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.

Connect Providers to Insurance Payers

Version 14.19
Path: Billing tab > Payers 

Overview

Once an Insurance payer has been entered into OP, all credentialed providers must be associated with the payer in order to generate a claim for that particular provider and payer combination. After a Provider's information has been entered once, it can easily be copied and applied to other payers.

Associating a Provider with an Insurance Payer

  1. Navigate to the Insurance Payers List.
  2. Select the Insurance Payer for which you will associate a credentialed provider.
  3. Click + to display providers associated with this payer. When a payer is first entered into OP, this list will be blank.

  1. Click the Add buttonto associate a credentialed provider. The Insurance Carrier Provider Information window opens.
  2. Complete the following fields as they are relevant to the billing requirements in your state.

  • Provider's Initials: Select from the provider drop-down list.
  • Place a checkmark in the Active box.
  • Line 24J ID Number: This is a Provider ID number issued by the selected insurance payer and assigned directly to the provider. It will appear in box 24J. 
  • Line 24J ID type: (only to be populated if Line 24J ID Number has been populated) The most commonly used types for this field are:
    • 24: EIN/Federal Tax ID
    • G2: assigned by a commercial carrier
    • 1B: Blue Cross/Blue Shield numbers
    • 1D: Medicaid number
    • 1H: Champus/Tricare ID
Do not enter a National Provider ID (NPI) in this field. NPIs should only be entered in the Provider Directory.
  • Entity type: as related to the information entered in the Line 24J field as assigned to either a person or a corporation (e.g., if it is a personal pin number, select Person; if it is a tax ID, select Corporation). 
  • Line 33B ID Number: Number assigned by the payer for use on HCFA line 33B. This is an identifier issued by the selected insurance payer and assigned directly to the Practice; if the Practice was not assigned an individual number by the payer, enter the Practice tax ID).
  • Line 33B ID type: Select the type of number entered in 33B for identification. The most commonly used types for this field are:
    • 24 - EIN/Federal Tax ID
    • G2 - assigned by a commercial carrier
    • 1B - Blue Cross/Blue Shield numbers
    • 1D - Medicaid number
    • 1H - Champus/Tricare ID
Do not enter a National Provider ID (NPI) in this field. NPIs should only be entered in the Provider Directory.
  • Entity type: as related to the information entered in the Line 33B field as assigned to either a person or a corporation (e.g., if it is a personal pin number, select Person; if it is a tax ID, select Corporation).
  • Taxonomy: See Taxonomy Fields for important warnings regarding populating Taxonomy Codes in these fields.
  • Line 25 (Tax ID): Typically this field will be left blank. An OP Implementation Specialist should be consulted prior to adding a Tax ID number in this field.
Warning:  Line 25 (Tax ID) is the first place OP looks when populating the Tax ID on claims. If this field is blank, OP will defer to the Tax ID field of the Locations table. For more information on the order in which OP considers Tax ID for claims, visit Tax ID Setup.
  • Capitation ID: If patients on this insurance plan must be enrolled with your practice before receiving services, enter the payer-assigned Office ID that would appear in their insurance records.
  • Locator Code: Medicaid Locator Code; should be 3 numbers.
  1. Click Save to save changes and return to the Insurance Payers List window.
  2. Repeat these steps as necessary for each associated provider for this payer.

Copying Credentialed Provider Records 

After entering a Provider's credentials once, it is easy to apply the same credentials to multiple payers. Note, the record will be applied exactly as it appears in the record it is being copied from. If individual payers have assigned different Provider numbers, etc. it will be necessary to edit the record once it has been applied to another payer. To copy credentials:

  1. In the Insurance Payers List window, sort the payer list so that the record you will be copying from is listed above the payer you are copying to.
Note: Because the Insurance Payers List is listed alphabetically, you may click the column header for the Payer Short Name column to change the listing from ascending to descending order in order to get the correct payer listed first.
  1. Select the Payer whose credentialed providers will be copied.
  2. Click to select the Payer(s) who the credentialed providers will be copied to. In the screenshot below, United Health's credentialed Providers are going to be copied to OP Insurance Co. 

Note: If the payers are listed one after another, use Shift on the keyboard to select all payers. If they are separated by other payers in the list, use CTRL on the keyboard and select each payer.
  1. Click the Cred button. A confirm box opens stating the action OP is about to take.

  1. Select from the following options:
  • Replace: replaces the information about all providers.
  • Insert: inserts only those providers who are missing.
  • Cancel: closes the Confirm window and does not copy any records.
  1. Review and click OK in the Information window that displays.

