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Managing HIPAA Code Tables
This page will help you with managing HIPAA code tables.
Default Adjudication Match Status
Learn about the different Match Statuses used when posting ERA payments and how to edit the default selections.
Adding Adjustment Codes used in Office
Office Practicum has quite an extensive list of adjustment code reasons for patient and insurance adjustments.
Fetch and Process ERA Files
Before posting ERA (Electronic Remittance Advice) payments, the ERA files (835) are retrieved from supported clearinghouses or those clearinghouses with which OP has vendor relations using a process called Fetch and Process.
Purpose of Using Force Pay Date
The Force Pay Date can be used to match the posting date with the deposit date. When posting an ERA it will post with the ERA Date not the Pay Date.
Categorization of Adjudications
The Adjudications tab of the Billing Center displays all pending claim adjudications that have been processed through ERA (835) files but have not yet been posted to patient claims.
Post ERA Payments
Learn how to post ERA Payments after fetching and processing Adjudications into OP.
Process Adjudications on the Unmatched Tab
You must match these adjudications against existing transactions so that they move to the Matched tab for review and processing as follows.
Editing Standard Adjudications when Posting ERA Files
At times, an adjudication will apply the incorrect settlement information for a claim, based on payment information received from the payer.
Processing a Primary Adjudication for Submission to a Secondary Payer on File
When a user is posting ERA's payments back in to Office Practicum, there may be instances where there is a patient responsibility due.
Process an Adjudication from a Secondary Payer or an HSA Account
Learn how to process secondary insurance payments included in ERAs.
Add a Miscellaneous CPT, eg. Interest, for the Purpose of Posting a Payment
Interest payments can be added into a patient account by entering a charge for the interest amount and then applying the interest payment.
Processing e-Bill Adjudications for Interest Payments
Interest payments received through an ERA adjudication will automatically process to a generic account setup for payments/retractions that OP cannot specifically trace to a specific patient account.
Processing Reverse Adjudications Assigned to the E-bill Provider Adjustment Account
Payers will, at times, reverse previous adjudications for numerous reasons (e.g. plan termed, duplicate charge, etc).
Process a Retraction or Offset for the Purpose of Issuing a Refund
Payers will, at times, reverse previous adjudications for numerous reasons (e.g. plan termed, duplicate charge, etc).
Manually Add a Credit for an Overpayment
Overpayments can be received by a patient and/or an insurance payer via an EOB or an ERA.
Balance all Payments on an ERA, EFT or ACH
After posting an ERA, it is important to make sure that the postings balance to the ERA payment amount. This ensures that there are no posting errors and that all adjudications received for the ERA have been reviewed and posted.
Indicate ERA Payment Funds Were Received
An indication may be made on a specific ERA Payment to confirm that funds for the corresponding ERA Payment have been received by the practice.