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.

Working A/R

Version 14.19

Overview

In order to maintain a financially healthy practice, you will want to make sure that your outstanding Insurance and Patient balances are being worked regularly. This article will instruct you on ways to work your A/R. A/R tasks can be performed from the Billing Center or from the Patient Chart. 

Claim Notes

Claim notes can be added anywhere claims are visible. This includes: the stages in the Billing Center, the Patient Chart, or even while posting payments. To add a claim note:

  1. Locate the claim that requires a note.
  2. Click in the Claim Note field.
  3. Enter the desired note. 
  4. Use the Stamp tool to add the date, user, and time to the note.
  • Click the Stamp button.
  • Right-click where you would like to apply the stamp.
  • Select Paste.

For more information on creating claim notes and additional windows where claim notes can be added, visit Entering Claim Notes.

Correcting Claims

Claims that have been archived, or processed on a daysheet, can be corrected.  For instruction on correcting claims, visit Correcting Claims.

Sending a Claim to a Different Payer

If you find that a claim needs to be sent to a different payer than the original payer, visit Change Insurance on Individual Transactions (Daysheeted Claims).  

Sending a Claim to the Transmit Queue

While working your Insurance A/R, it may be necessary to send a claim back out to the same insurance. To do so:

  1. Locate the claim in either the Claims (A/R) tab of the Billing Center or in the Patient Chart.
  2. Select the claim.
  3. Click the Queue Primary (Q Prim) or Queue Secondary (Q Sec) button.
  4. Click the OK button in the confirmation box.
  5. The claim will now show in the Transmit Queue tab of the Billing Center.

Checking Claim Status

If you are using full HIPAA transactions (fetching/processing) reports from your clearinghouse, the claim status is reported by your clearinghouse. A clearinghouse generally has more than one claim status level. 

  • The first level is the clearinghouse review of the claim. Here the claim can be accepted or rejected based on basic criteria. 
  • Some clearinghouses have a second level of review. At this level an accepted claim can change to rejected based on more complex criteria. 
  • Finally, some clearinghouses provide a third level of review. At this level an accepted claim can be rejected or pended or even finalized for payment based on a response from an individual payer.

To check the status of an individual claim from the Claims (A/R) tab of the Billing Center:

  1. Select the claim.
  2. Click the Check Status button.
  3. If available, the new claim status will display in the claim's Status History.

To check the status of an individual claim from the Patient Chart:

  1. Navigate to the patient's chart.
  2. Click Claims .
  3. Select the claim.
  4. Click the Check Status button in the lower potion of the window.
  5. If available, the new claim status will show in the Status History for the claim.

Adding a Claim Status

While working Accounts Receivable (A/R), it may be necessary to create elaborate claim notes that exceed the allotted character limit in the claim note field. To free up space on the actual claim line, you may consider adding a Claim Status. 

To add a Claim Status from the Claims (A/R) tab of the Billing Center:

  1. Select the claim.
  2. Click the Status history radio button.
  3. Click the Add Status button.
  4. A blank status line will appear for the claim with the current date as the Status Date and your initials as the Staff #.
  5. Select the appropriate Status Category, Code, and Entity from the respective dropdown menus.
  6. Click in the notes field and enter your claim note/status.
  7. Click the Save button  button to save your work.
Note: You can also copy notes from the claim note line and paste them in the new status field. Be sure to click the Save Changes button to save your edits in the new status. You can then delete that note from the claim note line.

To add a Claim Status from the Patient Chart:

  1. Navigate to the patient's account.
  2. Click the Claims tab.
  3. Select the claim.
  4. Click the Add Status button in the lower potion of the window.
  5. A blank status line will appear in the lower portion of the window under Claim Status History. It will be automatically dated and contain the Staff member's initials.
  6. Select the appropriate Status Category, Code, and Entity from the respective dropdown menus.
  7. Click in the notes field and enter your claim note/status.
  8. Click the Save button to save your work.
Version 14.10

Overview

In order to maintain a financially healthy practice, you will want to make sure that your outstanding Insurance and Patient balances are being worked regularly. This article will instruct you on ways to work your A/R. A/R tasks can be performed from the Billing Center or from the Patient Account. 

Claim Notes

Claim notes can be added to claims within the Patient Account and also from the Claims + A/R tab of the Billing Center. To add a claim note:

  1. Locate the claim that requires a note.
  2. Click in the Claim Note field.
  3. Enter the desired note. 
  4. Use the Stamp tool in the Smart Toolbar to add the date, user, and time to the note.
  • Click the Stamp button.
  • Right-click where you would like to apply the stamp.
  • Select Paste.

For more information on creating claim notes and additional windows where claim notes can be added, visit Entering Claim Notes.

Correcting Claims

Claims that have been archived, or processed on a daysheet, can be corrected.  For instruction on correcting claims, visit Correcting Claims.

Sending a Claim to a Different Payer

If you find that a claim needs to be sent to a different payer than the original payer, visit Change Insurance on Individual Transactions (Daysheeted Claims).  

Sending a Claim to the Transmit Queue

While working your Insurance A/R, it may be necessary to send a claim back out to the same insurance. To do so:

  1. Locate the claim in the Claims + A/R tab of the Billing Center or in the Patient Account.
  2. Select the claim.
  3. Click the Queue Primary Insurance  button.
  4. Click the OK button in the confirmation box.
  5. The claim will now show in the Transmit Queue tab of the Billing Center.

Checking Claim Status

If you are using full HIPAA transactions (fetching/processing) reports from your clearinghouse, the claim status is reported by your clearinghouse. A clearinghouse generally has more than one claim status level. 

  • The first level is the clearinghouse review of the claim. Here the claim can be accepted or rejected based on basic criteria. 
  • Some clearinghouses have a second level of review. At this level an accepted claim can change to rejected based on more complex criteria. 
  • Finally, some clearinghouses provide a third level of review. At this level an accepted claim can be rejected or pended or even finalized for payment based on a response from an individual payer.

To check the status of an individual claim from the Claims + A/R tab of the Billing Center:

  1. Select the claim.
  2. Click the Check Status button .
  3. If available, the new claim status will display in the claim's Status History.

To check the status of an individual claim from the Patient Account:

  1. Navigate to the patient's account.
  2. Click the Claims tab.
  3. Select the claim.
  4. Click the Check Status button in the lower potion of the window.
  5. If available, the new claim status will show in the Status History for the claim.

Adding a Claim Status

While working Accounts Receivable (A/R), it may be necessary to create elaborate claim notes that exceed the allotted character limit in the claim note field. To free up space on the actual claim line, you may consider adding a Claim Status. 

To add a Claim Status from the Claims + A/R tab of the Billing Center:

  1. Select the claim.
  2. Click the Add Status button .
  3. A blank status line will appear for the claim with the current date as the Status Date and your initials as the Staff #.
  4. Select the appropriate Status Category, Code, and Entity from the respective dropdown menus.
  5. Click in the notes field and enter your claim note/status.
  6. Click the Save Changes  button to save your work.
Note: You can also copy notes from the claim note line and paste them in the new status field. Be sure to click the Save Changes button to save your edits in the new status. You can then delete that note from the claim note line.

To add a Claim Status from the Patient Account:

  1. Navigate to the patient's account.
  2. Click the Claims tab.
  3. Select the claim.
  4. Click the Add Status button in the lower potion of the window.
  5. A blank status line will appear in the lower portion of the window under Claim Status History. It will be automatically dated and contain the Staff member's initials.
  6. Select the appropriate Status Category, Code, and Entity from the respective dropdown menus.
  7. Click in the notes field and enter your claim note/status.
  8. Click the Save Changes button to save your work.