Advanced Action

Option

When it appears

What will it do

Primary Payer is Invalid

Use this option when the primary payer is no longer valid. This typically occurs when a claim is denied due to inactive or invalid insurance. Common reasons include an employment change, a lapsed insurance policy, or coverage termination.

1. Moves the primary payer’s EOB(s) to Inactive Payer
2. Updates the primary payer to a placeholder payer called “Patient”
3. Automatically generates a dummy EOB with “Patient” listed as the payer

Secondary Payer is Invalid

Use this option when the secondary payer is no longer valid. This is typically identified when a claim is denied due to inactive or invalid secondary insurance. Common reasons include employment changes, lapsed coverage, or past-due insurance policies.

1. Removes the secondary insurance from the encounter
2. Moves the secondary payer’s EOB(s) to Inactive Payer

Add Primary Payer

Use this option when a claim previously had its primary payer removed through an Advanced Action, and the primary insurance now needs to be added back to the claim.

1. Prompts you to add a primary insurance payer to the claim
2. Moves the claim to the Claim Review queue once the primary payer is added

Add Secondary Payer

Use this option when a claim needs a secondary payer added. This typically applies when the patient did not have secondary insurance on file in the EHR at the time the claim was generated, but a secondary EOB is later received.

1. Prompts you to add a secondary insurance payer to the claim
2. Once added, the claim will be included in the automated secondary claim submission

Patient does not have primary insurance

Use this option when it has been confirmed that the patient does not have any primary insurance and the encounter should be treated as self-pay.

1. Adds a dummy primary insurance labeled “Patient” to the claim
2. Generates a dummy EOB with “Patient” as the payer
3. Creates a patient statement
4. Updates the patient balance accordingly

Primary denied, need to bill patient

Use this option when Primary insurance denied the charge and you wish to move the payment to patient responsibility.

Our system will automatically calculate the bill amount for denied codes and generate the corresponding patient statement.

Secondary denied, need to bill patient

Use this option when Secondary insurance denied the charge and you wish to move the payment to patient responsibility.

Our system will automatically calculate the bill amount for denied codes and generate the corresponding patient statement.

Patient called to negotiate the balance

Use this option when a patient contacts your team to negotiate their outstanding balance.

1. Prompts you to enter a negotiated final balance amount
2. Updates the patient balance in the Practice Portal to reflect the new amount
3. If the primary payer is the dummy payer “PATIENT”, the system automatically updates the dummy EOB to match the new balance
5. If the patient has a valid primary insurance, the difference between the original balance and the negotiated balance is recorded as a patient write-off

I need to regenerate the patient statement

Use this option when an encounter’s payment data has changed. This typically occurs after a user edits a posted EOB.

1. Deletes the original patient statement associated with the encounter
2. Updates the payment summary, Practice Portal claim section, and Patient Portal to reflect the revised payment information for that encounter

Patient Write-Off, requested by the office

Use this option when the office requests that a patient balance be written off.

1. Allows you to write off a custom patient balance amount
2. Records the written-off amount as a patient write-off with the reason “Requested by the office”

Patient Write-Off, bad debt

Use this option when the office requests that a patient balance be written off.

1. Allows you to write off a custom patient balance amount
2. Records the written-off amount as a patient write-off with the reason “Bad Debt”

Insurance Write-Off

Use this option to write off procedure code(s) that will no longer be paid by the payer.

1. Allows you to select one or more codes to write off and choose the appropriate write-off reason from a dropdown
2. Updates the written-off code’s adjustment amount to reflect charge minus allowed amount
3. Marks any denied codes that are written off as finalized, meaning no further appeal is required

Resend Secondary Claim

Use this option when a secondary claim has already been sent, but needs to be resent (for example, if no response was received or corrections were made).

1. After applying this option, the claim will be included in the automated secondary claim submission

None of the listing above

Use this option when you have a question or when the existing options do not fully address the situation.

1. Allows you to send a message directly to the admin with details or questions about the case

Update Secondary Insurance Info

Use this option when you need to update the secondary insurance information on a claim.

1. Redirects you to the page where you can edit the current secondary insurance details
2. After clicking Confirm, the system updates the secondary insurance information for the claim

This should be a Workers’ Comp claim

Use this option when a claim needs to be converted to a Workers’ Comp claim.

1. After clicking Confirm, the system removes the current encounter
2. A new encounter with the claim type set to Workers’ Comp will be automatically regenerated later that night

This should be a Medical Insurance claim

Use this option when a claim needs to be converted to medical insurance claim.

1. After clicking Confirm, the system changes the claim type to medical insurance claim
2. The claim will be moved to the Claim Review queue for further action.

This claim is non-billable

Use this option to mark a claim you do not wish to bill as Non-billable

1. The claim will be marked as Non-Billable

2. It will be excluded from patient statements

3. It will be removed from system reporting

4. The patient balance will be updated accordingly

After being marked as non-billable, the claim will remain visible in All Claims panel with a "Non-Billable" tag

This claim is billable

Use this option to mark a non-billable claim as billable

1. The non-billable claim will be reverted to a normal, billable claim

2. Patient balance will be updated