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, Check ERAs fetches whatever the clearinghouse is holding. The count beside it tells you how many are waiting, so an unchanging number means nothing new has arrived - not that something is broken.

Do this on a regular day of the week. ERAs sit until you fetch them, and a fortnight of unposted remittances makes every patient balance you look at wrong.

Reading the list

New arrivals appear under ERAs Received, each showing:

• ERA ID - the reference to quote to the payer or to support.
• Payer and Provider Tax ID - who paid, and which of your entities.
• Check Number and Amount - what to match against the deposit in your bank.
• Paid On - the payer's payment date.

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

Process applies one remittance: payments and adjustments land on the claims it names, and the claim balances move accordingly. Once posted it moves to PROCESSED ERAs with a Processed On date.

Process ERAs does the same for the batch, which is what you will normally use.

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.