ERA FAQs

ERA FAQs

ERA FAQs

When do the ERAs load into the System?

As soon as the Clearinghouse, Etactics, receives the ERA files, they are sent to the PM System.

  • The System processes them hourly on the half hour. (The job actually runs at the 26th minute.)

How is the Reference Batch Received Date determined for an ERA? 

  • By default, the Received Date is populated by the Paid Date on the ERA File.

  • If you want the Received Date to be a different Date, there is a System Setting to allow the entry of a Received Date on the Reference Batch (ERARECEIVEDDATE) (Release 4.7)


What Report can I run to see my ERA Receipts?


When will the ERA be generated if the Patient pays with a Virtual Credit Card?

  • The ERA 835 File will not be generated until after the Credit Card is processed.


Why is Medicaid (Secondary) dropping to a Patient Balance?

  • Is there a CO45?
  • If yes, create a rule for Medicaid in ERA Management Rules with the Procedure Code attached.
  • Add Rule CO45 > Post as Remitted > Balance Management.
  • This will write off the amount that is dropping to a Patient Balance.


How do I work unbalanced Claims when posting ERAs?

Payer adjustments seen in special circumstances, such as sequestration amounts for Medicare payers, incentive payments, penalties, etc., have been causing claims to be unbalanced when posting ERAs. This is indicated with the red banner error on the Encounter Dashboard, above the line items for encounter.  When this occurs, expand the line items to see which CARC codes are being used in that encounter. 

  • This commonly occurs because of CARC codes: COA2, CO223, CO253, CO144, OA253, PI253, and CO237
  • To correct this, create the ERA Management Rule "Charge - Allowed - Adjustments does not Equal $0" with the following criteria:
  • Claim Types: Primary [1], Primary Forwarded [19]
  • Criteria: Event: Charge - Allowed - Adjustments does not Equal $0
  • Exclude CARC from Unbalanced Calculation: COA2,CO223,CO253,CO144,OA253,PI253,CO237 (No spaces between Codes, use commas to separate)
  • Action: Put on Hold
  • This ensures that any other CARC codes/adjustments that were not included will still trigger the rule and go on hold for further review.
  • Remit Note: Enter a note (optional).
  • Additionally, edit the System Setting ADJBALEXCL to include Manually Posted Payments.
  • If neither of these solutions resolve the problem, review the line items to ensure the ERA was applied correctly and the funds balance.
  • If the Claim is still unbalanced, contact Support.


What should I do if the Primary accidently forwards to a Payer that is not on the Insurance Profile?

It is incorrect when the Primary forwards to a payer who is not on the Profile and that Payer makes a Payment as if they are Primary.  This happens at times when the true Primary pays nothing.  This can also happen if the Payer is on the Profile, but the Secondary pays as Primary since the Primary paid $0.

  • The ERA generates a receipt for the insurance that the patient has on insurance management. To correct this error:

  1. Add the Insurance that paid to a Profile.

  2. Go to the Receipt > Edit > correct the Insurance ID > Save [F2].

  3. Post the Remit manually and use Post as Responsibility to post correctly as Secondary.


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