In an ERA, double-click on a patient in the Claims Paid grid.
If a matching claim is not found, users will instead be prompted with the ERA Match with Claim. If a matching claim is found, this window will open.
From this window, users can verify that payment amounts are accurate in order to manually process claims on an ERA.
Any adjustments to the claim payment will be listed in the grid with the reason, amount, and any remarks. This section is read-only and for reference when entering payment.
This grid displays procedures attached to the ERA. This section is read-only and for reference when entering payment.
EOB Totals: Totals in each box correspond to the numbers in the column directly above them (i.e., Fee Billed, Deduct, Allowed, or InsPay).
To view additional details about procedures, double-click a row in the EOB Procedure Breakdown grid. The Procedure Paid window will open. See EOB Claim Details: EOB Procedure Breakdown for more details.
Verify and adjust payment information in the Enter Payments grid.
Include WriteOffs for Category Percentage and Medicaid/Flat CoPay plans: Determine if write-off amounts are transferred from the ERA when dealing with Category Percentage or Medicaid/Flat CoPay Plan Types. To only have write-offs post for PPO plan types, uncheck the option ERAs post Write-offs for Category Percentage and Medicaid/Flat Copay in Preferences.
Split Claims: Click to split any procedures marked with an X in the Split column into a new claim.
Enter Payments Grid Columns:
Total Payments Row: This row will appear when insurance sends back a code or dollar amount that does not match the original claim. It can be left as-is or can be manually applied to the appropriate claim items. If the payment is applied to claim line items, the InsPay field of the Total Payment line must be zeroed out.
Deductible: Click to assign the deductible to the selected line item.
Write Off: Click to write off unpaid amounts on all procedures.
EOB Claim Details: Open EOB Claim Details.
OK: Save payment information. Claim and all line items will be marked received.
Cancel: Do not save payment information. Claim and line-item statuses will not be changed.
Secondary Claims: If there are any secondary claims, a new window will show listing the claims. See Secondary Insurance.
Supplemental Payments: Supplemental payments, claim corrections, and claim reversals can be done by processing an ERA as normal.
Preauths: Preauthorizations can be received by processing an ERA as normal, and the estimates will be updated.