OPIE Billing User Guide - Oandp

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OPIE Billing User GuideTable of ContentsBilling & Collections . 5Create a Claim . 5Get Started in Billing – Add a New User to OPIE Billing . 5Log into Billing and Use Batches . 6Create a New Batch. 6Print a Batch Report and Close a Batch . 7Get Started in Billing - Set up Global Settings in Billing . 7General Settings . 8Patient Statements & Invoices . 14Statement Notes . 16Clean & Repair. 17User Permissions . 18Task List . 201500 Form . 21EDI . 22Getting Started in Billing – Setting up Existing Insurance Companies . 23Insurance Company – Contact Info . 23Insurance Company – Additional Options . 24Insurance Company – 1500 Form . 27Insurance Company – Practitioner PIN Information . 28Insurance Company – Invoices. 29Insurance Company – Attachments . 30Claims – Find a Claim . 31Find a Claim Using Claims by Patient . 31Finding a Claim - What the OPIE Billing icons mean . 33Find a Claim – Using the Task List . 36Understanding the Tabs on a Claim . 36Patient Tab on a Claim . 38Primary Insurance Tab on a Claim . 39Secondary Insurance Tab on a Claim . 42www.opiehelp.com-2-Support: (800) 876-7740, option 3

OPIE Billing User GuideReferring Physician/Other Tab on a Claim . 43Codes Tab on a Claim . 44Submissions Tab on a Claim . 52Submit a Claim . 53Task Items Tab on a Claim. 57Notes Tab on a Claim . 60Attachments Tab on a Claim . 61Validation Tab on a Claim . 62The Payment History . 64The Transaction History . 66Other Claims. 67Payments. 67Patient Payments . 68Insurance Payments . 74Adjustments . 87Adjust a Claim on Which a Payment Has Not Been Made and Applied. 87Create an Opie Billing Adjustment . 87Processing Insurance Take-Backs. 90Refunds (On Unapplied Payments) . 92Refunds (on Overpaid Claims). 92OPIE Balancing . 99Working with Batch Reports . 99Balancing the Activity Report to the AR Aging Report . 101Posting Monthly Totals . 102Posting Totals by Branch . 102Running the Activity Report by Branch . 102Unapplied Payment by Branch. 102Other Key Opie Financial Reports . 103Important Notes about Permissions and Corrections/Deletions-Data Modification Log. 104Month-End Process . 104Step 1: Verify ALL billing batches are closed. 104www.opiehelp.com-3-Support: (800) 876-7740, option 3

OPIE Billing User GuideStep 2: Generate the Activity Report . 105Step 3: Generate the A/R Aging Report . 106Step 4: Generate the Sales Report [Charges Billed (by Date Billed)] . 108Step 5: Generate the Payments Report . 110Step 6: Unapplied Payments – Balancing to the AR Aging Report. 111Step 7: Generate Adjustments Report . 113Reports . 114Activity Reports . 114AR Aging Report . 115Data Modification Log . 116Patient Statements . 117Appendix A - TIPS . 120Correct New Payment Created Twice in Error; Payment Not Yet Applied . 120Moving Patient Overpayment from One Claim to Another . 120How to Correct LCodes or Quantities on Claims in OPIE Billing . 121Preview a HCFA/1500 Form . 122Add Modifiers. 1221500 form doesn’t line up on print . 122Billing claim shows incorrect default fee schedule . 123How to modify an incorrect branch or location on a claim: . 123Delete a Claim . 124How can I get my Taxonomy Code to Print on the HCFA 1500 Form? . 124Remove a Claim from Queued Claims: . 127Fix a Claim that has Different Dates of Service on the LCode Lines Shown on the Codes Tab . 127Task Items . 128OPIE Billing Task Lists and Items . 128Statements . 134Eliminate the Detail of L-Codes and Fees on Patient's Statement . 134Billable Event. 134Show Prices/Fees . 135www.opiehelp.com-4-Support: (800) 876-7740, option 3

