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.

Processing a Primary Adjudication for Submission to a Secondary Payer on File

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

Overview

When a user is posting ERA payments, there may be instances when there is a patient responsibility due. If the patient holds other coverage, the practice will likely send that responsibility to the Secondary Payer on file. To do this, follow the below steps:

  1. Navigate to the Adjudications in the Billing Center using the path above.
  2. Select the Adjudication line where the patient's secondary insurance is listed.
  3. Expand the Adjudication to see the patient's responsibility is displayed.
  4. Ensure the following:
  • The patient's responsibility amount is listed in the Pt. Rsp. and Pat Bal. columns.
  • Xfr sec: is shown in the Insurance Action field with the secondary insurance listed.
  • Hold on account is shown in the Patient Action field.
  1. Approve all Adjudications for the claim.
  2. Click Post Paymt. The secondary claim will be sitting in the Transmit Queue waiting for electronic submission or print.
Note: For payers not accepting electronic secondary submission, click the CMS-1500 button to print a paper claim. Mail it with a copy of the EOB/ERA received from the primary carrier. Generally, you should be able to obtain a copy of the corresponding EOB (for this ERA) on your clearinghouse or payer website.
Version 14.10
Path: Smart Toolbar > Billing button > Adjudications tab

Overview

When a user is posting ERA's payments back in to Office Practicum, there may be instances where there is a patient responsibility due. You can use the note field to keep track of any information you need to maintain based on the primary adjudication. For example, primary payer assigned patient due copayment, deductible or co-insurance. However, if the patient holds other coverage the office most likely will want to assess any remaining responsibilities to the Secondary Payer on file and send the claim out electronically to the other payer on file. To do this, follow the below steps:

  1. Open the Billing Center by clicking on the Billing button on the Smart Toolbar.

Smart Toolbar: Billing

  1. Click on Adjudications tab.
  2. Open the Adjudication details of the claim by clicking on the expand button .
  3. Notice in the column for Sec Ins, a payer other than the primary payer listed.

  1. Approve all Adjudications for your claim.

 Adjudications tab

  1. Click on Post Payment button  .
  2. If the payer accepts electronic secondary claims, click on the Transmit Queue tab .
  3. Click the Create Files button to send the claims. The claims will include all primary payment details.
  4. Click Yes to Create claim files for transmission to payers and Yes to Transmit now.

Note: For payers not accepting electronic secondary submission, click the CMS-1500 button to print a paper claim. Mail it with a copy of the EOB/ERA received from the primary carrier. Generally, you should be able to obtain a copy of the corresponding EOB (for this ERA) on your clearinghouse or payer website.