the day to see what is being paid by patients.

  1. Click the Billing Center button located in the Billing tab.
  2. Click the Claims (A/R) tab.
  3. Click the Fetch button
  4. Click the Process button. Payments from the DPA file are auto-applied to the newest of the patient's balances.
  5. Click the Receipts tab.
  6. Filter the Deposit Source column to show Portal payments.

Balancing Payments from DPA files 

The balancing or allocating of DPA files is recommended to be done before running a daysheet so that payments can be confirmed in the Receipts tab of the Billing Center. When reviewing credit card payments in OP, those with an Auth Code have been successfully transmitted to InstaMed. Therefore, you can safely assume the payment is underway.

  1. In the Billing Center, click the Receipts tab.
  2. Compare the credit card payments listed against Instamed's End of Day (EOD) report engine daily.

To access Instamed's EOD Report:

  1. Log into your Instamed Portal using your login credentials.
  2. Select the Payment tab.
  3. Select the Payment History tab.
  4. Select EOD (end of Day Summary).
  5. In the Date field, select the date for which you would like to balance.
  6. Leave the Users field blank.
  7. Leave the Outlet option blank to run this report for all outlets. 

Note: Always leave the Outlet option blank. If you are processing DPA Files into OP for online payments via the InstaMed portal, and you don't have the right outlet selected, the payment data will not match.

  1. Click Search.

NoteIf you have questions about a certain payment or if something in InstaMed does not match with OP, it may be best to contact Instamed. They can see each payment and authorization/denial codes related to them. In addition, they have the ability to see if a payment was deposited into your bank account or when it is scheduled to be deposited.

How do I correct charges if I clicked cancel while posting and now charges show as posted?

  1. Navigate to the Charges section in the Patient Chart.
  2. Select the charge(s) in the Posted Charges section of the window. 
  3. Click the Edit button and make the necessary change(s).
  4. Click Save or Save + Queue.

If I void payment taken at front desk and applied during charge entry, where does the money go?

If a payment is voided prior to daysheeting then it is deleted from OP. There is no record of the payment as it will not be reflected in the audit log or in the patient's account.

If a payment is voided after it was posted on a daysheet then the money will be moved to the credits tab. All actions will be listed in the audit log, on reports, and on the patients claim history.

How do I adjust off a balance at same time as posting copay in charge window?

To adjust off a patient balance while in the payment window, click in the adjustment field and enter the amount to be adjusted. 

Note: You will also need to enter your adjustment reason at this time

How do I post an ERA that has payments that belong to OP and to legacy system?

If you have recently gone live with OP, you may receive ERAs that contain claim payments for claims in your former billing system (also known as legacy system). Only the payments that belong to OP claims can be posted in OP. 

This means that the ERA will appear that it does not balance. For more information on reviewing an out of balance payment, click here.

What do my claim status categories mean?

The claim categories group your claims according to the last claim phase the claim went through. For example, after your claim has been transmitted, it will have a Q2 category, indicating "Transmitted."

Note: The categories rarely have to be manually changed.

The other category changes occur when either an OP user makes a change with the claim, or a response is received from the clearinghouse or payer. For example, if a claim is transmitted, it will be a Q2 category and then when the clearinghouse has accepted the claim and forwarded it to the payer, the category will automatically change from a Q2 to an A1, indicating "Accepted for Adjudication."

To learn more about how the claim status categories are defined, click here.

How do I move a payment posted to the wrong account?

When a payment has been posted to an incorrect account, you'll first want to determine if the payment has been archived.  Archived transactions (or ones that appear on a daysheet) appear in black text, while current transactions appear in blue text.  The steps below are also determined by the source of the payment (Patient or Insurance).

Correcting a Current Payment Posting (Patient or Insurance) 

  1. Click the Account button.
  2. Navigate to the account that has the incorrect posting.
  3. Click the Claims tab.
  4. Expand the date of service to see the payment posting.
  5. Highlight the payment (and associated adjustment and patient responsibility if applicable).
  6. Click the Void button located at the top of the window.
  7. Navigate to the correct Account, and post the payment as you normally would.

