by Professional Practice Systems, Inc.

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Insurance Mgmt
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The insurance management features of OPTO are an integral part of OPTO II. Most of the information needed for the insurance forms is automatically obtained as you let OPTO compute the charges for your daysheet. It takes only seconds to complete the actual form. The complicated rules needed for Medicare are followed automatically, so you needn't be concerned about learning them. You may customize forms easily for other plans, so  OPTO learns how to fill them out with a different set of rules. This way you don’t have to remember how fill out forms differently for each insurance plan.


The patient will receive a bill for any outstanding charges that are his responsibility, such as deductibles, co-payments and non-covered services.

Amounts owed by each participating plan, such as Medicare or VSP is tracked on a ledger system for each plan. The accounts receivable aging report shows the dates of service and amounts due for each patient billed to that plan. Amounts over the maximum allowed can be written off automatically. This helps you keep track of overdue payments from each participating plan. An insurance claim inquiry form can be used to send to insurance companies to check on overdue unpaid claims.


The HCFA1500 form for use with Medicare and most other companies is included with the program. Most state Medicaid forms, as well as many other special forms such as General Motors, MES in California, Michigan Blue Cross/Blue Shield Vision, Equicor, Ohio Medical Value Plan, and Oregon Blue Cross/Blue Shield may also be completed.

It is an easy procedure to have the form printed by OPTO in a matter of seconds. The laser printer will either print the entire HCFA form and the doctors' signature on plain paper or fill in the red HCFA form.

CPT-4 Codes are attached to the fee schedule and over 1000 ICD-9 Codes are already entered and stored for use on the insurance forms. The ICD-9 code list is arranged so that you may pick only codes that Medicare will accept according to Medicare's latest rules.


OPTO includes the ABN (Advanced Beneficiary Notice) required by Medicare to explain to patients what may not be covered, what extra charges they may incur, and a "signature-on-file" letter.


You may automatically fax an authorization list straight from the computer to VSP using the appointment scheduler.

There is a patient note to enter the coverage information received from VSP. This is then used to fill out the Basic Benefit form.

By registering the plan, grid, and comment numbers, you can print out a worksheet with what all of those numbers mean. This eliminates looking through many manual pages. OPTO has all of this information built into the computer. The VSP form may then be printed on plain paper with copies for VSP, the lab, and the doctor.

OPTO gives you a lot of help entering VSP checks into the system, so you can make sure VSP paid the correct amount. Patient frame charges and contact lens discounts are automatically calculated. Your lab bill and reserve deductions are taken into account when entering the check.


We send an NSF file through a clearing house for most Medicare and Medicaid carriers. This is done automatically with a press of a key. Some commercial insurance carriers are also supported with this method. The set-up charge for this option is $500.

MediCal (California)

We have gone to a great deal of effort to help you complete California's  MediCal forms. A separate set of MediCal procedure codes including qualifier codes is included for those doctors needing to handle MediCal.


We fill out specialized Medicaid forms in most states including California, Colorado, Indiana, Massachusetts, Michigan, and, Ohio.

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