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.

Validate Insurance

Version 14.19
Path: Smart Toolbar > Schedule button > Tracking tab

Overview

To use the validation feature in Office Practicum, offices will need to:

  1. Enroll for Full HIPAA transactions with Office Practicum.
  2. Enroll with an integrated clearinghouse.
  3. Set up the Insurance Payer Table to use the Validation Feature.

This feature will work contingent on the proper set up of the Insurance Record, accurate Patient Information entered into the patient record, and whether the payer is supported by the clearinghouse for Real-Time Eligibility.

This page will instruct you on how to use the validation feature to: 

  • Verify an individual patient's insurance in the Add/Edit Appointment window.
  • Verify an individual patient's insurance in the Tracking tab of the Schedule and Practice Workflow window .
  • Verify insurance coverage for every patient (based on parameters set) on the schedule for a particular day. 

Verify Insurance for an Individual Patient from the Appointment

  1. Click the Sched button.
  2. Navigate to the patient whose insurance you would like to validate.
  3. Double-click on the patient's appointment. This will open the Add/Edit Appointment window.
  4. Click the Validate button located in the Primary Insurance section of the window.
  5. Validation will process for the patient.

Verify Insurance for an Individual Patient from the Tracking Tab

  1. Click the Schedule button .
  2. Click the Tracking tab .
  3. There are two columns that you will use to perform insurance validation.
  • Insurance Validation column : this column will populate with the color key result after validation has been performed.
  • Verify Insurance column:  this column will populate with a Verify Insurance button on each individual patient's line in the Tracking window and will be used to validate insurance for that patient.

Note: If you do not see the Ins. Valid or Verify Insurance columns in your window, it is likely the columns have been removed from view. To learn how to add columns to your view, click here.
  1. Click on the line for the patient whose insurance you would like to verify. The Verify Insurance button appears.
  2. Click the Verify Insurance button. Validation will process and return a result in the Ins. Valid column based on the color key.
  • If nothing comes back into the system or the field is White in color, ask the patient for updated insurance information or call the payer for further information.
  • If a Dark Green color comes back into the system, the validation check has returned a valid insurance status.
  • If a Yellow color comes back into the system, retry your validation attempt.  There could have been connectivity issues at the time of validation attempt.
  • If a Light Green color comes back into the system, then there is no insurance policy to validate on file. The patient is either listed as Self Pay or the insurance was not ranked.
  • If a Pink color comes back into the system, then the insurance on file is invalid.

Verify Insurance for All Patients on Schedule

  1. Follow steps 1-3 above.
  2. Click on the Validate button  at the top of the Tracking window.

  1. In the Insurance Validation box, select your criteria and click the Begin button to start validating.

  1. Validation will process and return a result in the Ins. Valid column based on the color key.
  • If nothing comes back into the system or the field is White in color, ask the patient for updated insurance information or call the payer for further information.
  • If a Dark Green color comes back into the system, the validation check has returned a valid insurance status.
  • If a Yellow color comes back into the system, retry your validation attempt.  There could have been connectivity issues at the time of validation attempt.
  • If a Light Green color comes back into the system, then there is no insurance policy to validate on file. The patient is either listed as Self Pay or the insurance was not ranked.
  • If a Pink color comes back into the system, then the insurance on file is invalid.

Version 14.10
Path: Smart Toolbar > Schedule button > Tracking tab

Overview

To use the validation feature in Office Practicum, offices will need to:

  1. Enroll for Full HIPAA transactions with Office Practicum.
  2. Enroll with an integrated clearinghouse.
  3. Set up the Insurance Payer Table to use the Validation Feature.

This feature will work contingent on the proper set up of the Insurance Record, accurate Patient Information entered into the patient record, and whether the payer is supported by the clearinghouse for Real-Time Eligibility.

This page will instruct you on how to use the validation feature to: 

  • Verify an individual patient's insurance in the Add/Edit Appointment window.
  • Verify an individual patient's insurance in the Tracking tab of the Schedule and Practice Workflow window .
  • Verify insurance coverage for every patient (based on parameters set) on the schedule for a particular day. 

Verify Insurance for an Individual Patient from the Appointment

  1. Click the Sched button.
  2. Navigate to the patient whose insurance you would like to validate.
  3. Double-click on the patient's appointment. This will open the Add/Edit Appointment window.
  4. Click the Validate button located in the Primary Insurance section of the window.
  5. Validation will process for the patient.

Verify Insurance for an Individual Patient from the Tracking Tab

  1. Click the Schedule button .
  2. Click the Tracking tab .
  3. There are two columns that you will use to perform insurance validation.
  • Insurance Validation column : this column will populate with the color key result after validation has been performed.
  • Verify Insurance column:  this column will populate with a Verify Insurance button on each individual patient's line in the Tracking window and will be used to validate insurance for that patient.

Note: If you do not see the Ins. Valid or Verify Insurance columns in your window, it is likely the columns have been removed from view. To learn how to add columns to your view, click here.
  1. Click on the line for the patient whose insurance you would like to verify. The Verify Insurance button appears.
  2. Click the Verify Insurance button. Validation will process and return a result in the Ins. Valid column based on the color key.
  • If nothing comes back into the system or the field is White in color, ask the patient for updated insurance information or call the payer for further information.
  • If a Dark Green color comes back into the system, the validation check has returned a valid insurance status.
  • If a Yellow color comes back into the system, retry your validation attempt.  There could have been connectivity issues at the time of validation attempt.
  • If a Light Green color comes back into the system, then there is no insurance policy to validate on file. The patient is either listed as Self Pay or the insurance was not ranked.
  • If a Pink color comes back into the system, then the insurance on file is invalid.

Verify Insurance for All Patients on Schedule

  1. Follow steps 1-3 above.
  2. Click on the Validate button  at the top of the Tracking window.

  1. In the Insurance Validation box, select your criteria and click the Begin button to start validating.

  1. Validation will process and return a result in the Ins. Valid column based on the color key.
  • If nothing comes back into the system or the field is White in color, ask the patient for updated insurance information or call the payer for further information.
  • If a Dark Green color comes back into the system, the validation check has returned a valid insurance status.
  • If a Yellow color comes back into the system, retry your validation attempt.  There could have been connectivity issues at the time of validation attempt.
  • If a Light Green color comes back into the system, then there is no insurance policy to validate on file. The patient is either listed as Self Pay or the insurance was not ranked.
  • If a Pink color comes back into the system, then the insurance on file is invalid.