The Electronic Remittance Advice (also known as ERA or 835 file) is a convenient and quick way to post payments in Therabill. An ERA is really just an electronic version of the Explanation of Benefits (EOB) or Payer Claim Summary (PCS) that the insurance company (payer) would normally send you in the mail. The ERA is delivered directly to your Therabill account where you can apply the payments fairly quickly (sometimes with just the click of a single button).
How do I start receiving ERA's?
This depends on the payer (insurance company). Not all insurance companies send out ERA's and for those that do, most will require that you request for them to send those to you using an ERA enrollment form specific for that payer. This ERA enrollment request will also let them know where you want them sent (i.e. to which clearinghouse).
Obtaining the ERA enrollment forms
- You can search for the ERA enrollment forms at Therabill using the searchable list of ERA enrollment forms for Office Ally at https://www.therabill.com/healthcare-billing-info/office-ally-edi-enrollments.php (make sure to look for the forms labeled ERA).
- You can request that Therabill send you a list of the forms. To do this, simply e-mail email@example.com with a list of payers that you would like to receive ERA from.
IMPORTANT: You should get the ERA enrollment forms from Therabill. The ERA request forms that we give you will have the technical (clearinghouse) information pre-filled for you. Simply search our ERA enrollment form list or e-mail firstname.lastname@example.org with a description of what you are requesting (i.e. ERA enrollment forms) and for which payer you are requesting them for. If you are e-mailing us, please use the full name of the insurance company, do not use abbreviations. If you know the payer ID of the insurance company, please let us know the payer ID in the e-mail
Will receiving an ERA change the way the insurance company pays me?
People often ask if receiving an ERA will cause the insurance company to electronically deposit the funds into their bank account. In general, the answer is No. The electronic depositing of funds into your account is referred to as Electronic Funds Transfer (EFT) and this is not automatically established by asking for ERA. However, often times, the ERA request form will also ask if you would like to set up EFT.
In general, Therabill plays absolutely no part in how the insurance company pays you. We do not have EFT request forms (unless they are included in the ERA request form). Giving the insurance company the ability to deposit funds directly in to your bank account is something you have to set up with the insurance company, not with Therabill.
Will I stop receiving paper EOB/PCS in the mail if I enroll for ERA?
This depends on the payer (insurance company). Often times the payer will stop sending paper EOB/PCS in the mail when you enroll for ERA. Therabill does not know the policies of each insurance company when it comes to whether or not they will stop sending paper EOB/PCS in the mail. That is something you would want to ask the insurance company prior to enrolling for ERA.
What role does Therabill play in the handling of ERA?
Therabill is simply a receiver of the ERA. We then post the ERA to your account. We are really just like the mail delivery person. Therabill plays no part in the adjudication of your claims or in creating the content of what is reported back in the ERA.
How will I know when I receive an ERA?
When you receive an ERA, you will get an alert on your dashboard in the To Do list. This alert will be labeled Electronic Remittance Advice (ERA). You can click on the icon in the To Do item to go directly to your ERA filing cabinet. You can also check for new ERA by going to the ERA filing cabinet. To go to your ERA filing cabinet, click Filing in the top navigation bar of Therabill and then click EOBS/ERA in the sub-navigation bar. New ERA's will be labeled as new.
Your ERA Filing Cabinet.
You can navigate to your ERA filing cabinet by clicking Filing in the top navigation bar of Therabill and then clicking EOBS/ERA in the sub-navigation bar. If you have ERA, then you will see a page that resembles the image below.
The image above shows your ERA list. Each ERA that you have received is a row in the list. The list will show you general information about the ERA such as the date of the ERA, who sent you the ERA (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 dollar amount being paid on the ERA. You can search your ERA using the search filters at the top of the page in the gray box. Use the search filters to search by 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 the box next to Show flagged only. If you need to see an ERA that has been archived, you can check the box next to Show archived ERA's.
Each ERA will also have a dollar sign icon and an archive icon. Clicking the dollar sign icon will open up the ERA and display details of the ERA and also give you the ability to apply the payments and adjustments reported on the ERA. Clicking the archive icon will hide that line from the display by marking it as archived. The ERA is not deleted, only hidden. You will still be able to view that ERA, if needed, by checking the box next to Show archived ERA's.
