ERA Workflow

See ERAs.

Electronic Remittance Advice (ERA) can be processed manually, automatically, and semi-automatically. Below are the steps for inital set up to start receiving ERAs and how process them.

Initial Setup Requirements

To start using ERAs, offices must sign up for ERAs with their clearinghouse and participating insurance carriers.

Some setup is needed in Open Dental to enable ERAs. If a clearinghouse is not set up in in Open Dental, see Clearinghouse Setup.

  1. Ensure the Open Dental Service is installed and running on the server.
  2. In Clearinghouse Setup, check Receive Reports by Service
  3. In Clearinghouse Setup, double-click on the clearinghouse. Ensure Download ERAs is selected and that there is a designated report path. (e.g., C:\ClaimConnect\Report\).
  4. Ensure necessary users have Permissions for Insurance Payment Create.
  5. In the Send Claims window, click Get Reports, select the clearinghouse, then check for a successful connection to the clearinghouse server.
  6. (Optional) Enable ERA Automation (automatic processing) in Preferences.

Once this initial setup has been completed, the office is ready to begin receiving and processing ERAs. Proceed to one of the sections below to process ERAs.

Manually Processing ERAs

If ERA Automation is set to Review All in Preferences, all ERAs must be processed manually:

  1. From the Manage Module, click ERAs
  2. Verify the date range is correct. Enter any criteria to filter the list.
  3. Double-click an ERA to see the ERA - Electronic EOB (e.g., attached claims and payments).
  4. Double-click on a claim to process payment.
  5. Verify the amounts being entered are correct.
  6. Click Save to mark the claim as Received
  7. If multiple claims are included on the ERA, repeat steps 4-6 as needed for any remaining claims.
  8. Once all claims in the ERA have been marked as Received, click Finalize Payment. See Finalize Payment on Process ERA.
Note: If a claim payment is missing the X in the Recd column, continue with the steps below to detach the claim and finalize the payment outside the ERA window.

Detaching a Claim

If a claim cannot be processed in the ERA window, the claim can be detached and payment information entered manually.

  1. Select the problem claim from the Claims Paid grid.
  2. Click Detach Claim. Once detached N/A appears in the Recd column for the selected claim.
  3. Right-click on the detached claim; Select Go to Account.
  4. From the Account Module, enter payment details and receive the claim as normal. See: Receive Claim.
  5. Repeat steps 1-4 as needed for any other claims that need to be detached from the ERA.
  6. After all claims have been received on the ERA (Recd column marked X) or detached from the ERA (Recd column marked N/A) and received through the account module, finalize the payment as batch outside of the ERA window. See: Batch Insurance Payment.
Note: Once all claim payments have been processed or detached, and all claims (including $0 payments) have been attached to the batch check, the status of the ERA is updated to Finalized*. The asterisk (*) indicates an ERA with detached claims.

Semi-Automatic ERA Processing

If ERA Automation is set to Semi-automatic in Preferences, users can process ERAs with a single click in the ERA window:

  1. In the ERAs window, double-click on an ERA to see the attached claims and payments.
  2. Click Auto Process.
    • All claims associated with the ERA are automatically received or a message is shown detailing any problem claims..
    • If there are any errors, correct them as needed. Click Auto Process again. If necessary, follow steps above for Detaching a Claim.
  3. If all claims on the ERA Auto Process successfully, payment is automatically finalized.

Fully-Automatic ERA Processing

If ERA Automation is set to Fully-automatic in Preferences, Open Dental automatically completes the ERA Match with Claim process without any work needed from the office:

Additional Information About Semi and Fully-Automatic ERA Processing

Automatic ERA processing:

Automatic ERA Processing does not: