If you have received an ERA and you are seeing a section on the ERA in Therabill labeled The Following could not be matched to a client in Therabill, then you are probably wondering what is going on. This article will explain.
When billing software, such as Therabill, sends out an electronic claim it attaches a claim line indicator code to each charge. The payer is required to echo this claim line indicator code back in the ERA for each line item. This is how the billing software can match the line item on the ERA to the charge in the softwares database of charges.
Most payers will send back this claim line indicator, as required by ASCX12 5010 835 standards. However, many do not. If the claim line indicator is not present in the ERA, then Therabill will attempt to manually find the session(s) using a simple matching algorithm. Therabill will try to find a session/charge in your database with the same date of service, same procedure code, and same client ID. To do this, it must first match the client/patient. Matching the client is usually fairly simple and can be done using a simple first and last name match. However, if Therabill cannot first match the client, it will have to stop there, as it will not be able to match the line item on the ERA to a charge in Therabill.
Matching a client/patient from the ERA
Therabill will try to find the client in your client database using a first name and last name search. If it cannot find the client using a first and last name search, then it has to stop. If Therabill cannot match the patient, then it will surely not be able to match to a specific session/charge. When this happens, on the ERA, it will list the session under a section labeled "The following could not be matched to a client in Therabill". You will need to manually enter these payments.
Common Reasons for this happening
Here are some things that will make this happen more often. The scenarios listed below do not mean that Therabill will not be able to match the client. However, an inability to match the client may happen more often under the following scenarios.
- You submitted the claim by paper. If you submit a claim by paper, it is more likely that Therabill will not be able to match the client. This is because the claim line indicator does not go out on paper claims. It only goes out on electronic claims.
- You submitted the claim electronically through billing software other than Therabill. When this happens, the ERA may be reporting back a claim line indicator from other software, or no claim line indicator at all. This can actually be dangerous if the claim line indicator actually matches a claim line indicator associated with another charge in your account. It is not recommend to use two different sets of software for electronically billing the same payer.
- You changed the name of the patient in Therabill after submitting the claim. Remember, this is a computer doing a string matching. Either the first names match exactly or they do not match. Either the last names match exactly or they do not. Even a small difference in the name will result in it not being able to match.
What to do when it does happen
Therabill always recommends that you browse through the entire ERA to make sure all entries are the way you want them to be posted. While doing this, always look at the bottom of the ERA for entries that could not be matched to a client. If there are entries that could not be matched to a client, then you will have to manually post those payments.
Therabill is consistently unable to match a specific client - on all ERA
Check the spelling of the client name. It is most likely different than the spelling of the client name coming back from the payer on the ERA. You may want to change the spelling of the client name in Therabill to match what the payer is responding with on the ERA.