Recently some of my ERA's have been stating that the client can not be matched to a session in Therabill even though I billed the session through Therabill. Why is this happening?
When billing software, such as Therabill, sends out an electronic claim (EDI claim), each session is assigned a code. This code is supposed to be repeated back in the ERA from the insurance company (or payer) for the line item. This code is used to match the line item from the ERA to a session in the database at Therabill.
Recently, some insurance companies have failed to repeat back that code in the new 5010 version of the ERA.
When this happens, Therabill tries to manually match the session. However, the matching technique is VERY strict. That is, Therabill would rather say "We couldn't match the session" than accidentally match the payment to the wrong session. This is a conservative approach.
Here is how Therabill tries to match the session from the ERA to a session in the Therabill database if the "code" was not properly sent on the ERA from the insurance company.
1.) The first thing that must be done is to match it to a client in your database. This is done by a first name, last name search. If Therabill can find a single (one and only one) client in the database, then Therabill assumes it has found the correct client.
If Therabill can't find the client, or there are more than one matching clients, then the sessions will be listed on the ERA in Therabill under the heading "Items below could not be matched to a client or session in Therabill".
2.) If Therabill can match it to a client, it then looks for the specific session. This is done by a match to a client, date of service, and service code (including modifier).
If Therabill did find the client in step 1, but could not find the session in step 2, then the session will be listed under the client sessions, but will have a red "No session match" listed next to it.
Therabill hopes that over time, the insurance companies will stop making the mistake of not repeating back the code. The repeating back of that code is crucial and is *required* by the HIPAA 4010 and 5010 standards for EDI claims. Unfortunately, they are not always following the requirements for one reason or another.
If a session can't be matched for any of the above reasons, then you will have to manually enter the payment. You can print out the ERA by clicking the Print link at the top right when viewing the ERA in Therabill.