Version 21.2
 This window map article points out some of the important aspects of the window you're working with in OP but is not intended to be instructional. To learn about topics related to using this window, see the Related Articles section at the bottom of this page. |
About Payment Processing Rules
Path: Billing tab > More button (Customize group) > Payment Processing Rules
The Payment Processing module allows you to build out rules based on the payer, claim type, national payer ID, payer reason, or CPT code that will be applied when an ERA file is processed in OP.
User Permission: To access the module, users must have the Billing_Payment_Processing_Rules security permission. |
Building these rules will streamline ERA processing by:
- Auto setting a match status for transactions in the Adjudication window
- Create a follow-up task
- Set the patient actions to create statements
Payment Processing Rules Map
Number | Section | Description |
1 | Start/End Date | All rules require a start date. The end date is optional and should be used when you want to end the use of a rule. When creating a new rule today’s date will automatically populate by default. The rule will be applied to claims with a claim date that falls between the start and end date of a rule. |
2 | Rule Name | This is a required field and needs to be unique to the rule you are creating. The system will not allow for 2 rules to have the same name. The character limit is 255. |
| 3 | When Payment Transaction Contains The Payment Transaction also contains | The Payment Transaction Contains sections allow you to set qualifications (or triggers) that your transaction must meet in order for the rule to apply. You can choose to create a rule based on National Payer ID, Insurance Code, Claim Filing Type, Payer Reason, CPT, and Modifier.
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| 4 | Perform the following action when Processing ERA Files | This is required when creating a rule. You can set one or more of the following actions that will be performed on the transactions that meet the selected qualifications that you set in the "When Payment Transaction Contains" section: Mark Transaction Status, Create a follow-up task, or set the patient action to Create Statement. See the Payment Processing - Actions article for more information |
