Electronic Remittance Advice(ERA) is an electronic version of a paper explanation of benefits (EOB), which allows you to auto-post payments as opposed to manually posting them.

To view and process the ERAs in the system, select Payments from the main menu, and then click on ERA Posting. When the ERA Posting screen opens up, provide appropriate search parameters. ERA Date, Payer, Status, Payment#, Check# are some of the search fields. The search screen is as shown in Image 1.

Image 1

The ERAs will be listed as in Image 2.

Image 2

Table 1 explains each column of the ERA Listing in detail.

Column Description
Payer Name of the insurance. This is a hyperlink which opens the ERA screen for posting
Payer ID Unique ID of the payer
Check Date The date specified in the check
Check Amount The amount specified in the check
Check/EFT#  Check number /EFT number
Type This is the Payment method Code. The different payment method codes are ACH (Automated Clearinghouse), BOP (Financial Institution Option), CHK (check payment), FWT (federal Reserve Funds/Wiretransfer-nonrepetitive), NON (Non Payment Data)
Payment# The unique number created for the payment in the system
Payment Amount The amount for which the payment was made
Unapplied Amount The amount unapplied in the payment
Status PENDING/PROCESSED/VOID. Clicking on the status will open a drop-down. To change status, select another status from the drop-down. Users can now void ERAs by selecting VOID from the drop-down.
Open ERA  Opens the ERA screen in a popup page for posting
Download  To download the ERA file in the system.

Table 1

Different Options Available in the ERA Listing screen:

A. Erroneous ERAs due to syntax or semantic errors in the 835 file structure would show up in the Unsaved ERA(s)  (labeled A in Image 3). Clicking on the unsaved count hyperlink will open the file information in a pop-up window.

B. ERAs can be uploaded into the system by the Upload ERA option. Click on Browse and choose the file. It can be saved through the button beside the Browse button (Refer to label B in Image 3).

C. The system automatically retrieves ERAs once a day. If a user wants to specifically retrieve ERAs without waiting for the next day, he can do so by the button available on the top right of the page (labeled C in Image 3).

D. Payment# in the report column is a hyperlink (label D in Image 3) that opens the Payment Entry screen.

Image 3

Posting ERAs :

1. Click on the Payer or the Open ERA button of the ERA to be posted. This opens the ERA page as in Image 4.

Image 4

2. Initially, each patient record in the ERA page has a mark to indicate that it is an unmatched claim.  Click on button to create a payment entry and to match claims. Once processed, all matched claims will have a mark and all unmatched lines will be highlighted in Red as in Image 5.

Image 5

COB Automation

When the claim status code indicated is 19 ( CoB is for a crossover claim) and if the secondary insurance indicated in the ERA is not present in the patient’s record, so as to facilitate the COB posting & to efficiently move the line(s) to secondary responsibility, the system will automatically create the secondary insurance for the patient as part of the auto-posting process. The system will use the secondary insurance name and patient insurance id presented in the electronic remit to create the secondary insurance for the patient. If the secondary insurance is already present in the patient demographics, the system will simply add insurance to the Case.

In the process of adding secondary insurance for the patient, if the insurance company is not present in the insurance master, the system will first auto-create the insurance company with generic information. Please note – users will need to complete any missing secondary insurance information in both the insurance company master and inpatient insurance records.

Note: The above-mentioned COB automation will happen only if in the Billing Options set up page, ‘Auto create COB payer From ERA’ option is set to YES. 

Negative payments

In order to prevent inadvertent auto-posting of negative amounts by users that can result in posting errors, the claim selection checkbox in the ERA screen is disabled when a negative amt is present in the remit. Below are the couple of the negative amount ERA posting scenarios where the system will prevent selection of the claim for auto-posting  –

1. If the claims status code is 22 (indicating negative payment or adjustment)

OR

2. If the Paid Amt. is a negative amount; see Image 5.1

Image 5.1

However, if the sum of adjustments is a negative value, the claim can be selected for posting but the system will display a warning in the ERA posting screen. Users will need to make necessary corrections and post the ERA.

3. Click on button. The ERA Posting screen opens for the patients having mark, as shown in Image 6.

Image 6

4. Click on button to post the ERAs. If the checkbox Show Posting Detail Report is checked, this action opens the report as in Image 7.

Image 7

Options/Links available in the ERA Posting screen

Each posting line in this screen is colored according to the legend given in Table 2.

Color Description
PAID_CLOSE / WO_CLOSE
Charge=Bal.Amount
Processed directly as Secondary
Charge = Adjustments

Table 2

Different options/links available in the ERA Posting screen are labeled in Image 6 and described in Table 3.

Option/Link Description
1 This link at the top-left part of the screen takes the user to the ERA screen. It can be used for reference.
2 Opens the Recalls & Alerts screen
3 Payer Remark
4 Reverses the payment
5 To add line notes
6 Exceptions link to a page where all unmatched claims are listed. This separate listing helps users to quickly identify claims that failed to match/post from the ERA.
7 Link to Charge Master

Table 3