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 Tertiary Claims

Version 14.19

In the rare case where a child has a tertiary insurance, you will find that the options for claim submission only includes transmitting claims to a primary payer or a secondary payer. In order to queue a claim to a tertiary insurance where there is a patient responsibility, you will need to manually change the insurance on the claim.

Note: It is recommended when sending claims to a tertiary insurance that the claim be sent on a CMS-1500 form rather than electronically.

While posting the secondary payment, do the following:

  1. In the Add Payments and Adjustments window, click the Insurance Action field dropdown and select the tertiary payer listed as XFR sec to send the balance to the tertiary payer.

  1. Save the secondary payment information.

In the Patient Account:

  1. Select the claim with the tertiary insurance balance.
  2. Click the CMS-1500 button  to print the claim. The claim will be printed with the tertiary insurance listed as the addressee and will show the cumulative primary and secondary payment amounts.
  3. Attach a copy of the primary and secondary EOBs and mail the claim.
Version 14.10

In the rare case where a child has a tertiary insurance, you will find that the options for claim submission only includes transmitting claims to a primary payer or a secondary payer. In order to queue a claim to a tertiary insurance where there is a patient responsibility, you will need to manually change the insurance on the claim.

Note: It is recommended when sending claims to a tertiary insurance that the claim be sent on a CMS-1500 form rather than electronically.

While posting the secondary payment, do the following:

  1. In the Add Payments and Adjustments window, click the Insurance Action field dropdown and select the tertiary payer listed as XFR sec to send the balance to the tertiary payer.

  1. Save the secondary payment information.

In the Patient Account:

  1. Select the claim with the tertiary insurance balance.
  2. Click the CMS-1500 button  to print the claim. The claim will be printed with the tertiary insurance listed as the addressee and will show the cumulative primary and secondary payment amounts.
  3. Attach a copy of the primary and secondary EOBs and mail the claim.