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.

Process an Adjudication from a Secondary Payer or an HSA Account

Version 14.19
Path: Smart Toolbar > Billing button > Adjudications tab

Overview

Adjudications from secondary insurance carriers and/or adjudications for HSA or HRA payments should be processed manually if you do not want to apply the secondary adjustment since this adjustment includes both a secondary adjustment AND an adjustment based on your original payment from the primary payer.

Typically, when processing these types of payments, you should not enter the full adjustment amount as a portion of the adjustment represents payment previously received from the primary payer. If you do approve and post these adjudications, the claims will appear over-posted and ultimately result in false credits being issued on the specified accounts.


Please be advised that automating this process through the adjudication tab is currently being addressed for a future release.

The recommended best practice at this time is to manually post the adjudication from the secondary and/or the HSA or HRA payer and enter the adjustment as appropriate (excluding the amount initially paid by the primary).

  1. Enter the payment (and corresponding adjustment) on the specified patient account according to standard posting procedures.
  2. Once the manual payment is entered, go to the Adjudications tab of the e-Billing center, change the match status of the specified adjudication to Discard, approve and post the transaction. 

Version 14.10
Path: Smart Toolbar > Billing button > Adjudications tab

Overview

Adjudications from secondary insurance carriers and/or adjudications for HSA or HRA payments should be processed manually if you do not want to apply the secondary adjustment since this adjustment includes both a secondary adjustment AND an adjustment based on your original payment from the primary payer.

Typically, when processing these types of payments, you should not enter the full adjustment amount as a portion of the adjustment represents payment previously received from the primary payer. If you do approve and post these adjudications, the claims will appear over-posted and ultimately result in false credits being issued on the specified accounts.


Please be advised that automating this process through the adjudication tab is currently being addressed for a future release.

The recommended best practice at this time is to manually post the adjudication from the secondary and/or the HSA or HRA payer and enter the adjustment as appropriate (excluding the amount initially paid by the primary).

  1. Enter the payment (and corresponding adjustment) on the specified patient account according to standard posting procedures.
  2. Once the manual payment is entered, go to the Adjudications tab of the e-Billing center, change the match status of the specified adjudication to Discard, approve and post the transaction.