Layout of Adjudications Tab

Version 14.8
Path: Smart Toolbar > Billing button > Adjudications tab

Overview

The Adjudications tab is only used if the practice has enrolled for Electronic Remittance Advice through their clearinghouse. The Adjudication tab shows all claims that were finalized by the insurance payer.

Adjudications Tab

 Electronic Billing Center

Sort Options

The following are options on the Adjudications tab:

Sort Options

  • View by payer.
  • View by provider.
  • View by date range.
  • View by location.

Filters

Electronic Billing Center

  • Payment ID: Paste check number here to isolate to check number.
  • Force Pay Date: Enter date of bank deposit to show as posting date (if not will default to post with ERA Date).
  • Default Statement Type: Selection will show desired information on statement when printed out.
  • Ins + Pt Resp: Statement will show insurance balance and patient balance.
  • Pt Resp Only: Statement will only show patient balance.

Matched vs. Unmatched

Electronic Billing Center

  • Matched: A claim was transmitted out of OP and a payment was found for the claim.
  • Unmatched: One of two scenarios.
  • 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.