Correcting an Archived Patient Payment Posting

  1. Click the Account button.
  2. Navigate to the account that has the incorrect posting.
  3. Click the Claims tab.
  4. Void the incorrectly posted payment (this will create a credit on the patient's account) and adjustment.
  5. Click the Credits tab.
  6. Click the +Refund button.
  7. Select Refund Method: Refund Transfer.
  8. Enter the amount being moved from the Patient.
  9. Enter a Note if desired.
  10. Click the Save / Post button.
  11. Navigate to the account where the money belongs.
  12. Click on the Credits tab.
  13. Click the +Credit button.
  14. Select Pay Method: Transfer General.
  15. Enter the amount being credited to the account.
  16. Enter a Note if desired.
  17. Click the Save / Post button.

Correcting an Archived Insurance Payment Posting

Follow the 12 steps above.  Then, perform the following:

  1. Select Pay Method: Insurance Transfer.
  2. In the Debit Patient field, search for and select the patient who currently holds the credit.
  3. Enter the transfer amount to the right of the patient's name.
  4. Enter a Note (if desired).
  5. Click the Save / Post button.

How can I mark stuck clearinghouse files as reviewed?

Clearinghouse files, such as payments and acknowledgements, can sometimes become "stuck" which causes subsequent files to not pull into OP. Stuck files are usually identified by either an ISC error message (such as when an Instamed portal payment file is stuck) or by a lack of files coming in (such as ERA payment and acknowledgements). There may also be instances where you do not want a specific file to pull into OP.  In either of the above scenarios, you can follow the steps below to mark the stuck file as reviewed and resume file processing as normal:

  1. Navigate to the Administrative Documents Repository: Admin tab > Admin Documents.
  2. Select the Transaction type for the stuck file. Here are some examples:
  • 835 = ERA payments
  • 277, 997, 999 = Acknowledgments
  • PAY = Instamed portal payments (see Example below)
  1. Click the Search button.  All outstanding files are displayed with the stuck file at the top of the list.
  2. Select the Revd? checkbox for the stuck file to mark it as reviewed.
  3. Click the Mark Reviewed button.  
  4. Navigate to the Billing Center: Billing tab > Billing Center button.
  5. Click the Claims (A/R) tab (if processing Instamed portal payments or Acknowledgement files) or the Adjudications tab (if processing ERA payment files).
  6. Click the Process button. The files being held up by the stuck file are processed into OP.
  7. Repeat this process until all files that have not been reviewed have been marked reviewed.

Example: One reason Instamed portal payments become stuck is when the patient account number was incorrectly entered. Users should visit their Instamed account to review patient payments and enter them manually into OP if the account number was incorrectly entered. To review the files in OP:

  1. Navigate to Admin tab > Admin Documents.
  2. Select the Correspondent ID IMD and Transaction type PAY.
  3. Follow the above remaining steps above.

Why won't the insurance rank?

If you are unable to rank an insurance entry, it is likely that there is a space in the Subscriber ID number or Group Number.  To remove the space, simply locate the space and use the backspace function on your keyboard to remove it.  

Note: If a claim has already been submitted under the ID or Group Number with the space, OP will not allow you to make any edits to that insurance record. You will need to recreate the insurance without the space and rank the new entry. 

Why is the same insurance showing as Primary and Secondary?

If you have one insurance entry, but that insurance is showing as Primary and Secondary, then it is likely the the ranking was not cleared prior to switching the ranking. To avoid this, be sure to click the C in the ranking field to clear the existing ranking before selecting P for primary or S for Secondary.

Where does the CLIA number pull from?

CLIA numbers are often required to appear on claims where labs are being billed.  Where the CLIA number pulls from depends on how the claim is being submitted.  

  • For electronic claims (837): the CLIA number is pulled from the CLIA ID field located under Practice Management tab > Practices/Locations > Locations tab and appears in box 23.  You will not see the CLIA number in the Add/Edit charges window, but it will transmit electronically on the claim.
  • For paper claims (CMS-1500): the CLIA number must be manually added to the claim in box 23.
  1. In the Add/Edit charges window or the Edit Archived Claim Transactions window, navigate to the Other Items (1-27) tab.
  2. Enter the CLIA number in the Item 23: Referral # field.
  3. Click the Save button.
  4. Print the claim.

Note: Box 23 is the most typical placement of this information. Depending upon the state in which you are billing, it may be required to record the CLIA number elsewhere on paper claims.

How can I make sure patients are included in my batch statements?

