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.

Electronic Billing Center: Adjudications

Version 14.19

About Electronic Billing Center: Adjudications Tab

Path: Billing tab > Billing Center button > Adjudications tab

The Electronic Billing Center, or eBilling Center, is the one-stop location in the OP software where claims are tracked. It lets you view claims from the time they are created until the time they are paid.

The Adjudications tab is only used if the practice has enrolled for Electronic Remittance Advice through their clearinghouse. The window shows all claims that were finalized by the insurance payer and will display claims payments from the ERA Payment ID. Entries disappear when the payments are posted.

Electronic Billing Center: Adjudications Tab Map

Number
SectionDescription

1

Electronic Billing Center Tabs

The Electronic Billing Center contains the following tabs:

2
ScopeThe Scope selections determine the data available in the Adjudications grid. All of the Scope options listed in this panel are available for use in the Adjudications tab.

3

Function buttonsThe Function buttons change based upon the tab selected.  However, some main function buttons appear on every tab.  The main function buttons are Edit, Delete, Select All (items), Select None, and Print Grid.
4
Data Application buttonsThe Data Application buttons include:
  • The Contracts button opens he Update Insurance Contract window, which manages your Insurance Contracts.
  • The Post Payment button opens the patient's Payments form.
  • The Fetch button downloads payer reports from supported correspondents.
  • The Process button processes downloaded payer reports.
5
Payment IDThe Payment ID field filters the Adjudications grid based on the selected Payment ID in the Payment ID dropdown.  Paste check number here to isolate to check number.
6
Force Pay DateThe Force Pay Date field filters the Adjudications grid based on the Force Pay Date selected.  Enter date of bank deposit to show as posting date (if not will default to post with ERA Date).
7
Matchaed/Unmatched tabs
  • Matched: The Adjudications grid is split into two tabs (Matched and Unmatched).  Claims in this tab appear when a transmitted out of OP and a payment was found for the claim.
  • Unmatched: Unmatched claims appear in this tab for one of two reasons.
    • Legacy payment: Claim was billed out of legacy system but payment is now coming through OP. Since the claim was not billed out of OP, OP cannot find a claim to match the payment. These payments should be posted in the legacy system and the adjudication deleted. Note: In order to view payment details for a legacy claim a paper EOB must be referenced.
    • Discrepancies in claim information: A name change or CPT code change can cause for OP to not be able to match the claim. In many instances OP will show a possible match.
8
Default Statement TypeThe Default Statement Type displays the adjudications based on statement type (Insurance + Patient Responsibility or Patient Responsibility Only).  Selection will show desired information on statement when printed out.
  • Ins + Pat Resp: Statement will show insurance balance and patient balance.
  • Pat Resp Only: Statement will only show patient balance.
9
Adjudications gridThe Adjudications grid displays all claims that were finalized by the insurance payer and will display claims payments from the ERA Payment ID. Entries disappear when the payments are posted
10
Expand grid checkboxThe Expand Grid checkbox expands and collapses the categories within the grid.
Version 14.10

About Electronic Billing Center: Adjudications Tab

Path: Smart Toolbar > Billing button > Adjudications tab

The Electronic Billing Center, or eBilling Center, is the one-stop location in Office Practicum where claims are tracked. It lets you view claims from the time they are created until the time they are paid.

The Adjudications tab is only used if the practice has enrolled for Electronic Remittance Advice through their clearinghouse. The window shows all claims that were finalized by the insurance payer and will display claims payments from the ERA Payment ID. Entries disappear when the payments are posted.

Electronic Billing Center: Adjudications Tab Map

Number
SectionDescription

1

Electronic Billing Center Left Tabs

The Electronic Billing Center contains the following tabs:

2
ScopeThe Scope selections determine the data available in the Adjudications grid. All of the Scope options listed in this panel are available for use in the Adjudications tab.

3

Function buttonsThe Function buttons change based upon the tab selected.  However, some main function buttons appear on every tab.  The main function buttons are Edit, Delete, Select All (items), Select None, and Print the list of items in the statement queue grid.
4
Fetch buttonsThe Fetch button downloads payer reports from supported correspondents.
5
Process buttonThe Process button processes downloaded payer reports.
6
Contracts buttonThe Contracts button opens he Update Insurance Contract window, which manages your Insurance Contracts.
7
Post Payment buttonThe Post Payment button opens the patient's Payments form.
8
Payment IDThe Payment ID field filters the Adjudications grid based on the selected Payment ID in the Payment ID dropdown.  Paste check number here to isolate to check number.
9
Force Pay DateThe Force Pay Date field filters the Adjudications grid based on the Force Pay Date selected.  Enter date of bank deposit to show as posting date (if not will default to post with ERA Date).
10
Default Statement TypeThe Default Statement Type displays the adjudications based on statement type (Insurance + Patient Responsibility or Patient Responsibility Only).  Selection will show desired information on statement when printed out.
  • Ins + Pat Resp: Statement will show insurance balance and patient balance.
  • Pat Resp Only: Statement will only show patient balance.
11
Matched tabThe Adjudications grid is split into two tabs (Matched and Unmatched).  Claims in this tab appear when a transmitted out of OP and a payment was found for the claim.
11
Unmatched tabUnmatched: Unmatched claims appear in this tab for one of two reasons.
  • Legacy payment: Claim was billed out of legacy system but payment is now coming through OP. Since the claim was not billed out of OP, OP cannot find a claim to match the payment. These payments should be posted in the legacy system and the adjudication deleted. Note: In order to view payment details for a legacy claim a paper EOB must be referenced.
  • Discrepancies in claim information: A name change or CPT code change can cause for OP to not be able to match the claim. In many instances OP will show a possible match.
12
Adjudications gridThe Adjudications grid displays all claims that were finalized by the insurance payer and will display claims payments from the ERA Payment ID. Entries disappear when the payments are posted
13
Expand grid checkboxThe Expand Grid checkbox expands and collapses the categories within the grid.