Let's review how to post ERA payments. You can watch a short video or read the article for further details.
ERA Filing Area
Navigate to Filing > EOBS/ERA. You will see a list of your active ERAs within the default date range.
The list will show you general information about the ERA such as the date of the ERA (Post Date), the payer, the invoice/check number of the ERA, the number of lines in the ERA, the number of lines that are still unapplied, and the total amount paid. You can filter your ERAs using parameters such as Invoice Date, Client Name, Payer Name, and Check Number. You can also limit the display to only those ERAs that have been flagged by checking Show flagged only. If you need to see an ERA that has been archived, you will need to check Show archived ERA's.
Clicking the icon will open up the ERA, displaying service line details, and giving you the ability to apply the payments and adjustments. Clicking the icon will hide that ERA from the display by marking it as archived. The ERA is not deleted, only hidden.
Note: Identifying information, such as client name, check number, and the payer claim reference number has been removed.
The top area will state the payer's name, including the check date, check number, and amount. There is also a Print link that allows you to print the ERA in 5 different formats, the most common being Remittance Advice.
Just above the service lines, there will be an area for you to enter the Insurance Company name that corresponds to the system's database. Once entered, all future ERAs from this payer will map to that payer name in the database. If you ever need to update this mapping link, enter a new payer name and click Update Insurance Mapping. Optionally, you can enter the Deposit Date for the ERA.
Below this will be all the service lines the payer is reporting adjudication information on. The lines are first grouped by Client Name and then sorted by Date of Service. If the client has any unassigned payments, it will be displayed in red next to their name. Each service line will display the Payer Claim Reference #, DOS, CPT code, Units billed, Billed amount, Adjustment amount, Paid amount, Reason (remark) code for adjustments and patient responsibility, Claim Status, Patient Responsibility amount, Apply to Unassigned, Apply boxes, and a Session Action drop-down.
Note: The first row (uneditable values) on each service line is generated using the 835 file sent by the payer. If you feel that the information displayed is incorrect, you will need to contact the payer.
Applying an ERA
Choosing how much adjustment/payment to apply.
Each service line will have a row that starts with an Apply checkbox. To skip posting that line when applying an ERA, simply uncheck that box. Each adjustment column and payment column will have a text box underneath it. The application will automatically fill in the text box with the adjustment amount and the payment amount reported by the payer. Whatever amounts are entered into the boxes when the ERA is applied will be posted to those service lines. You have the ability change the value in these boxes.
NOTE: If the adjustment amount is equal to the billed amount, the adjustment text box will be blank.
You also have the option to change the Session Action for each service line. Make sure that the appropriate action you want to be applied is selected before you apply the ERA. The system will select a default action based on a variety of factors listed in the table below.
|Paid?||Patient Resp.||Add'l Insurance?||Session Action|
|No + Denied||N/A||N/A||Send to insurance invoice area|
|No + Processed||N/A||Yes||Send to insurance invoice area|
|No + Processed||Yes||No||Close session|
|Yes||Yes||Yes||Send to insurance invoice area|
|Yes + Crossover||Yes||Yes||Marked as billed to|
For more information, please see Session Actions.
Applying to Unassigned
If the system detects a client has unassigned payments and there is Patient Responsibility (PR) designated by the payer, it will automatically be disbursed to the service lines. If you do not want those payments to be disbursed or you want to disburse them differently, you can manually change the amounts the Apply to Unassigned boxes. You cannot apply more than the total unassigned payments available.
Applying the ERA
Once you have reviewed/entered all of the Adjustment and Paid boxes and you have chosen the session action for each line item, you can post the payments. Simply click the Apply Payments & Adjustments button at the bottom of the ERA.
NOTE: You can only apply payments/adjustments to a service line using an ERA a single time. If all payments/adjustments on the ERA have been applied, then the Apply Payments & Adjustments button will not be present.
I clicked Apply Payments & Adjustments, but nothing happened
If you try to post an ERA and nothing happens, there is an error. There are 3 reasons why an ERA will not post:
- The Insurance Company field is blank
- A Session Action is not selected
- The Session Action is set to Mark as billed to, but the accompanying box is blank. If the Claim Status states it was forwarded to another payer, you must tell the system where it was sent. This field will be blank if there is not an additional insurance card on a client's chart. To remedy, you will either need to add that insurance card into the system or select a different action.
Items on my ERA state: 'Could Not Match To Client' or 'Session Not Found'
For more information, please see: Could Not Match To Client or Session Not Found