Path: Billing Tab > Billing Center button > Statements Tab > Bulk Stmts button 

Here are a few of the batch statement parameters you can check to ensure that your patients are included in your statement batches.

  • When batching your statements, ensure that Exclude if all sent >= XX times is deselected or the number in the field is high enough to not effect the batching.
  • Make sure the Minimum family balance is set appropriately.

Example: If the minimum family balance is set to $20, and the family's balance is only $10, then that family will be excluded from the statement batch.

  • Make sure the Days since last printed is set appropriately.

Example:  If all patients should receive a statement regardless of when a previous statement was sent, enter -1.

Additionally, you will want to ensure that all patients have a Guarantor and Statement Method selected at the top of the Insurance tab in their Account or Register. To do this: 

  1. Navigate to the Patient Register: (Path: Smart Toolbar > Register button).
  2. Select the Insurance tab.
  3. Make sure that all patients have a Guarantor and Statement Method selected.

For more information on creating batch statements, click here.

How can I set up a payment plan in OP?

Currently, OP does not have a platform for creating or maintaining payment plans. Until a feature for this has been developed, practices may track patients they have put on a payment plan by editing the patients' statuses and making notes on the respective patient accounts. For more information on patient statuses, click here.

How can I view the Current Receipts by specific data?

If you want to change the view of the Current Receipts report, click a link below for further instruction.

How do I reprint a daysheet?

  1. Navigate to Admin tab > Admin Documents. The Repository for Practice Administration Documents is displayed.
  2. Select Transaction type: Daysheet.
  3. (Optional) Enter a Begin and End Date range. This is the date that the daysheet was actually processed. It is not the date of the transactions contained in the daysheet.
  4. Click the Search button. A list of processed daysheets is displayed. 
  5. (Optional) Click the Date column header to sort the data in ascending or descending order.
  6. Click the document icon to the left of the Document Name to view and/or print the desired daysheet.

How do I bill under a Provider's Medicaid Assigned ID?

Medicaid insurances (and sometimes non-Medicaid insurances) commonly require the assigned Provider numbers to appear on claims. The placement of this number depends on the requirements for the state in which you are billing. To reflect that information in the OP software and ensure the payer-assigned ID number appears in the correct location, follow these steps:

  1. Add the Provider's payer-assigned ID number to the Insurance Carrier Provider Information window.
  1. Click Utilities > Manage Practice > Insurance Payers. The Insurance Payers List will open.
  2. Expand the insurance who requires a payer-assigned ID number to be submitted on claims.
  3. Double-click the credentialed provider listed below the payer. The Insurance Carrier Provider Information window will open. For more information on adding credentialed providers to insurances, click here.
  4. Enter the payer-assigned ID number in either the Line 24J ID Number field or the Line 33B ID Number field. The ID type and Entity type should also be populated according to the type of number that has been entered in the ID number field.

  1. Click Save.
  1. Set the Rendering or Billing Loop for the Insurance Carrier. The Loop will depend on where the Insurance Payer requires the payer-assigned number to appear on claims.
  1. If you have closed the Insurance Payers List, navigate back to it by clicking Utilities > Manage Practice > Insurance Payers.
  2. Select the payer that requires the assigned number.
  3. Click the Edit Record button. The Insurance Payer Details window will open.
  4. Click the Claims/Routing tab.
  5. Set the Billing loop (Line 33B) or Render loop (Line 24J) to Provider NPI + payer assigned.

  1. Click Save.

Why don't I see all of the CPT code charges that were in the visit's Coding tab?

Only one instance of each CPT code passes from the visit's Coding tab to the electronic superbill. This rule applies whether or not a CPT code was pulled in from an applied template and whether or not there is a modifier present on the second (or third etc.) code instance. 

However, units of a CPT code may be changed on the Coding tab of a visit and will pass to the electronic superbill.

For example, if a provider adds the following CPT codes in the Coding tab (in this order): 99213, 94640, 94640-76, A7003, the only charges that will appear on the electronic superbill will be: 99213, 94640-76, and A7003. Please note, when a CPT code is entered twice, the most recent duplicate code entry (or second instance added) will be the one passed to the superbill.

What do the codes for payment methods mean?