  1. Review the credentialed Provider information that was copied into the Insurance Payer.

Disassociating a Provider from a Payer Record

If a claim has not been created for the Provider for a specific insurance, you are able to delete the Provider from this payer. If claims were submitted, the Provider can only be marked as Inactive in the Insurance Carrier Provider Information window

Delete a Provider from an Insurance Payer

  1. Select the Payer for which the Provider is associated.
  2. Click + to display the Providers associated with the Payer.
  3. Click the Delete  button  to remove the Provider from the Payer.

Inactivate a Provider from an Insurance Payer

  1. Select the Payer for which the Provider is associated.
  2. Click the Edit  button .
  3. Deselect he Active checkbox.
  4. Click Save.
Version 14.8
Utilities > Manage Practice > Insurance Payers

Overview

Once a payer has been entered into OP, all provider(s)  MUST be associated with payer in the Insurance Payer List who they are credentialed with in order to generate a claim for a provider. 

Creating an Associated Provider Record for an Insurance Payer

  1. Open the Insurance Payers List.
  2. Click to highlight the Insurance Payer.
  3. Click at the left of the Insurance Payer Name. The list expands to display providers associated with this payer. 

  1. Click the Edit pencil to complete the following in the Insurance Carrier Provider Information window:
  • Provider's Initials - Select from the provider drop-down list.
  • Place a checkmark in the Active box.
  • Provider ID (Line 24J) (optional) - Assigned by the payer; should appear in box 24 J (this is an identifier issued by the selected insurance payer and assigned directly to the provider; if the provider was not assigned an individual number by the payer, enter the practice Tax ID).
  • Type of Provider ID (to the left of Line 24J field) - The most commonly used types for this field are:
  • 24 - EIN/Federal Tax ID
  • G2 - assigned by a commercial carrier
  • 1B - Blue Cross/Blue Shield numbers
  • 1D - Medicaid number
  • 1H - Champus/Tricare ID
DO NOT enter a National Provider ID (NPI) in this field. NPIs should only be entered on the Provider Directory.
  • In the drop-down field to the far right, further identify the number entered in the Line 24J field as assigned to either a person or a corporation (e.g., if it is a personal pin number, select "Person"; if it is a tax ID, select "Corporation"). Click the down arrow button and select from the drop-down menu accordingly.
  • Practice ID (Line 33B) - Number assigned by the payer for use in line 33B (this is an identifier issued by the selected insurance payer and assigned directly to the practice; if the practice was not assigned an individual number by the payer, enter the practice tax ID).
  • Type of Practice ID - Select the type of number entered in 33B for identification; most commonly used types for this field are:
  • 24 - EIN/Federal Tax ID
  • G2 - assigned by a commercial carrier
  • 1B - Blue Cross/Blue Shield numbers
  • 1D - Medicaid number
  • 1H - Champus/Tricare ID
DO NOT enter a National Provider ID (NPI) in this field. NPIs should only be entered on the Provider Directory.
  • In the drop-down field to the far right, further identify the number entered in the Line 33B field as assigned to a person or a corporation (e.g., if it is a personal pin number, select "Person"; if it is a tax ID, select "Corporation"). Click the down arrow button and select from the drop-down menu accordingly.
  • Capitation ID (Optional) - If patients on this insurance plan must be enrolled with your practice before receiving services, enter the payer-assigned Office ID that would appear in their insurance records.
  • Locator Code (Optional) - Medicaid Locator Code; should be 3 numbers.
  1. Click Save to save changes and return to the Insurance Payers List window.



Modifying an Associated Provider Record

From time to time, your office may need to edit a provider pin or group number, as identified by a payer. To do so, follow these steps:

  1. Open the Insurance Payers List (Utilities > Manage Practice > Insurance Payers > Insurance Carrier Provider Information).
  2. Click to highlight the Insurance Payer in question.
  3. Click   to the left of the Insurance Payer Name. The listing will expand, displaying associated providers for this payer.

  1. Click to highlight the associated provider record you wish to edit.
  2. Click the Edit  button in the small tool bar below the Associated Provider listings for this payer. The Insurance Carrier Provider Information window will open.

  1. In the Insurance Carrier Provider Information window, edit the fields as appropriate.
  2. Click the Save button at the bottom of the form to save changes and return to the Insurance Payers List window.

Repeat these steps as necessary for each associated provider for this payer.

Disassociating a Provider from a Payer Record


If a claim has not been created for the provider for this insurance you are able to delete the provider from this payer. If claims were submitted, the provider can only be marked as Inactive.
  1. Follow the steps above to modify an associated provider record.
  2. Click the Delete  button to remove the provider from this payer.
  3. To Inactive a provider click on the Edit  button instead.
  4. Remove the checkmark next to the Active box.
  5. Click Save to exit.

