Process ERA

In an ERA, double-click on a patient in the Claims Paid grid.

If a matching claim is not found, you will be asked to manually locate it in ERA Match with Claim. If a matching claim is found, this window will open.

Verify that payment amounts are accurate. The amounts for EOB totals should match the Totals amounts.

Click OK to mark the claim as received. An X will show in the Recd column of the main ERA window. For each claim in the ERA, repeat verification process. Once complete, proceed to Finalize Payment section below.

Note: For in-network plans, if you change insurance paid or deductible amounts, manually change the write-off. If billing out-of-network plans, you may need to manually remove the write-off amounts. 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 Manage Module Preferences.

Total Payment - 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 that is done make sure to zero out the InsPay field on the Total Payment line.

EOB Claim Adjustments, EOB Procedure Breakdown and EOB Totals are read only and for reference when entering payments.

Include Write-offs for Category Percentage and Medicaid/Flat CoPay plans: Check to include write-off amounts in payment grid for all plan types. Uncheck to zero out write-off amounts on all procedures for Category Percentage and Medicaid/Flat CoPay plans.

Split Claim: To split a claim, mark those to be split off by clicking in the Split column on individual procedures. Click Split Claim to split all selected procedures into a new claim.

Note: If a claim attached to the ERA is split, the claim will need to be detached from the ERA in order to properly finalize payment. For detailed instructions, follow the Detaching a Claim steps on ERAs: A Step-by-Step Guide.

Deductible: Click to move all deductible amounts to the selected row (it can be any row, including Total Payment).

Write Off: Click to write-off all unpaid amounts on all procedures.

Finalize Payment

When every claim in the ERA is marked Received, click Finalize Payment.

  1. Most information will be auto-populated. Enter any other details if needed.
  2. Click OK to open the Insurance Payment window. Verify that the correct claims are attached and the amount is accurate.
  3. If payment is paid via a prepaid insurance card and XCharge (OpenEdge), Edge Express, PayConnect Window, or PaySimple is enabled, you will see the corresponding payment buttons. Click a button to process the payment. When the transaction is complete, the Edit Insurance Payment window will still be open and transaction details will show in the Note.
  4. Click OK again to finalize the payment.

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.