Receiving and Posting ERAs

An ERA is the payer's explanation of a payment: which claims it covers, what was allowed, what was adjusted and what is left. Posting it applies all of that to the right claims at once, which is the whole point of billing electronically.

Bringing them in

From the BillPro Billing Center, click Check ERAs. There is one button for each tax ID you bill under, and the number in brackets is that tax ID - not a count of remittances waiting.

Do this on a regular day of the week. An ERA changes nothing until you process it, and a fortnight of unposted remittances makes every patient balance you look at wrong.

Reading the list

ERAs Received lists the remittances for that tax ID, newest first. Each row shows:

• Paid On / ERA ID - the payer's payment date, and the ERA ID to quote to the payer or to support. Click the ERA ID to read the remittance without posting anything.
• Payer - who paid.
• Amount and Check Number - what to match against the deposit in your bank.
• Payment - once the ERA is processed, a Pmt # button that opens the insurance payment it created.
• PDF - the payer's remittance as a PDF, in a window of its own.

To find one remittance, search by check number, ERA ID or amount.

Reconcile the Amount against the actual deposit before you post. A remittance total that does not match the money received is the one thing worth stopping for - it usually means a second ERA belongs to the same cheque.

Posting

Click Process on the remittance. A window opens over the list while Claim.MD is contacted, and when posting finishes the same window shows what was done:

• each claim, with every charge line's payment and adjustments and a Visit link that opens that encounter;
• Denial Alerts, when your practice has asked to be told about particular reason codes (see Controlling How ERA Denial Codes Post);
• Visit Balance Reconciliation - each visit the ERA touched, with its charges, credits and resulting balance;
• Transactions Posted - every amount the ERA now has applied: Patient, DOS, CPT, whether it is a Payment or an Adjustment, the Amount, the Credit it belongs to, and a link into the visit.

Total allocated at the foot of Transactions Posted is read back from what was actually saved, after any balance corrections, so it is the figure to check against the remittance.

Each visit link opens in a window of its own, one per visit, so you can check several without losing the ERA. Click Close when you are done: the list refreshes, and the row now shows when it was processed, a ReProcess button, and the Pmt # link.

If the window shows Request failed, nothing was posted. Try again, and contact support if it keeps happening.

ReProcess runs a remittance that has already been processed again. Reach for it when a posting went wrong, not as a matter of routine.

Checking the result

Open a claim from the remittance and look at Claim Detail:

• Claim Total against Total Payments, split into Insurance Payments and Patient Payments.
• Adjustments / Discounts - contractual write-offs the payer applied.
• Claim Balance - what is genuinely still outstanding.

Claim Balance is the number that matters. It is calculated from the claim's services and payments, and it is what the aged views work from.

What is left after the insurer pays

A balance remaining after an ERA is posted is usually the patient's - a deductible, co-insurance, or a non-covered service. It is not automatically a problem with the claim.

If the balance belongs to a secondary insurer instead, use Create SECONDARY Claim Document on the claim. That produces a Secondary Claim Document carrying the primary's payment and adjustments, which is what a secondary payer needs to see.

Payments that did not come as an ERA

Paper cheques, and payers whose ERA enrolment has not completed, are posted with Process Payer Payment from the billing centre. The result is the same; you are keying what the ERA would have told us.