OPIE Billing User GuideBilling & CollectionsNote: As you go through this manual and view OPIE Billing screens you will often see a question mark in an orange circle(see image below). This will link you directly to the associated content in the online OPIE Billing User Guide.Create a ClaimThe practitioner must select a series of LCodes which will be used and billed as part of the creation of the patient’sdevice. When this LCode selection is created in OPIE and Sent to Admin, it creates the initial claim in OPIE Billing and aTask Item (the OPIE Billing’s Task List serves as the claim’s status indicator and tickler file). This initial task item will havethe Task description “Authorize/Preauthorize.” At this point, whoever is responsible for verifying and authorizinginsurance information will ensure all documentation required to correctly bill the claim when it is delivered is obtained.The biller will open the claim and verify that the LCodes, modifiers, charges and allowables, etc. look correct.The second critical pre-billing step occurs when the practitioner creates a Delivery Receipt in OPIE which the patientmust sign. This is created at delivery of the patient’s device. Once that form is saved and Sent to Bill a new Task Item iscreated with the description “Bill Claim.” At this point the Biller can do a final review of the claim and then submit it tothe payer for payment.Get Started in Billing – Add a New User to OPIE BillingThis process will begin in OPIE and then move to OPIE Billing.This first step must be done by the OPIE Administrator. Open OPIE and go to Admin Tools. Add the user by going toUsers, Add User and type in the new User’s Name, Password and set all permissions you want them to have in OPIE.Also include the permission for OPIE Billing. Save and Close.1. The next step must be done by the OPIE Administrator who must also have been given access to OPIE Billing.2. Log into OPIE Billing. At the top left of the screen there are three menus: File, Windows, and Help. Click on Helpand then Settings.3. You will see a tab to the right which says User Permissions.4. Select the new user’s name from the drop down and give the permissions they will need. They MUST have theBatch Create/Close permission which will allow them to login.Generally, we recommend that care should be taken in granting the following permissions: Make Corrections/Delete Payments in any batch*Log into Other Users’ BatchesClose Other Users’ BatchesDelete Claims (Any Time)*www.opiehelp.com-5-Support: (800) 876-7740, option 3

OPIE Billing User Guide Edit Payments in any Batch*Edit Charge Amount after SubmissionEdit Allowable Amount after SubmissionUsers who have the permissions listed above will be able to change history, that is, edit or make corrections tosubmitted claims, payments or adjustments done in closed batches which are already part of the AR balances. They canalso Delete Claims (Any Time), which means they can also delete claims which have already been submitted to the payerand whose AR balances are already part of the AR totals. The new permissions affecting other users batches could allowa user to accidentally log in using someone else’s batch and close that batch at will.5. Once all of the permissions have been marked, click on Save Permissions and then Save and Close.6. Log out and allow the new user to log in by selecting the correct name from the drop down, typing in thepassword you gave them in OPIE, selecting a branch and clicking on the to create their first new batch andthen clicking on Logon. OPIE Billing will open.Please Note: if you do not select a batch you will be logged in, in a “read only” status.If you need further assistance please call OPIE Billing Support at 1-800-874-7440.Log into Billing and Use BatchesA new batch should be created every day as part of the daily work and balancing process. The batch groups together allthe financial transactions done for that day. These include submitting claims, entering and applying payments andmaking adjustments. At the end of the day, run the batch report and balance to the total of new payments entered (thetotal which presumably will be your bank deposit for the day) and to any miscellaneous adjustments, such as, write offs,refunds, etc. that may be made to claims.Please Note: if you do not select a batch you will be logged in, in a “read only” status.Create a New BatchEach OPIE Billing user can have only one batch open in OPIE Billing at any time. The format of the batch ID looks like this:36, 10/24/2011 9:24:22 AM, SAM, O&P Digital1.2.3.4.The first number is the Batch Number. Batch numbers increase incrementally for all batches.The date and time shown is the date and time when the batch was created.The user’s Initials follow the comma after the date and time.The Branch Name follows the comma after the user's initials.Login and create a new batchYou must have the proper permissions in OPIE Billing to be able to create a batch. If you already have a batch open, youwill not be allowed to create another batch until the first batch is closed.www.opiehelp.com-6-Support: (800) 876-7740, option 3

