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.

Insurance Validation

Version 14.19

About Insurance Validation

Path: Clinical tab > Schedule button > Tracking radio button > Validate button
Path: Practice Management tab > Schedule button > Tracking radio button > Validate button
Path: Billing tab > Schedule button > Tracking radio buttonValidate button

The Insurance Validation window performs a batch update insurance validation for scheduled patients. This will verify a patient’s insurance coverage.

To use the validation feature in the OP software, offices need to:

  • Enroll for Full HIPAA transactions with Office Practicum
  • Enroll with an integrated clearinghouse
  • Set Up the Insurance Payer Table to use the Validation Feature

Note: This feature will work contingent on the proper set up of the Insurance Record, accurate Patient Information entered into the patient record, and whether the payer is supported by the clearinghouse for Real-Time Eligibility.

Insurance Validation Map

Number
Section
Description

1

Batch Update Insurance Validation tab
The Batch Update Insurance Validation tab sets the criteria for the insurance validation.

2

Begin button
The Begin button performs the validation.

3

Color Key tab
The Color Key tab explains the color codes that will populate in the Ins. Valid column on the Tracking tab after a validation is performed. 
  • If nothing comes back into the system or the field is White in color, ask the patient for updated insurance information or call the payer for further information.
  • If a Dark Green color comes back into the system, the validation check has returned a valid insurance status.
  • If a Yellow color comes back into the system, retry your validation attempt.  There could have been connectivity issues at the time of validation attempt.
  • If a Light Green color comes back into the system, then there is no insurance policy to validate on file. The patient is either listed as Self Pay or the insurance was not ranked.
  • If a Pink color comes back into the system, then the insurance on file is invalid.
Version 14.10

About Insurance Validation

Path: Smart Toolbar > Schedule button > Tracking tab > Insurance Validation

The Insurance Validation window performs a batch update insurance validation for scheduled patients. This will verify a patient’s insurance coverage.

To use the validation feature in the OP software, offices need to:

  • Enroll for Full HIPAA transactions with Office Practicum
  • Enroll with an integrated clearinghouse
  • Set Up the Insurance Payer Table to use the Validation Feature

Note: This feature will work contingent on the proper set up of the Insurance Record, accurate Patient Information entered into the patient record, and whether the payer is supported by the clearinghouse for Real-Time Eligibility.

Insurance Validation Map

Number
Section
Description

1

Batch Update Insurance Validation tab
The Batch Update Insurance Validation tab sets the criteria for the insurance validation.

2

Begin button
The Begin button performs the validation.

3

Color Key tab
The Color Key tab explains the color codes that will populate in the Ins. Valid column on the Tracking tab after a validation is performed. 
  • If nothing comes back into the system or the field is White in color, ask the patient for updated insurance information or call the payer for further information.
  • If a Dark Green color comes back into the system, the validation check has returned a valid insurance status.
  • If a Yellow color comes back into the system, retry your validation attempt.  There could have been connectivity issues at the time of validation attempt.
  • If a Light Green color comes back into the system, then there is no insurance policy to validate on file. The patient is either listed as Self Pay or the insurance was not ranked.
  • If a Pink color comes back into the system, then the insurance on file is invalid.