NS - Knowledgebase

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.

Here's a concise summary of the Encounter Billing tab process for creating an insurance claim using the OfficePro Suite:

Accessing the Billing Tab:

• Click the letter [B] next to the visit from the schedule or patient detail page.
• Alternatively, open the Encounter window and select the Billing tab.

Billing Case Details:

• View patient billing case details by clicking the blue information icon, which reveals details such as the named insured and referring provider.
• Perform billing actions like adding a claim, entering insurance payments, and editing case details.

Creating a Claim:

• A list of services added to the encounter is displayed, including their CPT codes and diagnosis codes.
• Ensure each service has both a diagnosis code and a CPT code. Yellow alert symbols indicate missing information.
• Click the Edit link next to the alert symbol to modify codes.
• For convenience, you can apply the selected diagnosis code to all services on the visit.
• Check the services you want to include in the claim and click Create claim from visit.

Viewing the Claim:

• After the claim is created, it will appear in the Encounter Billing window below the case details.
• Review claim details such as the claim number, total amount claimed, payment status, and duration since the claim was submitted.
• Open the PDF or text version of the claim document for review or manual submission.

Additional Resources:

• For detailed information on insurance billing, refer to BillPro tutorials and Knowledge Base articles.
• For managing diagnosis codes, consult the Configuration video on Diagnosis Code Administration.

Editing and resubmitting an insurance claim is a straightforward process in OfficePro. Follow these steps to ensure your claim is accurate and submitted successfully.

Step 1: Locate the Claim

You can find the claim in OfficePro using one of the following methods:

By Patient:

• Navigate to the Patients section.
• Find the patient who received the services.
• Open the patient detail page and click on the Billing tab.
• Look for the claim associated with the date of the visit.

By Visit:

• Go to the Visits section.
• Open the visit that the claim was for.
• Click Edit, then click on the Encounter icon.
• In the Encounter window, navigate to the Billing tab to view the claim.

Using BillPro:

• Open BillPro by selecting Tools > BillPro from the top menu.
• Find the claim in the list by either date or patient name.

Step 2: Open the Claim Details

• Once you've located the claim, click the pencil icon next to it to open the Claim Details window.

Step 3: Edit Claim Information

Click on either the ID or CPT field to open the Edit Service window.

Navigate to the Billing Details tab.

Make Necessary Edits:

• Update the Dx codes or Modifiers fields based on the feedback received from the clearinghouse or insurance company.

After making your changes, click Save Encounter Service.

Step 4: Re-create and Resubmit the Claim

1. After saving your changes, go back to the Claim Details window.
2. Click Re-create Claim Document at the bottom of the Claim Details window.
3. Once the claim document is re-created, click the Submit Claim button at the bottom of the claim details page.

Conclusion

By following these steps, you can efficiently edit and resubmit an insurance claim in OfficePro, ensuring that your claims are accurate and compliant with the requirements of the insurance companies. If you have any questions or encounter any issues during this process, feel free to reach out for further assistance!