OPIE Billing User Guide1.2.3.4.Select the appropriate Username, enter your Password and select the Branch for the batch.Click on the plus sign ( ) on the Billing Batch line.Click on the drop down to select the new batch. Please Note: if you do not select a batch you will belogged in, in a “read only” status.Click on LogonIf you logout of billing at any time during the day, your Username, branch and batch will appear automatically. In thefuture, when you have closed your batch in the evening and click on the OPIE Billing shortcut the next morning the logonscreen will default to your username and branch. Only your password and the creation of the new batch will berequired.Note: You will notice that on the bottom right corner of your Billing window you will see an entry like this.This will display your batch number, the date and time it was created, your branch name, your status and who iscurrently logged on with that batch.Print a Batch Report and Close a Batch1. On the left navigation bar, click on Close Batch under Batches2. When the Close Batch window opens, click on the drop down arrow and select the batch number to close. Youwill only be able to close your own batch unless you have permissions in OPIE Billing to close the batches ofothers.3. Click on the Batch Report button. When the Activity Report window opens, click on Generate Report. (Reviewand balance to this report before closing the batch. You may also print the report if you wish.)4. After the report has been reviewed, close it. If the report is accurate, click on the button Batch is Clean, CloseThis Batch.5. The batch will close and so will the OPIE Billing application.6. To return to OPIE Billing, create a new batch.Get Started in Billing - Set up Global Settings in BillingAdmin Rights in OPIE are required to access Billing Settings.1. Log into OPIE Billing, go to the top left part of the Window to the menus: File, Windows, Help and click on Helpand then Settings.2. There are 9 tabs: General, Statements & Invoices, Statement Notes, Clean & Repair, User Permissions, Task List,1500 Form EDI and GL.www.opiehelp.com-7-Support: (800) 876-7740, option 3

OPIE Billing User GuideGeneral SettingsAR Starting Balance: Enter 0.00 in this box.Include estimated contractual adjustment in AR Report: Leave this box unchecked. See: Reports, AR Aging for furtherexplanation.Idle Timeout: This is the number of minutes before OPIE Billing will lock itself for HIPAA protection. 3 minutes is thedefault.Federal Tax ID Numbers: This displays the tax ID numbers entered in OPIE under Admin Tools, Edit Branches. If there isa different tax ID number for each branch, apply those tax IDs by branch to claims by clicking on Use Branch Tax ID.Use Branch Tax ID: If checked will use branch tax ID’s entered in OPIE under Admin Tools, Edit Branches.www.opiehelp.com-8-Support: (800) 876-7740, option 3

OPIE Billing User Guide1500 Form Settings:1. 1500 Form Version to Use: This is the version of the 1500 form that you want to use for most of your claims. Itshould display 1500 (02/12).2. PT Account Number: This is normally defaulted to the Patient ID – Claim Number.3. Service Facility: Set this to where services are “Usually rendered”, i.e. Branch, Service Facility etc.4. Billing Provider: This is normally defaulted to Home Office. The Home Office historically was the first branchlisted in OPIE Admin Tools when OPIE was installed for a client. Now there is an option, controlled by OPIESupport, which can change the Home Office designation as your branches may change.Appearance: Use Blue style is the normal default. However, if there are any problems seeing some of the buttons in thebilling application we recommend changing this setting to Use OS Style.Default Scan Resolution: This is normally defaulted to Standard.Note/Reason Pre-set:To set pre-set adjustment or corrective notes, this will appear in a drop down menu when posting payments or makingcorrections.www.opiehelp.com-9-Support: (800) 876-7740, option 3

OPIE Billing User Guide1. Select Adjustment or Corrective2. Click Manage3. Select Adjustment Type or Corrective Action4. Enter the Note/Reason in Adjustment Noteor Corrective Reason field5. Click Save each one entered will drop in theNote/Reasons box1. Show Allowables Column: Normally checked. This will allow you to see both the charge and the allowableamount on each line of a claim.2. Show DOS to Column: If checked will allow “span dates” for Date of Service.3. Auto process/submit on batch close: Normally checked. This will allow an automatic submission to the nextpayer after you post a payment. This submission occurs when your batch is closed.www.opiehelp.com-10-Support: (800) 876-7740, option 3

