Process ERA Payments

  Permissions: You must have Billing Permissions with the ability to "Submit Claims to Clearinghouse" enabled.

After a Claim is Accepted by the Payer you will receive an ERA with payment for that Claim. 
If your Organization uses Claims with Apex Clearinghouse, you can enable a setting to have ERAs processed automatically.

NOTE: You will not typically receive the ERA Payment the same day the Claim is Accepted. It often takes time for the ERA Payment to process after the Claim is Accepted.

NOTE: If you are a non-partnered clearinghouse user, the client will be matched based on the CLP01 value. If the match is not made to the CLP01 value, the match is made to the client's first name/last name. 

Jump To: [Enable Auto Processing] [Process Payments One by One]  [Manually Adjust an ERA] 

[Match to ERA] [Resolve a Mismatch] [Troubleshooting]

Enable Auto Processing

Once you receive the ERA, TheraNest will auto-process ERAs that match certain criteria. If an ERA is not auto-processed, you will be able to make adjustments, write off a balance, shift the balance to the client, or leave it as is from within the ERA Received tab.

The ERA will be automatically processed if:

• The ERA payment was received without any adjustments.
• The ERA payment was received were the only adjustments were Patient Responsibility or Contractual Obligation.
  • If the adjustment was Patient Responsibility (PR-1, PR-2, or PR-3), an invoice adjustment will be created and the amount will be shifted to the client.
  • If the adjustment was Contractual Obligation (CO-45 or CO-253), an invoice adjustment will be created and the adjustment amount will be written-off.

1. Click Organization and Claims Service.
2. Click the Settings tab.
3. Click Turned On for the Automatic claims processing setting. Claims will be automatically processed.
   
   

Process Payments One by One

1. Click Actions for every Payment and select one of the following:
   • Process Payment - This means you're taking the Insurance Payment and applying it to that Invoice/Claim on the Ledger. When you choose this option the Payment will automatically be applied to the Invoice/Claim. The ERA will then move to the Paid/Processed tab on the Claims screen.  
   • Mark as Process - No Payments are being applied to the Invoice but that Payment line moves to the Paid/Processed tab. If you accidentally marked a Payment as processed without applying, see below. 

Manually Adjust an ERA 

NOTE: This feature is only available for organizations who are using Claims with Apex Clearinghouse.

1. Click Billing, Claims.
2. Select ERA Received tab.
3. Click Actions for the appropriate ERA you want to adjust.
4. Click Process Payment Adjustments to match the action in the application.
   
   
   
   
5. Claim Details display at the top.
6. Adjustment Codes display.
7. To add a Write Off - Enter the Write-Off amount in the field. 
8. To Shift Balance to Client - Enter the Balance amount in the field. 
9. To leave an Insurance Balance Due - Enter the amount in Do Not Apply field.
10. After you have made the adjustment, the Remaining Amount, the Resulting Insurance Balance, and the Resulting Client Balance will be reflected below.
11. Click Process Payment button to complete the adjusment.
    
    

Match Invoice to ERA

If an ERA has been matched to a client but not an invoice, you can resolve the mismatch by linking the appropriate invoice.

1. Click Billing, Claims.
2. Select ERA Received tab.
3. Click Actions menu for the invoice.
4. Select Match Invoice on the drop-down menu.
   
   
   
5. The Match Invoice to ERA Payment pop-up window opens. Select the desired invoice.
6. Click the Match Invoice button.
   
   

Resolve a Mismatch

When you receive an ERA that does not match back up with the original Claim you submitted,  you will need to manually resolve the mismatch before you Process Payments.

1. Click Billing, Claims.
2. Select ERA Received tab.
3. Click Actions menu for the invoice.
4. Select Resolve Mismatch.
   
   
   
5. The Resolve Mismatch pop-up window opens. Select the Client.
6. Select the Payer.
   
7. Click the Resolve Mismatch button.
   
   

Troubleshooting

If you accidentally marked a Payment as processed without applying, you can reverse the movement.

1. Go to the Paid/Processed tab.
2. Click Actions next to the Payment.
3. Select Mark As Not Processed. The Payment will go back to the ERA Received tab for you to apply.