ERA (Electronic Remittance Advice) FAQ

To see full instructions for entering Payer ERAs, review the ERA Electronic Remittance help file.

 

Q: What format does the Remittance Advice have to be in?  

A: In order to import and post Electronic Remittance Advice it must be in the Standard 835 X12 ANSI Format.

 

Q: Is ERA posting limited to only Certain Payers?

A: If a payer does not submit 835 format, then it cannot be imported.  Generally clearinghouses provide this format for the payer’s remittance advice. There are some payer websites that will provide the 835 file download directly from their website, but to import from a clearinghouse, the payer must also be contracted with the clearinghouse to provide this information. When in doubt, contact the center's clearinghouse for a list of contracted payers and to determine whether enrollment is required.

 

Q: Will payments automatically be posted to the system once imported?

A: No. Users will have the ability to review the data coming back prior to creating and posting payment transactions. This provides the center with control over which transactions are created and posted. Transactions that will not be posted can be deleted.

 

Q: Are contract write offs/adjustments also created when the payment transaction is being generated?

A: Yes, but it is recommended that contractual write-offs and/or adjustments be reviewed for accuracy by the center prior to posting to ensure that claims were processed according to the center's contract. The transaction may be edited as needed prior to posting.

 

Q: What information gets posted/updated when an ERA transactions are imported?

A:

Payments and Adjustments:

  • Header Information:  Payment Type: EF - Electronic Funds Transfer or CH-Check
  • Check Number, Check Date (Date Check or EFT was issued)
  • Transaction Date, Transaction Amount (Check or EFT amount)
  • Applied Accounts:  Applied Amount, Switch Current Payer (will move to the next logical payer if selected during the ERA Create TX process.  Note: HST Practice Management will not bill the next payer automatically.
  • Line Item:  If the system can find a match HST Practice Management will post Line Item payments (Amount Paid on each CPT).  Otherwise it will apply the entire amount paid to the primary CPT Code billed.
  • EOB:  HST Practice Management will insert the Claim Adjudication information that comes back on the ERA and post it back to the Patient Account/EOB form, as well as Payment Remarks returned on the ERA.

Patient Account:

  • Billed Payers Tab:  ICN (Internal Claim Number), Amount Paid on Billed Service Lines. (Secondary Payer Claim Adjudication information that is necessary to process the claim).

 

Q: Can I delete an ERA?

A: If a transaction has not been created, then an ERA can be deleted and imported again. If a transaction has been created but not posted, the Transaction must be deleted prior to deleting the ERA.

If a transaction has been created and posted, the ERA cannot be deleted, even if the transaction is reversed.  In this scenario, it would be necessary to import the same ERA again and create a new Payment Transaction.

 

Q: What information can I change on the ERA that has been imported?

A:  Payer ID, Payment Transaction Code, Apply to Payer, and Provider Adjustments can be changed. If any information needs to be changed, it can be changed in the Payment Transaction and Patient EOB.