ERA FAQs

ERA FAQs

ERA FAQs

Archived ERAs

How do I Archive ERAs?

Archive ERAs

  1. Update an ERA's File Status

Where do I find Archived ERAs?
Find Archived ERAs

Claim Type

Why does the ERA Claim Type say it is Processed as Tertiary when the Patient only has a Primary Insurance?

Processed as Tertiary/Patient only has a Primary Insurance

  • The Claim Type comes in the Electronic File from the Payer.

  • Even if the Claim Type is incorrect, it does not prevent the posting of the Payment.

Credit Cards

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

Virtual Credit Card

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

Dates

When do the ERAs load into the System?

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?

Reference Batch Received Date

  • 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, enable the System Setting, ERARECEIVEDATE.

    • This allows the entry of the Received Date on the Reference Batch.

  • Release v 4.7

ERAs/EOBs (Explanation of Benefits)

How do I delete part of an ERA EOB?

Delete part of an ERA EOB

Why is "Post as Remitted" not an option in the Claim Action Dropdown on the Remit?

Post as Remitted is not an option

Hold

What happens when an ERA is on hold because the "Insurance on remit does not exist on Profile"?

ERA is on Hold because Insurance does not exist on the Patient
What happens when an Individual Remittance goes on Hold and not the whole ERA?

Individual Remit Item goes on Hold


Insurance Profile

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

Primary forwards to a Payer not on the Patient's Insurance Profile.

  • The Remit will not post and is assigned a Status of CM.

  • Map the Insurance using the Mappings button on the ERA Remits Items screen.

Medicaid

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

Medicaid Secondary is dropping the balance to the Patient

  • 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.

Post an ERA

How do I post an ERA?

Post an ERA

How do I find Posted ERAs?

Find posted ERAs

Reports

What Report can I run to see my ERA Receipts?

ERA Receipts Report

Secondary Payer

What if the Secondary Pays as Primary?

Secondary Pays as Primary

This most often occurs when the Primary Insurance pays $0, such as applying to the deductible.

  • The Secondary pays as the Primary.

  • The Remit is statused as On Hold because the System does not know how to post the Payment.

Unbalanced Claims

How do I work unbalanced Claims when posting ERAs?
 



Archived ERAs

How do I Archive ERAs?

Where do I find Archived ERAs?


Claim Type

Why does the ERA Claim Type say it is Processed as Tertiary when the Patient only has a Primary Insurance?

  • The Claim Type comes in the Electronic File from the Payer.
  • Even if the Claim Type is incorrect, it does not prevent the posting of the Payment.


Credit Cards

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.


Dates

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)


ERAs/EOBs (Explanation of Benefits)

How do I delete part of an ERA EOB?

  • To see and print only one Patient's EOB without seeing the rest of the Patients on the Remit:

Why is "Post as Remitted" not an option in the Claim Action Dropdown on the Remit?

Hold

What happens when an ERA is on hold because the "Insurance on  remit does not exist on Profile"?


What happens when an Individual Remittance goes on Hold and not the whole ERA?


Insurance Profile

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

  • The Remit will not post and is assigned a Status of CM.
  • Map the Insurance using the Mappings button on the ERA Remits Items screen.


Medicaid

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.

Post an ERA

How do I post an ERA?

How do I find Posted ERAs?


Reports

What Report can I run to see my ERA Receipts?


Secondary

What if the Secondary Pays as Primary?

This most often occurs when the Primary Insurance pays $0, such as applying to the deductible.

  • The Secondary pays as the Primary.
  • The Remit is statused as On Hold.


Unbalanced Claims

How do I work unbalanced Claims when posting ERAs?


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