Version 14.10
Utilities > Manage Practice > Insurance Payers

Overview

Once an Insurance payer has been entered into OP, all credentialed providers must be associated with the payer in order to generate a claim for that particular provider and payer combination. After a Provider's information has been entered once, it can easily be copied and applied to other payers. 

Creating an Associated Provider Record for an Insurance Payer

  1. Navigate to the Insurance Payers List.
  2. Select the Insurance Payer for which you will associate a credentialed provider.
  3. Click + to display providers associated with this payer. When a payer is first entered into OP, this list will be blank.
  1. Click the Add Record button to attach a credentialed provider. The Insurance Carrier Provider Information window will open.

  1. Complete the following fields as they are relevant to the billing requirements in your state.

  • Provider's Initials - Select from the provider drop-down list.
  • Place a checkmark in the Active box.
  • Provider ID (Line 24J) (optional) - Assigned by the payer; should appear in box 24 J (this is an identifier issued by the selected insurance payer and assigned directly to the provider.)
  • ID type (to the left of Line 24J field) - The most commonly used types for this field are:
  • 24 - EIN/Federal Tax ID
  • G2 - assigned by a commercial carrier
  • 1B - Blue Cross/Blue Shield numbers
  • 1D - Medicaid number
  • 1H - Champus/Tricare ID
DO NOT enter a National Provider ID (NPI) in this field. NPIs should only be entered on the Provider Directory.
  • Entity type: as related to the information entered in the Line 24J field as assigned to either a person or a corporation (e.g., if it is a personal pin number, select "Person"; if it is a tax ID, select "Corporation"). 
  • Practice ID (Line 33B) - Number assigned by the payer for use in line 33B (this is an identifier issued by the selected insurance payer and assigned directly to the practice; if the practice was not assigned an individual number by the payer, enter the practice tax ID).
  • ID type - Select the type of number entered in 33B for identification; most commonly used types for this field are:
  • 24 - EIN/Federal Tax ID
  • G2 - assigned by a commercial carrier
  • 1B - Blue Cross/Blue Shield numbers
  • 1D - Medicaid number
  • 1H - Champus/Tricare ID
DO NOT enter a National Provider ID (NPI) in this field. NPIs should only be entered on the Provider Directory.
  • Entity type - as related to the information entered in the Line 33B field as assigned to either a person or a corporation (e.g., if it is a personal pin number, select "Person"; if it is a tax ID, select "Corporation").
  • Taxonomy - See Taxonomy Fields for important warnings regarding populating Taxonomy Codes in these fields.
  • Line 25 (Tax ID) -  typically this field will be left blank. An OP Implementation Specialist should be consulted prior to adding a Tax ID number in this field.
Warning:  Line 25 (Tax ID) is the first place OP will look when populating the Tax ID on claims. If this field is blank, OP will defer to the Tax ID field of the Locations tab. For more information on the order in which OP considers Tax ID for claims, visit Tax ID Setup.
  • Capitation ID (Optional) - If patients on this insurance plan must be enrolled with your practice before receiving services, enter the payer-assigned Office ID that would appear in their insurance records.
  • Locator Code (Optional) - Medicaid Locator Code; should be 3 numbers.
  1. Click Save to save changes and return to the Insurance Payers List window.
  2. Repeat these steps as necessary for each associated provider for this payer.

Copying Credentialed Provider Records 

After entering a Provider's credentials once, it is easy to apply the same credentials to multiple payers. Note, the record will be applied exactly as it appears in the record it is being copied from. If individual payers have assigned different Provider numbers, etc. it will be necessary to edit the record once it has been applied to another payer. To copy credentials:

  1. In the Insurance Payers List window, sort the payer list so that the record you will be copying from is listed above the payer you are copying to.
Note: Because the Insurance Payers List is listed alphabetically, you may click the column header for the Payer Short Name column to change the listing from ascending to descending order in order to get the correct payer listed first.
  1. Select the Payer whose credentialed providers will be copied.
  2. Click to select the Payer(s) who the credentialed providers will be copied to. If the payers are listed one after another, use Shift on the keyboard to select all payers. If they are separated by other payers in the list, use CTRL on the keyboard and select each payer.
  3. Click the Cred button. A confirm box opens stating the action OP is about to take.
  4. Select from the following options:
  • Replace: replaces the information about all providers.
  • Insert: inserts only those providers who are missing.
  • Cancel: closes the Confirm window and does not copy any records.
  1. Review and click OK in the Information window that displays.
  2. Review the credentialed Provider information that was copied into the Insurance Payer.

