Review Electronic Claim Responses in oops

When Partner receives an electronic claim response from the insurance payor or the claim clearinghouse, a one-line message is added to oops. Here are two examples:

If the claims were sent through the Copario (MedAvant, ProxyMed) or Emdeon claim clearinghouses, you can review a more detailed response report from within the oops program. Press [fkey title=’F3′ subtitle=’See Claim Rpt/Bill’ display=’inline’ /] and then select any billing response item that begins with “Payor Response” or that indicates a rejection or acceptance.

Example 1

In the example below, you can see that the electronic claim clearinghouse (ProxyMed) sent several messages to Partner regarding William Amis’s visit on 01/06/06.

To read the full electronic report, press [fkey title=’F3′ subtitle=’SeeClaim Rpt/Bill’ display=’inline’ /] and then select any entry beginning with “Payor Response” or “PROXYMED Accepted Claim”:

Partner will open the relevant ECS report and display portions related to this patient that are on that report:

In the above example, the claim was accepted.

Example 2

You can also review information about a rejected charge. In the next example, Female Baby Garg’s immunization administration charge was rejected by the MVP insurance company:

To find out why the claim was rejected, press [fkey title=’F3′ subtitle=’See Claim Rpt/Bill’ display=’inline’ /], enter the number next to the rejection, and press Enter:

Partner will display the segment of the report related to the patient, and you can read all the information that the insurance company (or claim processor) returned:

Using this feature, you can read your ECS reports from within the oops program. You can also read ECS reports in your e-mail or through the ecsreports program.

Here are some related articles in Billing and Practice Management > Edit Charges and Encounter Claim Information:

Edit Encounter Charge Information and Generate a New Claim
Use the Correct Mistakes (oops) program to review an account's charge history, adjust the responsible party for a charge, change charge and encounter information, resubmit claims, and link or unlink payments. Correct Mistakes is part of PCC's under-the-hood Practice Management window (Partner).
Adjust Charge Details and Claim History (Correct Mistakes)
When you need to fix charge and claim details, change the responsible party for an encounter, or alter encounter information that appears on a claim (such as diagnoses or prior authorization numbers), use the Correct Mistakes tool in the Practice Management window. After you make changes, you can resubmit claims. You can also use oops to research the billing and payment history for each encounter on an account.
Unlink and Relink a Payment
If you post a payment and later discover the procedure or payment was a mistake, you may need to "relink" the payment to different procedure.
Edit an Encounter’s Diagnoses, Billing Provider, and Other Claim Information
Your practice can enter a diagnoses, adjust the billing provider, and add other claim information when you Post Charges in PCC EHR. If you need to make changes later (and resubmit a claim), use the Visit Status screens in Correct Mistakes (oops) in the Practice Management window. You can change diagnoses, the billing provider, and adjust other important encounter information for a charge.
Change the Responsible Party and Copay for Charges
Your practice can adjust the responsible party for a charge and edit copay amounts when you Post Charges in PCC EHR. If you find out the patient's policy has changed, you can edit the charges later in Correct Mistakes (oops), found in the Practice Management window. You can change the responsible payor for any charge on any encounter, and change the portion of the charge that is the copay.
Enter and Review Encounter Visit Notes
You can add and review visit notes for an encounter in Correct Mistakes (oops).
Add an Attachment Code to a Claim
If a secondary insurance requires the EOB from the primary, or any claim requires a certificate of medical necessity, discharge summary, or other clinical documentation, you can add attachment codes to a visit’s charges, generate a unique attachment ID, and specify the attachment type and method.
Change an Encounter’s Billing Place of Service After Posting Charges
You can adjust an encounter’s place of service when you Post Charges in PCC EHR. Sometimes you need to change the billing place of service of an encounter after the charges have already been posted. Read below to learn how to change the billing place of service of a phone note, portal message, or visit […]
Change the Copay Due on a Charge
Learn how to change the copay due on a charge. You may need to do this after charges have been posted and a claim has been filed.

Related Articles