Billing Workflow in Omnipractice

Setting Up Billing, NPIs, and Insurance Payers

Step 1: Set up your practice details in the system. Access the Settings menu, navigate to Practice Settings, and fill in all required address and practice information necessary for billing.

Step 2: Add and configure your services. Ensure all services are listed, with the correct rates and charges. For each service code, add payer-specific fees if required, including any necessary payer rates and modifiers. You can manage these individually or in bulk for convenience.

Step 3: Configure online payment methods. Open the Billing section and select Manage Online Payments. Choose which payment methods you’ll accept, and make sure your billing address (which can be the same as your practice address) is entered correctly.

Step 4: Set up NPIs and payers. In the Insurance tab, add NPIs—both clinician and group types. Assign names and specific providers as appropriate, and set up any required CPT exceptions or other configurations.

Step 5: Add payers and manage enrollments. Go to the Payers section, select Add Payer, search and enroll with the desired payers, and keep enrolling as needed. You can check enrollment status (pending, accepted, etc.), add manual payers for paper claims, and bulk upload payer information for efficiency.

Step 6: Import fee schedules for each payer as necessary. You can also add plan variants and multiple payer names for complex setups.

Step 7: Configure claims settings. Assign team members as necessary and adjust claim configuration rules to match your practice’s needs.

Step 8: Enable and use the AI payer compliance check. Set which CPT codes can be scheduled or billed together on the same day according to payer rules, helping to reduce claim issues.

Step 9: Complete contracted rates setup. Ensure contracted rates are added and configured for each payer. Edit or delete rates as needed and assign multiple plan names if one ID covers several plans.

Creating and Managing Insurance Claims

Step 1: Review upcoming insurance-related appointments in the Insurance tab. All scheduled appointments not yet claimed will be visible here.

Step 2: Bulk select appointments to generate claims automatically. Once created, claims will move to the Claims tab for tracking and management.

Step 3: Monitor claim statuses with filters and sorting for easy review. See creation dates, service dates, and all status changes from submission to payment.

Step 4: ERAs (Electronic Remittance Advices) are received and posted automatically. Manual EOB (Explanation of Benefits) posting is possible in the EOB tab.

Step 5: For manual payment posting, create a payment batch, select paid services, and apply payments as needed.

Step 6: Use the Denial Management section to review all denied claims, along with reasons provided. Use this information to resubmit corrected claims.

Step 7: The Dashboard provides quick visual access to claim aging, payments by payer, net collection trends, and custom KPI cards to review and analyze your practice’s billing performance.

Client Billing, Eligibility, and Claim Readiness

Step 1: Visit the Billing tab to review and manage all appointments. Charge clients directly or process their insurance claims. If a client has a saved card, process charges automatically.

Step 2: Use available filters to narrow down appointments by service or client type. Add manual payments, or generate and track invoices for sessions.

Step 3: Access eligibility, claim, and payment history for each client. Create and manage superbills as needed, and quickly reference eligibility statuses (run, failed, etc.).

Step 4: To verify client eligibility, open their file, go to the Info and Settings, and check insurance and benefit status using system integrations or AI tools for real-time benefits and account balances.

Step 5: Ensure notes are signed and locked before submitting claims. Track and audit clinician notes for pending signatures, and send reminders with shareable links when needed. This step minimizes claim denials.

Step 6: Review compliance warnings in insurance claims. Correct any flagged missing data for a cleaner submissions workflow.

Understanding the Billing Workflow and Reports

Step 1: Understand the billing workflow: Appointments are scheduled and completed, notes are signed and locked, claims are generated (individually or in bulk), and submissions are made. Claims move through status stages until paid or denied, with payment posting and copay management handled within the system.

Step 2: Edit session or invoice details by accessing the client’s file and updating necessary session or billing information.

Step 3: Use the Reports section for comprehensive billing insights, including patient claims and copay reports. Leverage these reports to actively manage your financial outcomes.

Conclusion

With accurate setup and regular management using these features, you’ll streamline billing, reduce denials, and stay on top of your practice’s financial health. For further assistance, reach out to Omnipractice AI support.

Thank you for following along!