Important Content Update Message
We are currently updating the OP Help Center content for the release of OP 20. OP 20 (official version 20.0.x) is the certified, 2015 Edition, version of the Office Practicum software. This is displayed in your software (Help tab > About) and in the Help Center tab labeled Version 20.0. We appreciate your patience as we continue to update all of our content.

Process Adjudications on the Unmatched Tab

Version 14.19
Path: Billing tab > Billing Center button > Adjudications tab > Unmatched tab

Overview

The top half of the window includes adjudications that are unmatched because OP was unable to clearly identify the patient and/or CPT that was received in an ERA. This could happen for several reasons, such as:

  • The claim was originally billed in another billing program (other than OP). 
  • The claim adjudication is listed under the name of the insured as opposed to the patient (e.g. for newborn claims).
  • The claim adjudication is for a CPT or claim that no longer exists on the corresponding patient chart (e.g., if a claim was billed, then identified as billed incorrectly in OP and corrected; payment will come in under the original CPT/claim number that no longer exists).
  • The claim adjudication is slightly different than the original claim (e.g., the adjudication contains a modifier that does not exist on the corresponding claim in OP).
  • The claim adjudication is for a current claim. When OP attempts to match adjudications to claims, it is checking for archived transactions only as the assumption is that if a payment is being received, the corresponding date of service has already been processed on a daysheet. 

You must match these adjudications against existing transactions so that they move to the Matched tab for review and processing as follows:

  1. Navigate to the Unmatched tab of the Adjudications tab in the Billing Center using the path above.

  1. Match the adjudication to an existing claim/transaction using one of the following methods:
  • Method 1:
  1. On the lower half of the screen, you will find a list of possible matches, as defined by OP (based on the patient name, CPT code billed and date of service).
Note: The list of possible matches look at archived claims, so if the reason that adjudication is unmatched is because daysheets have not been processed for these dates of service, it is suggested that you run daysheets to archive these transactions. Once the daysheets have been processed, OP should list the patient in the lower portion of the screen as a possible match.
  1. If the matching transaction is located in this portion of the screen, double-click on it. This will auto-populate the Match Transaction field with the corresponding transaction number.
  • Method 2:
  1. If the matching transaction is not located in the lower half of the screen, navigate to the Claims in the patient chart.
  2. Review the patient's claim history.
  3. Locate the specific transaction and double-click on it to access the Claims Details: Linked Charge Transactions window. 
  4. Copy the Transaction # and close the window.
  5. Go back to the Unmatched tab in Adjudications tab and enter the number in the Match Transaction field.
  6. Click the Match button.
  7. Click Yes to confirm that you are matching the adjudication.


The matched adjudication will now disappear from the Unmatched tab, and display under the Matched tab for your review and approval, as applicable.
Version 14.10
Path: Smart Toolbar > Billing button > Adjudications tab

Overview

The top half of the Unmatched screen will include adjudications that are unmatched because OP was unable to clearly identify the patient and/or CPT. This could happen for several reasons, such as:

  • The claim was originally billed in another billing program (other than OP). 
  • The claim adjudication is listed under the name of the insured as opposed to the patient (e.g. for newborn claims).
  • The claim adjudication is for a CPT/claim that no longer exists on the corresponding patient account (e.g., if a claim was billed and sent electronically, then identified as billed incorrectly in OP and corrected; payment will come in under the original CPT/claim number that no longer exists if the user previously corrected the problem).
  • The claim adjudication is slightly different than the original claim (e.g., the adjudication contains a modifier that does not exist on the corresponding claim in OP).
  • The claim adjudication is for a current claim as a result of daysheets not being processed. When OP attempts to match adjudications to claims, it is checking for archived transactions only as the assumption is that if a payment is being received, the corresponding date of service has already been "closed". 

You must match these adjudications against existing transactions so that they move to the Matched tab for review and processing as follows:

  1. Click on the Billing Icon on the Smart Toolbar.

Smart Toolbar: Billing

  1. Click on the Adjudications tab.
  2. Click on the Unmatched Tab.

  1. Match the adjudication to an existing claim/transaction.
  • Option 1:
  1. On the lower half of the screen, you will find a list of possible matches, as defined by OP (based on the patient name, cpt billed and date of service).
Note: The list of possible matches are, again, looking at archived claims so if the reason that adjudication is unmatched is because daysheets have not been run for these dates of service, it is suggested that you run daysheets to archive these transactions. Once the daysheets have been run, OP should list the patient in the lower portion of the screen as a possible match.
  1. If the matching transaction is located in this portion of the screen, double-click on it. This will auto-populate the Match Transaction box (in the center of the window) with the corresponding transaction number.
  • Option 2:
  1. If the matching transaction is not located in the lower half of the screen, open the Patient's Account, and then click the Claims button to review the Patient's claim history.

  1. Locate the specific transaction and double-click on it to access the Claims Details: Linked Charge Transactions window to view the CPT codes Transaction number, copy that Transaction # and close the window.

  1. Go back to the Adjudications Unmatched tab and locate and record the number in the Transaction # field, then manually enter the transaction number in the match transaction box located in the center of the Unmatched window. 

  1. Regardless of how the match transaction box was populated, click the Match button in the center of the window.
  2. Click Yes in response to OPs prompt to confirm that you are requesting an adjudication match.


The matched adjudication will now disappear from the Unmatched tab, and appear under the Matched tab for your review and approval, as applicable.