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.

Patient Account: Claims

Version 14.19
The Patient Account window merged with the Patient Chart for easier convenience with the creation of OP 19. Since the Help Center supports both OP 14 and OP 19, the account functions within the patient chart for OP 19 will still be referenced at the same Help Center locations as OP 14.

About Patient Chart: Claims

Path: Clinical tab > Patient Chart button > Claims
Path: Practice Management tab > Patient Chart button > Claims
Path: Billing tab > Patient Chart button > Claims

The Patient Chart window maintains a patient’s account.  Some of the main functions that can be performed on a patient’s account include:

  • Enter a copay
  • Post a charge manually
  • Enter hospital charges
  • Verify claim accuracy
  • Post a patient payment
  • Issue a patient refund
  • Write an account note
  • View claim history
  • Print a CMS-1500
  • Print a statement

The claims button displays top-level listing of claims with open claims highlighted in red.  You can create tasks, recoup claims, rebuild claims, check transactions, change a payer, revert patient responsibility, and queue primary or secondary payers.

Patient Chart: Claims

Number
Section
Description

1

Claims button

The Claims button opens the patient's Claims window.

2

Search Criteria
The Search Criteria selections determine what claims are displayed in the claim list grid.  Criteria is determined by status and date range.  You can also include voids in the list and expand the details for all listed claims.
3
Edit button
The Edit button edits a selected claim.  Selecting the claim and clicking the Edit button opens the Edit Archived Claim Transactions window.  
4
Void button
The Void button deletes a selected task.
5
Rebuild buttonThe Rebuild button rebuilds all claims for archived transactions. This recalculates the values on the claim to fix any out of proof values listed on an individual claim.
6
Change Payer
The Change Payer button changes the payer for any unpaid transactions.
7
Revert Patient Responsibility
The Revert Patient Responsibility button reverts any conditionally assigned patient responsibility on a selected charge.
8
Add F/U TaskThe  Add F/U Task button adds a follow up task to the selected claim. Selecting a claim and clicking the Tasks button opens the Add Tasks to a Patient's Checklist window.  
9
Recoup buttonThe Recoup button will recoup all insurance payments for the entire highlighted claim.
10
Proof button
The Proof button opens the Account Proof window to check the transactions for inconsistencies in values for insurance or patient balances on the account.  
11
CMS-1500 button
The CMS-1500 button prints paper claims for HCFA-based insurance payers for all selected transactions.  CMS-1500 forms should be in the printer when using this function.
12
Q Primary
The Q Primary button places selected claim(s) in a queue for submission to the primary payer.
13
Q Secondary
The Q Secondary button places selected claim(s) in a queue for submission to the secondary payer.
14
Claim List grid
The Claim List grid displays top-level listing of claims with open claims highlighted in red.  Claims can be collapsed and expanded by clicking the the expand button or clicking the Expand All checkbox.  Expanding the claim will display the patient's transaction history for the expanded claim.  Double-clicking on a claim will open the Claim Details window, where you can add a note and patient responsibility date to the claim.  The Status History of each claim is displayed in the Claim Status History grid.
15
Claim Status History grid
The Claim Status History grid displays the status history for the selected claim in the Claim List grid. Statuses can be added, updated, and checked.
16
Claim Status History Function buttons
The Claim Status History function buttons are used to update and save changes to the Claim Status entries.
17
Add Status
The Add Status button adds an entry for the status history of the selected claim.
18
Check Status button
The Check Status button checks the claim status with the payer.
Version 14.10

About Patient Account: Claims Tab

Path: Smart Toolbar > Account button > Claims tab

The Patient Account window maintains a patient’s account.  Some of the main functions that can be performed on a patient’s account include:

  • Enter a copay
  • Post a charge manually
  • Enter hospital charges
  • Verify claim accuracy
  • Post a patient payment
  • Issue a patient refund
  • Write an account note
  • View claim history
  • Print a CMS-1500
  • Print a statement

The claims tab displays top-level listing of claims with open claims highlighted in red.  You can create tasks, recoup claims, rebuild claims, check transactions, change a payer, revert patient responsibility, and queue primary or secondary payers.


Patient Account: Claims Tab Map

Number
Section
Description

1

Patient Account tabs

The Patient Account contains the following tabs:

2

Scope
The Scope field narrows the parameters for the displayed information in the patient’s account.  Information can be displayed by patient or family.
3
Search Criteria
The Search Criteria selections determine what claims are displayed in the claim list grid.  Criteria is determined by status and date range.  You can also include voids in the list and expand the details for all listed claims.
4
Edit (Pencil icon) button
The Edit (pencil icon) button edits a selected claim.  Selecting the claim and clicking the Edit button opens the Edit Archived Claim Transactions window.  
5
Tasks button
The Tasks button adds tasks to the selected claim. Selecting a claim and clicking the Tasks button opens the Add Tasks to a Patient's Checklist window.  
6
Void
The - Void button deletes a selected task.
7
Recoup buttonThe Recoup button will recoup all insurance payments for the entire highlighted claim.
8
Rebuild button
The Rebuild button rebuilds all claims for archived transactions. This recalculates the values on the claim to fix any out of proof values listed on an individual claim.
9
Proof button
The Proof button opens the Account Proof window to check the transactions for inconsistencies in values for insurance or patient balances on the account.  
10
Change Payer
The Change Payer button changes the payer for any unpaid transactions.
11
Revert Patient Responsiblity
The Revert Patient Responsibility button reverts any conditionally assigned patient responsibility on a selected charge.
12
CMS-1500 button
The CMS-1500 button prints paper claims for HCFA-based insurance payers for all selected transactions.  CMS-1500 forms should be in the printer when using this function.

13
Q Secondary
The Q Secondary button places selected claim(s) in a queue for submission to the secondary payer.
14
Q Primary
The Q Primary button places selected claim(s) in a queue for submission to the primary payer.
15
Claim List grid
The Claim List grid displays top-level listing of claims with open claims highlighted in red.  Claims can be collapsed and expanded by clicking the the expand button or clicking the Expand All checkbox.  Expanding the claim will display the patient's transaction history for the expanded claim.  Double-clicking on a claim will open the Claim Details window, where you can add a note and patient responsibility date to the claim.  The Status History of each claim is displayed in the Claim Status History grid.
16
Claim Status History grid
The Claim Status History grid displays the status history for the selected claim in the Claim List grid. Statuses can be added, updated, and checked.
17
? Check Status button
The Check Status button checks the claim status with the payer.
18
+ Add Status
The + Add Status button adds an entry for the status history of the selected claim.
19
Claim Status History Function buttonsThe Claim Status History function buttons are used to update and save changes to the Claim Status entries.