Setting Up Electronic Claims and ERAs

BillPro submits your claims electronically and brings the payers' remittances back in. Both halves are enrolments handled through a clearinghouse, and neither happens the day you ask for it - so start earlier than feels necessary.

How it fits together

OfficePro builds the claim, the clearinghouse delivers it to the payer, and the payer sends back an electronic remittance advice - an ERA - saying what it paid and what it did not. The BillPro Account Center describes this as BillPro - Electronic Claims Submission, Powered by ClaimMD.

Enrol each tax ID

Enrolment is per business entity, not per practice. BillPro Enrolled Businesses : lists your Enrolled Entities with an Account #, Group and TaxID.

If you bill under more than one tax ID - a second location, a separate professional corporation - each needs its own enrolment. Claims for an unenrolled tax ID have nowhere to go.

Enrol for ERAs separately

This is the step people miss. Being able to send claims does not mean you will receive remittances. ERA enrolment is a separate agreement with each payer, and the big payers are the slow ones - allow weeks, not days.

Until a payer's ERA enrolment completes, its payments arrive as paper cheques and have to be posted by hand. That is workable, but it is not what you are paying for, so track which payers are done.

Enrolment forms are generated from OfficePro - the Claim Enrollment Link under Connecting to ClaimMD produces the link to complete.

Check your billing details before the first claim

These appear on every claim and a mistake in them rejects everything at once rather than one claim at a time:

• The billing entity's name, pay-to address and group NPI.
• The tax ID, which must match the enrolment exactly.
• Each provider's individual NPI and taxonomy.
• Payer IDs for the insurers you actually bill.

Send one real claim to one payer and follow it all the way to an ERA before you switch the practice over. A test of the whole path is worth more than checking each setting twice.

Where you will work day to day

The BillPro Billing Center is the hub. From there:

• Check ERAs pulls in new remittances - the number beside it is how many are waiting.
• Process Payer Payment posts a payment that did not arrive as an ERA.
• BillPro Account Settings is enrolment and entity details.
• BillPro Processing Reports is what the clearinghouse sent back about your submissions.
• Manual Cases, with Show Complete and Show Incomplete, is for claims built by hand rather than from a visit.