Disassociating a Provider from a Payer Record


If a claim has not been created for the provider for this insurance you are able to delete the provider from this payer. If claims were submitted, the provider can only be marked as Inactive.
  1. Follow the steps above to modify an associated provider record.
  2. Click the Delete  button to remove the provider from this payer.
  3. To Inactive a provider click on the Edit  button instead.
  4. Remove the checkmark next to the Active box.
  5. Click Save to exit.

Version 14.8
Utilities > Manage Practice > Insurance Payers

Overview

Once a payer has been entered into OP, all provider(s)  MUST be associated with payer in the Insurance Payer List who they are credentialed with in order to generate a claim for a provider. 

Creating an Associated Provider Record for an Insurance Payer

  1. Open the Insurance Payers List.
  2. Click to highlight the Insurance Payer.
  3. Click at the left of the Insurance Payer Name. The list expands to display providers associated with this payer. 

  1. Click the Edit pencil to complete the following in the Insurance Carrier Provider Information window:
  • Provider's Initials - Select from the provider drop-down list.
  • Place a checkmark in the Active box.
  • Provider ID (Line 24J) (optional) - Assigned by the payer; should appear in box 24 J (this is an identifier issued by the selected insurance payer and assigned directly to the provider; if the provider was not assigned an individual number by the payer, enter the practice Tax ID).
  • Type of Provider ID (to the left of Line 24J field) - The most commonly used types for this field are:
  • 24 - EIN/Federal Tax ID
  • G2 - assigned by a commercial carrier
  • 1B - Blue Cross/Blue Shield numbers
  • 1D - Medicaid number
  • 1H - Champus/Tricare ID
DO NOT enter a National Provider ID (NPI) in this field. NPIs should only be entered on the Provider Directory.
  • In the drop-down field to the far right, further identify the number entered in the Line 24J field as assigned to either a person or a corporation (e.g., if it is a personal pin number, select "Person"; if it is a tax ID, select "Corporation"). Click the down arrow button and select from the drop-down menu accordingly.
  • Practice ID (Line 33B) - Number assigned by the payer for use in line 33B (this is an identifier issued by the selected insurance payer and assigned directly to the practice; if the practice was not assigned an individual number by the payer, enter the practice tax ID).
  • Type of Practice ID - Select the type of number entered in 33B for identification; most commonly used types for this field are:
  • 24 - EIN/Federal Tax ID
  • G2 - assigned by a commercial carrier
  • 1B - Blue Cross/Blue Shield numbers
  • 1D - Medicaid number
  • 1H - Champus/Tricare ID
DO NOT enter a National Provider ID (NPI) in this field. NPIs should only be entered on the Provider Directory.
  • In the drop-down field to the far right, further identify the number entered in the Line 33B field as assigned to a person or a corporation (e.g., if it is a personal pin number, select "Person"; if it is a tax ID, select "Corporation"). Click the down arrow button and select from the drop-down menu accordingly.
  • Capitation ID (Optional) - If patients on this insurance plan must be enrolled with your practice before receiving services, enter the payer-assigned Office ID that would appear in their insurance records.
  • Locator Code (Optional) - Medicaid Locator Code; should be 3 numbers.
  1. Click Save to save changes and return to the Insurance Payers List window.



Modifying an Associated Provider Record

From time to time, your office may need to edit a provider pin or group number, as identified by a payer. To do so, follow these steps:

  1. Open the Insurance Payers List (Utilities > Manage Practice > Insurance Payers > Insurance Carrier Provider Information).
  2. Click to highlight the Insurance Payer in question.
  3. Click   to the left of the Insurance Payer Name. The listing will expand, displaying associated providers for this payer.

  1. Click to highlight the associated provider record you wish to edit.
  2. Click the Edit  button in the small tool bar below the Associated Provider listings for this payer. The Insurance Carrier Provider Information window will open.

  1. In the Insurance Carrier Provider Information window, edit the fields as appropriate.
  2. Click the Save button at the bottom of the form to save changes and return to the Insurance Payers List window.

Repeat these steps as necessary for each associated provider for this payer.

Disassociating a Provider from a Payer Record


If a claim has not been created for the provider for this insurance you are able to delete the provider from this payer. If claims were submitted, the provider can only be marked as Inactive.
  1. Follow the steps above to modify an associated provider record.
  2. Click the Delete  button to remove the provider from this payer.
  3. To Inactive a provider click on the Edit  button instead.
  4. Remove the checkmark next to the Active box.
  5. Click Save to exit.