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.

Editing Standard Adjudications when Posting ERA Files

Version 14.19
Path: Smart Toolbar > Billing button > Adjudications tab

Overview

At times, an adjudication will apply the incorrect settlement information for a claim, based on payment information received from the payer. If this problem occurs, you can manually edit the adjustment fields on the Adjudication Table to correct the adjustments. Again, this can happen if an adjustment is applied to the incorrect CPT and/or if a CPT is being adjusted on the insurance side when it is actually due by the patient based on the CPT rejection reason. For example, a CPT may be adjusted as a non-covered service that is actually due by the patient but is not listed this way on the incoming adjudication.


If your manual changes are in balance, the adjudication will allow you to approve and post these changes. If you made an error, and the total charge amount does not balance with the amount of payment plus adjustment plus patient responsibility (if applicable), the adjudication will appear yellow and will not allow it to be approved.

When manually editing adjudication, be sure that you are not "changing" the actual amount of monies received from the payer.
Version 14.10
Path: Smart Toolbar > Billing button > Adjudications tab

Overview

At times, an adjudication will apply the incorrect settlement information for a claim, based on payment information received from the payer. If this problem occurs, you can manually edit the adjustment fields on the Adjudication Table to correct the adjustments. Again, this can happen if an adjustment is applied to the incorrect CPT and/or if a CPT is being adjusted on the insurance side when it is actually due by the patient based on the CPT rejection reason. For example, a CPT may be adjusted as a non-covered service that is actually due by the patient but is not listed this way on the incoming adjudication.


If your manual changes are in balance, the adjudication will allow you to approve and post these changes. If you made an error, and the total charge amount does not balance with the amount of payment plus adjustment plus patient responsibility (if applicable), the adjudication will appear yellow and will not allow it to be approved.

When manually editing adjudication, be sure that you are not "changing" the actual amount of monies received from the payer.