Version 14.19

Path: Smart Toolbar > Account button > Claims tab

Overview

Payers will, at times, reverse previous adjudications for numerous reasons (e.g. plan termed, duplicate charge, etc). To issue a refund or process a retraction, the amount to be refunded/retracted (e.g., overpayment, erroneous patient payment) MUST first be entered as a credit in the patient's account. If a refund is being issued as a result of a retraction, the original payment must be deleted from the corresponding claim to allow OP to record an available credit on a patient's account.

 Process a Retraction

1. Once you are able to determine the reason for the reversal, proceed to the specified Patient Account.

 Patient Account

1. Click on the Claims tab .
2. Locate the claim associated with the retraction and click on the plus signto expand to view claim details, including prior payment lines.
3. Click on the payment line that is being retracted and click on the Minus Void button at the top of the screen.
4. Click Yes when prompted "The highlighted transaction is archived. Would you like to void it?"

 Confirm

Note: A credit will now be issued for the specified patient. At this point, you will need to record a refund against this amount in the form of a check or account transfer if the amount is retracted on an ERA or EOB.

1. If the payer is taking all of the monies back from a previously paid claim, click on Recoup to remove all insurance payments and adjustments from the claim.

 Patient Account

1. Click OK to the popup, "This action will recoup all insurance payments for the ENTIRE highlighted claim. Are you sure?"

 Confirm

Version 14.10

Path: Smart Toolbar > Account button > Claims tab

Overview

Payers will, at times, reverse previous adjudications for numerous reasons (e.g. plan termed, duplicate charge, etc). To issue a refund or process a retraction, the amount to be refunded/retracted (e.g., overpayment, erroneous patient payment) MUST first be entered as a credit in the patient's account. If a refund is being issued as a result of a retraction, the original payment must be deleted from the corresponding claim to allow OP to record an available credit on a patient's account.

 Process a Retraction

1. Once you are able to determine the reason for the reversal, proceed to the specified Patient Account.

 Patient Account

1. Click on the Claims tab .
2. Locate the claim associated with the retraction and click on the plus signto expand to view claim details, including prior payment lines.
3. Click on the payment line that is being retracted and click on the Minus Void button at the top of the screen.
4. Click Yes when prompted "The highlighted transaction is archived. Would you like to void it?"

 Confirm

Note: A credit will now be issued for the specified patient. At this point, you will need to record a refund against this amount in the form of a check or account transfer if the amount is retracted on an ERA or EOB.

1. If the payer is taking all of the monies back from a previously paid claim, click on Recoup to remove all insurance payments and adjustments from the claim.

 Patient Account

1. Click OK to the popup, "This action will recoup all insurance payments for the ENTIRE highlighted claim. Are you sure?"

 Confirm