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Process Claim Acknowledgements

Version 14.19

Overview

If your practice uses a supported clearinghouse, Claim Acknowledgment files can be processed into OP. These files provide the most up to date claim status as supplied by the clearinghouse and includes rejections. It is recommended that Claim Acknowledgements files are processed regularly. The process of pulling these files into OP is known as Fetch and Process.

Pull Claim Acknowledgement Files into OP

  1. Navigate to the Claims (A/R) tab of the Billing Center: Billing tab > Billing Center button > Claims (A/R) tab
  2. Click the Fetch Files button.
  3. Click the Yes button in the confirmation pop-up box. This action fetches (retrieves) any unread Acknowledgment reports from your clearinghouse and places them in the Administrative Documents Repository.

  1. Click the Process button. This action allows OP to read any unread acknowledgment reports from your clearinghouse and updates the corresponding claim category codes.
  2. Click the Yes button in the Confirmation pop-up box.

Tip: You can also manually add a claim status by doing the following:

  1. Select the Claim in question.
  2. Select the Status history radio button.
  3. Click the Add Status button. A blank entry line is displayed.
  4. Select and updated or alternate status from the Status Category drop-down menu.
  5. Edit the Note field if/as applicable to provide further details of this status change.
  6. Click the Save button to save this status update.

View Claim Acknowledgements

  1. Navigate to the Claims (A/R) tab of the Billing Center: Billing tab > Billing Center button > Claims (A/R) tab
  2. From the Stage drop-down menu, select Acknowledged by clearinghouse, Acknowledged by payer, or Rejected/Denied depending on what should be displayed.
  3. Select the Status History radio button as the Details option located directly above the claim grid, then click to the left of a specific claim to expand the claim details section and view Status History. This allows you to view the Status Date, Category, Notes, etc. pertinent to a specific unpaid claim. 

Version 14.10

Overview

If your office has a supported clearinghouse and your claim audit reports are automated through your clearinghouse.

Updating a Claim Status

  1. Click the Billing button to open the e-Billing center.
  2. Click the Claims + A/R tab .  
  3. Click the Fetch button, then click the Yes button in the confirmation pop-up box when prompted Fetch Payer Reports?. OP goes idle when the process is complete.

This action fetches (retrieve) any unread audit reports from your clearinghouse and place them in your Administrative Documents.

  1. Click on the Process button . This action allows OP to read any unread audit reports from your clearinghouse and updated the corresponding claim status.
  2. Click the Yes button in the confirmation pop-up box when prompted Process Payer Reports?. OP goes idle when the process is complete.

You can view the most recent audit report response of claim status from your clearinghouse.


You can also manually add known claim status as follows:
  • Click the Claim in question (it is highlighted)
  • Select the Status history radio button .
  • Click the Add Status Icon.
  • Click the Pencil icon to allow edits.
  • Select a Status Category from the drop-down menu.
  • Edit the Note field if/as applicable (to provide further details of this status change).
  • Click the Green Checkmark buttonto save this status update.