ERA Auto-posting

PracticeSuite implements ERA automation, which is an advanced AI-driven solution for automating ERA posting and operates based on pre-set user-defined rules. 

Users can add and edit rules using the ERA Rule screen created as part of the setup. The auto-post functionality will then automatically post any ERA in the system according to these rules.

Setup

Rules for auto-posting are created through the Billing Options page.  The billing options page now has a new field  ‘Setup ERA Posting’ beside the ‘Autosave ERA’ field. Click on ‘Configure’ beside this to create or edit rules for ERA posting automation.

This will take the user to the ERA Posting Configuration screen, where all existing rules will be listed.

To add a new rule, click on ‘Add New’ in the top-left corner of the screen to open the rule configuration screen. Click on the to edit any rule.

ERA Rule Creations/Edit screen

Rule Parameters

* Any one parameter is mandatory for rule creation.

Field Description
Rule Name Provide a unique name for the rule
Payer Name Lists all active payers from Insurance Master; select one if required
Insurance Level Primary/Secondary/tertiary
ERA Claim Status Code 1-Processed as Primary

2-Processed as Secondary

3-Processed as Tertiary

19-Processed as Primary, forwarded to Additional Payer(s)

20-Processed as Secondary, forwarded to Additional Payer(s)

21-Processed as tertiary, forwarded to Additional Payer(s)

4-Denied

22-Reversal of Prev. Payment

Prior Condition Primary Paid
Claim Level Adj. Group Codes CO/OA/PI/PR
Claim Level Adj. Reason Codes The reason code for the group code selected
Line Level Adj. Group Codes CO/OA/PI/PR
Line Level Adj. Reason Codes The reason code for the group code selected
Remark Code Lists the remark codes

Action

Action Description
Action Field This specifies what action is to be taken; select an appropriate action from the drop-down.
Action Specifies the field to be populated as per the action  ToCopay/ToCoins/ToDeductible/Tobalance/Topaid/ToAdjustment
Next Action Select a status from the drop-down to be set for the line after auto-posting
Remarks Remarks to be added to the auto-post

How to Autopost An ERA

Go to Payments->ERA Posting. On the ERA listing page, identify the ERA to be auto-posted and click on ‘Auto Post’, seen on the far right of the line. The ERA will be auto-posted according to the applicable rules set from the ERA Posting configuration screen.

Outcomes of Auto-Posting

1. Auto-reversals are performed.

2. The next action will be populated based on the rule. If no rules exist, it will be set as usual.

3. Once an ERA is posted, a toast message ‘ERA Auto Posting Successfully Completed’ will appear.

The line activity in Charge Master will show “ERA Auto Posted (AI).”