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Processing Reverse Adjudications Assigned to the E-bill Provider Adjustment Account

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

Overview

Payers will, at times, reverse previous adjudications for numerous reasons (e.g. plan termed, duplicate charge, etc). These are known as Provider Level Adjustments. ERA reversals received through an ERA adjudication automatically process to a generic account setup for payments/retractions that OP cannot specifically trace to a specific patient account. The generic chart is chart #-5, Provider Adj. e-Billing. OP automatically creates a Claim that is displayed in that chart. OP only makes adjudications visible to the user if the corresponding charge transaction is archived (i.e. daysheeted). Since OP creates a current Claim to post these reversal transactions against, you need to run a daysheet so that these adjudications are visible for posting.

To determine the reversal details, you can either:

  • Contact the payer directly. 

or

  • Check your clearinghouse for a copy of the corresponding remittance where this reversal was recorded. 
  1. On the Adjudications tab of the e-Billing center, change the match status of the reversal adjudication (as assigned to a chart by the name of Provider Adj. E-Billing) to Discard, approve and post the transaction.
  2. Navigate to the e-Billing Provider Adjustment Chart, and click Claims
  3. Locate and select the Claim with the referenced reversal. 
  4. Click the Void button to delete the Claim.
  5. Click the OK button in the confirmation pop-up box. If the Provider Level Adjustment is being used to pay another patient's claim on the same remit, click here to learn about processing the retraction. 

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

Overview

Payers will, at times, reverse previous adjudications for numerous reasons (e.g. plan termed, duplicate charge, etc). These are known as Provider Level Adjustments. ERA reversals received through an ERA adjudication automatically process to a generic account setup for payments/retractions that OP cannot specifically trace to a specific patient account. The generic account is acct #-5, Provider Adj. E-Billing. OP automatically creates a Claim that is displayed on your current claims tab. OP only makes adjudications visible to the user if the corresponding charge transaction is archived (i.e. daysheeted). Since OP creates a current claim to post these reversal transactions against, run a daysheet so that these adjudications are visible for posting.

To determine the reversal details, you can either:

  • Contact the payer directly. 

or

  • Check your clearinghouse for a copy of the corresponding EOB where this reversal was recorded. 
  1. On the Adjudications tab of the e-Billing center, change the match status of the reversal adjudication (as assigned to an account by the name of Provider Adj. E-Billing) to Discard, approve and post the transaction.

  1. Navigate to the E-Billing Provider Adjustment Account, and click the Claims tab. 

  1. Locate and select the Claim with the referenced reversal. 

  1. Click the Void button to delete the Claim.
  2. Click the OK button when prompted, This action will delete the entire claim, Are you Sure?

  1. If the Provider Level Adjustment is being used to pay another patient's claim on the same remit, click here to learn about processing the retraction.