Applying the payments and adjustments reported on the ERA.
Clicking the dollar sign above will open up the ERA. You will then see the details of the ERA (image to the right). The ERA will have pretty much the same information that a paper Explanation of Benefits (EOB) or Payer Claim Summary (PCS) will have. At the top right, you will see ERA information such as the ERA date, the check/invoice number, and the total amount paid on the ERA. At the top left, the name of the payer will be displayed. Moving further down the ERA, you will begin to see the adjudication results of the claims you have sent to them. All claims are grouped by client name (in the example on the left, the client name has been replaced with PATIENT NAME for privacy reasons). If you have unassigned payments entered for the patient, that will be indicated by red print next to their name showing how much that patient has entered in unassigned payments. If the patient has unassigned payments, you will be able to post from the unassigned directly from the ERA (see Apply to Unassigned below).
The first row for each line item will show information reported back by the payer. This includes the date of service of the session, the CPT code, the number of units, and the amount you billed them. In the same row, they will then report their adjudication results such as the amount they adjusted the billed amount down, the amount they will be paying you, a reason code for both adjustments and patient responsibility, and the amount that the insurance company is reporting as the patients responsibility. If there is an amount in the adjustment column or in the patient responsibility column, the reason (or remark code) will also be shown on that line item. Descriptions of the reason codes are shown below that clients adjudication results. Please remember that Therabill does not generate the amounts on the first row. This information is what is being reported by the payer. For questions on these values, you must call the payer.
The insurance company reports back how much they will be paying you and any adjustment amount on the session (i.e. in-network adjustments). However, you have complete control over how much of the payment / adjustment to apply in Therabill. This is accomplished through the second line for each line item.
Choosing how much adjustment / payment to apply.
Each line item will have a row that starts with a checkbox labeled Apply. To skip that line all together when applying this ERA, simply uncheck that checkbox for each line item you would like to skip. Each adjustment column (circled in red) and each payment column (circled in purple) also has a text box underneath it. Therabill will fill in the text box with the adjustment amount and the payment amount reported by the payer. NOTE: if the adjustment amount is equal to the billed amount, then Therabill will not fill in the adjustment text box. The amount that is entered in these text boxes is the amount that will be applied to that session when you apply the ERA. You can change the value to any other value you want. After the adjustment amount and payment amount, there is a drop down menu where you can choose what you would like Therabill to do with that session after applying the payment, options include Close Session, Send to insurance invoice area. For a description of what this session action means, please see our knowledge base article on the session action. Therabill will try to select an option that Therabill thinks would apply. But please do make sure that the appropriate action you want applied is selected before you apply the ERA.
Applying to Unassigned
If you have unassigned payments entered for this patient, then Therabill will highlight this by putting red text next to the patients name indicating how much this patient has entered in unassigned payments (image to the right, red arrow). There will also be a column on the ERA labeled Apply to Unassigned for that patient (image to the right, green arrow). The amount will automatically be filled in with the patient responsibility reported back by the payer on the ERA. If there is a value in the textbox for a specific line item under Apply to Unassigned, then when you post this ERA, Therabill will take the amount that you have entered and post it from the unassigned payments.
NOTE: The apply to unassigned is only available if you have unassigned payments entered for this patient.
Applying a deposit date.
If you are applying deposit dates to your payments, you can enter that deposit date at the time you enter the ERA by using the Deposit Date text box at the top right (pointed to with red arrow in image above). By entering a date in to the deposit date text box, Therabill will apply that deposit date to the payments when you apply the ERA.
Applying the ERA.
Once you have entered all of the values into the adjustments / paid text boxes and you have chosen the session action (i.e. Close Session) for each line item, you can then apply the payments. Simply click the Apply Payments & Adjustments button at the bottom of the ERA. NOTE: Therabill will only allow you to apply an ERA once (to help protect against double payment entry). If all payments/adjustments on the ERA have been applied, then the Apply Payments & Adjustments button will not be present.
Session not matched in Therabill (or Client not found)
You may come across some sessions in the ERA that are marked as either session not found or client note found. If you see this, please see our knowledge base on unmatched sessions on the ERA.