Payment methods are codes used to indicate how a payment was managed. The codes and definitions are found in Utilities > Manage Codes > Coded Values. The Coded Values table will open. Scroll to locate the payment lists and definitions of:

  • Payment Method

  • Credit Payment Method

How do I suppress a Rendering Provider's NPI from a claim?

  1. Navigate to the Insurance Payer list: Billing tab > Payers.
  2. Select the Insurance Payer.
  3. Click the Edit button to open the Insurance Payer Details window.
  4. Click the Claims/Routing tab.
  5. In the Rendering Loop field, use the drop-down to select Suppress (don't include). The Rendering Provider's NPI will be suppressed from all claims for this payer.
  6. Click Save. 

How do I add more than one modifier to a CPT code?

  1. In the Add/Edit Charges window, click the Show/Hide/Move Columns button. The list of available columns displays.

  1. Select the checkbox(es) to include Mod2, Mod3, and/or Mod4 to include the respective columns in the window.

NoteAfter adding the column(s) to the window, this can be saved as a preference by clicking the Save Preference button .

How do I process remit files that I downloaded from a website?

This content applies to users operating OP On-Premise only.

Once an 835 (or remit file) is downloaded from a website to the local computer, the file can be pasted into the OP > Claimnet folder. Once that is done, the user can navigate to the Adjudications tab of the Billing Center and click the Process button. If no files load, allow up to 15 minutes, and click the Process button again.

How do I add more than one NDC # to a Medication CPT code?

Only one NDC may be directly associated per CPT code in the CPT Code table.   However, OP Aware rules can let you cleverly manage multiple NDCs for a single CPT code by using fake CPT aliases as placeholders.

For example, a practice may stock three presentations of ceftriaxone (J0696), each with its own NDC number:

presentationNDC (from vial)11 digit padded NDC
250 mg vial0409-7337-1100409733711
500 mg vial0409-7338-1100409733811
1 g vial0409-7332-1100409733211

To minimize clicking and maximize automation, a practice might adopt this strategy:

Step one: Create three fake CPT aliases, one for each presentation

The practice adds new CPTs in the usual way and creates three aliases, one for each presentation, by appending a letter of the alphabet.  For example, if a practice creates J0696A for 250 mg vials, J0696B for 500 mg vials, and J0696C for 1 g vials, and adds each to their Meds category, the result so far would look like this:

The practice need not associate NDC numbers with these vials in the CPT creation process.

Step two: Create three new OP AWARE rules to convert each fake CPT alias back to J0696

The practice can use OP AWARE's to automatically convert the aliases back to the proper CPT code -- and add the NDC and CPT units!

For example, here is a sample rule that takes a J0696A (representing a 250 mg vial) and replaces it with a J0696, with 1 unit and the proper NDC for the 250 mg vial:


(The red arrows indicate fields that many users forget to set... don't forget to set the fields, or the rules won't fire!)

Similarly, here is a sample rule that converts J0696B to two units of J0696, with the appropriate NDC for the 500 mg vial:

Finally, here's a sample rule that converts J0696C to four units of J0696 with the NDC for a 1 g vial:

Converting the fake CPT aliases back to J0696 ensures that these fake CPT codes never go out on a claim.  While you should only send proper AMA-compliant CPT and HCPCS codes out on claims, it is perfectly acceptable to use fake CPT aliases in your superbills as placeholders.

Step three: test your work

To ensure that you have set things up correct, do a sample claim for a Testpatient.  Note: you may need to totally restart OP (not just log out and in) for your fake CPT additions and new OP AWARE rules to fire properly.

Before, in the superbill, J0696C is selected to represent 1 g ceftriaxone vial:

And after the charge is converted to a claim, note that now 4 units (since J0696 by definition is "per 250 mg") with the appropriate NDC for a 1 g vial.

Please note: properly formatted NDCs not only contain an 11 digit NDC, they also contain a unit of measure suffix (like ML1 or UN1).  Unit of measure suffixes are required but are not shown in this example.   You could either add them to your OP AWARE rules, or you could manually add them on the claim line if the volumes tend to vary a great deal.

What is a Rebook and how do I correct it on a claim?

A Rebook occurs when a user makes an edit to a claim that changes the status of the claim from Archived to Current and then voids a payment while it is current.

The only way to correct this transaction is to add an Insurance Credit. It is recommended to enter the credit with a Pay Method of Check and the Insurance Check number. This ensures that all payment entries are tied to the check number.