We are currently updating the OP Help Center content for the release of OP 14.19 or OP 19. OP 19 is a member of the certified OP 14 family of products (official version is 14.19.1), which you may see in your software (such as in Help > About) and in the Help Center tabs labeled 14.19. You may also notice that the version number in content and videos may not match the version of your software, and some procedural content may not match the workflow in your software. We appreciate your patience and understanding as we make these enhancements.

Billing Secondary Claims

Version 14.19

Overview

When posting EOBs from payers, there will be instances where the patient owes a responsibility. However, you would not want to send a bill to a patient when there is a secondary payer on file. Please see the step-by-step instructions below on how to send a balance to a secondary payer.

Assess Balances

When adjudicating claims in OP, the adjudication details must be entered exactly the way the EOB is indicating what the payer is:

  • Allowing
  • Paying
  • Adjusting
  • Assigning to Patient Responsibility

From the Patient Chart

  1. From the Billing, Clinical, or Practice Management tab, click the Patient Chart button.
  2. Click Payments.
  3. Click the New Payment button.
  4. Enter the Pay method, Check/Ref #, and Memo (optional).

  1. Post the payment and ensure that:
  • The patient responsibility amount is displayed in the Pat Resp. field
  • Xfr sec [payer and ID number] is displayed in the Insurance Action field. This sends the claim to the Transmit Queue in the Billing Center. If you want to print a CMS-1500, follow the instructions in Printing a CMS-1500 form.

The payment will be posted with a series of line items on a claim line to accommodate the need to assess responsibilities to a secondary payer on file. OP intentionally posts adjustments and patient responsibility and then intentionally does an exact reverse adjustment so that the secondary claim includes balances owed for everything except actual payment.

From the Bulk Payments Center

Path: Billing tab > Bulk Payments
  1. Search for and select the Patient.
  2. Enter the Pay method, Check/Ref #, and Memo (optional).

  1. Post the payment and ensure that:
  • The patient responsibility amount is displayed in the Pat Resp. field for each claim line.
  • Xfr sec [payer and ID number] is displayed in the Insurance Action field for each claim line. This sends the claim to the Transmit Queue in the Billing Center. If you wish to print a CMS-1500, please follow the instructions in Printing a CMS-1500 form.
  • Hold on Account is displayed in the Patient Action field for each claim line.

The payment is posted with a series of line items on a claim line to accommodate the need to assess responsibilities to a secondary payer on file. OP intentionally posts adjustments and patient responsibility and then intentionally does an exact reverse adjustment so that the secondary claim includes balances owed for everything except actual payment.

If you are unsure how the setup for Payers is entered, click here for Payer Set Up.

Version 14.10

Overview

When posting EOBs from payers there may be an instance where the patient owes a responsibility. However, you would not want to send a bill to a patient when there is a secondary payer on file. Please see the step-by-step instructions below on how to send a balance to a secondary payer.

Assess Balances

When adjudicating claims in OP, you need to enter in the adjudication details exactly the way the EOB is indicating:

  • Allowing
  • Paying
  • Adjusting
  • Patient Responsibility

From the Patient Account

  1. Click the Patient Account button.
  2. Click the Payments tab.
  3. Click  the Plus Payment button.
  4. Enter the Pay method, Check/Ref #, and Memo (optional).

  1. In the case that there was a patient responsibility, but you want that Patient Balance to go to a Secondary Payer on file, enter what the patient is responsible for in the Patient Responsibility field.

The claim is sent to the Transmit Queue in the Electronic Billing Center. If you wish to drop to a CMS-1500 please follow the instructions in Printing a CMS-1500 form.

OP 14 creates a series of line items on a claim line to accommodate the need to assess responsibilities to a secondary payer on file. OP intentionally posts adjustments and patient responsibility and then intentionally does an exact reverse adjustment so that the secondary claim includes balances owed for everything except actual payment.

From the Bulk Payments Center

Path: Activities menu > Post Bulk Payments (Keyboard Shortcut keys: Shift + F12)
  1. Search for the Patient.
  2. Enter the Pay method, Check/Ref #, and Memo (optional).

  1. In the case that there was a patient responsibility, but you want that Patient Balance to go to a Secondary Payer on file, enter what the patient is responsible for in the Patient Responsibility field.

The claim  is sent to the Transmit Queue in the Electronic Billing Center. If you want to drop to a CMS-1500 please follow the instructions in Printing a CMS-1500 form.

OP 14 creates a series of line items on a claim line to accommodate the need to assess responsibilities to a secondary payer on file. OP intentionally posts adjustments and patient responsibility and then intentionally does an exact reverse adjustment so that the secondary claim includes balances owed for everything except actual payment.

If you are unsure how the setup for Payers is entered, click here for Payer Set Up.