OPIE Billing User Guide4. Alphabetize Fee Schedule Drop Down: If selected will sort imported fee schedules in Alphabetic order whenattaching it to an existing Insurance5. Use Sales Tax: Normally unchecked. This box should be checked if you charging sales tax on claims. If this box ischecked, never uncheck it without consulting with OPIE Support.6. Sales Tax from Allowed: When checked will calculate sales tax from allowed amounts instead of Usual andCustomary charges7. Includes Sales Tax on 1500 form: Normally unchecked: checked only if sales tax is charged and is to be includedon the 1500 form.8. Round Sales Tax: Select one of these choices if you are using Sales Tax.As you will see on your claims if you select this box, per item Sales Tax is calculated to 7 decimal places. Depending onyour selection, calculated sales tax will round up, down, or will only round up if the calculated Sales Tax is exactly at .50.How to Add Sales Tax in OPIE and OPIE Billing1. Go into Administrative Tools in OPIE and click on Edit Branches.2. Make sure you have entered a Sales Tax Rate for each branch in the box shown.3. Now go into OPIE Billing and at the top left corner click on Help and Settings. Make sure the Sales Tax box onthe General Tab is checked. (Typically, the Include Sales Tax on 1500 form is left unchecked.) Click on Save andClose.4. If you open any claim at this point, you will see an extra column on the Codes tab of the claim which says Tax. Ifthat code is taxable, click in the Tax box and then click elsewhere on the form. The Sales Tax (per item) willdisplay. The Total charge will include the sales tax and the sales tax total will appear at the bottom of the form.(See the example below.) If you have a quantity greater than 1, the sales tax on the line will show for 1 item, butwww.opiehelp.com-11-Support: (800) 876-7740, option 3

OPIE Billing User Guidewill calculate into the total as that amount times the quantity.5. After you submit the claim the Sales Tax total will appear under Charges on your total page of your batch oractivity reports.6. Sales Tax amounts will also appear on your Charges Billed reports. However, they do not appear by default soyou will have to click on Choose Fields and add Sales Tax and Billed Amount (Net) (that is, before the tax) to thereport.www.opiehelp.com-12-Support: (800) 876-7740, option 3

OPIE Billing User Guide7. There is a second option available to you regarding Sales Tax. You can request that OPIE Support set some ofyour consistently taxable HCPC Codes to taxable. Then, whenever those codes appear either on a claim or inOPIE on a service estimate, the tax will be automatically turned on and included.www.opiehelp.com-13-Support: (800) 876-7740, option 3

OPIE Billing User GuidePatient Statements & InvoicesThere are three areas on the Statements & Invoices settings tab. The top section controls what information will print onthe Patient Statements and Invoices.1. Suppress detailed information/codes on Patient Statement: If unchecked the L-Code description will print onthe patient statement2. Suppress patient information on Invoices: If unchecked, the patient’s name and address will be included onany Invoices you create.3. Print negative patient statements: Normally checked. This will allow you to print statements for patients withcredit balances.www.opiehelp.com-14-Support: (800) 876-7740, option 3

OPIE Billing User Guide4. Payment/Adjustment History: Allows the practice to select the amount of history printed on the statements bydefault. Choices include Simple, Detailed or None.5. Display Create Follow-up Task Prompt: If checked when patient statements are printed prompt will displayasking if you wish to create a follow up task.6. PT Statement Auto-Print: If selected system will generate a patient statement for printing into the Patientstatement que once the claim has been submitted to Patient Responsibility.Below are settings which control what branch address prints on the Patient Statements and Invoices.1. Use default branch selection behavior: The default is for the radio button to be selected. This means thatdepending on the branch of the claim, the physical address of that branch will print on the form.2. Use Branch Billing Address: When completing the Edit Branch information in OPIE under Admin Tools, on theright side of the screen for each branch, enter the billing address to be used for this branch. Typically, this is theaddress of the ‘home office’ (the first branch in the list of branches). If this box is checked, the address thatappears in the right hand of that branch’s data under Billing Information will be the branch address that printson the form.3. Use selected branch: This radio button is selected

5. The batch will close and so will the OPIE Billing application. 6. To return to OPIE Billing, create a new batch. Get Started in Billing - Set up Global Settings in Billing Admin Rights in OPIE are required to access Billing Settings. 1. Log into OPIE Billing, go to the top left part of the Window to the menus: File, Windows, Help and click .

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