ERA Processing

ERA Processing

PracticeAdmin facilitates the downloading and initial processing of Electronic Remittance Advice (ERA) messages from insurance payers for ProviderSuite users. This article describes the daily workflow for these messages.

The American Medical Association has an excellent overview of ERAs with guides on how to get started with ERAs, how to enroll for ERAs with payers, and tips on processing ERAs.

Once a payer completes adjudication of a submitted claim, they will generate a document describing the adjudication results: amount requested, contractual amount allowed, deductible remaining, amount paid, etc. This document may be delivered as a traditional Explanation of Benefits (EOB) sent by mail or, if the provider is enrolled for electronic confirmations, as an Electronic Remittance Advice (ERA) digital message, also known as an X12.835 message.

Paper EOBs will be mailed to the provider and must then be posted manually using the Payment Application module of the Billing Manager.

Digital ERAs are transmitted from the payer to a clearinghouse and then downloaded by PracticeAdmin for processing into ProviderSuite. This ERA processing is a multiple step workflow.

  1. Payers generate and send ERAs to the clearinghouse throughout the workday as they complete adjudication on a claim.
  2. The clearinghouses receive the ERAs and then route them to the appropriate account mailbox. Once deposited in the mailbox, the ERA will be visible in that clearinghouse’s online portal, but is not yet available in Billing Manager.
  3. PracticeAdmin connects to the clearinghouse four times per day (midnight, 6 AM, noon, and 6 PM) to download any waiting ERAs.
  4. At 8 PM each day, PracticeAdmin opens each ERA received as of 6 PM to determine the specific client account, payer, and payment amount. Once this initial parsing is complete (normally by 11 PM), the ERA will be linked to the ProviderSuite account and visible by going to ProviderSuite > Billing > EDI Payments or to Billing Manager > Accounting > Payment Application > Batch > ERAs and searching for “Unprocessed ERAs”.
  5. At 5 AM each day, PracticeAdmin processes all the ERAs parsed during step 4 to attempt to auto-match them to a claim, create a payment batch, and assign a user. Once this ERA processing is complete (normally by 7 AM), the ERA will be visible by going to ProviderSuite > Billing > EDI Payments or to Billing Manager > Accounting > Payment Application > Batch > ERAs and searching for “Posted, Pending Review”. Please note that some ERAs cannot be auto-matched due to deficiencies in the data received from the payer and will remain with a status of “Unprocessed ERA” even after step 5 is complete. These ERAs will need to be manually matched to the appropriate claim by you.
  6. At 7 AM each day, PracticeAdmin generates an email alert for each ERA that has completed steps 4 and 5. The alerts are sent to the email on file for the user assigned to the batch (configured on ProviderSuite > Billing > EDI Payments > User for Payments) and to the Electronic Payments Contact for the account (configured on ProviderSuite > Setup > General > Electronic Payments Contact Email).

Frequently Asked Questions

The payer states that the claim has been paid, but I don’t see the ERA in the clearinghouse portal or in ProviderSuite?

The first step is to confirm that the payer has indeed generated an ERA and sent it to our clearinghouse partner.

1. Confirming if a payer has sent an ERA:
A. Login into ProviderSuite.
B. On the Main Billing tab, select the EDI Portal menu option.
C. Under the Manage Payments tab, select the View Insurance Payments (Remittances) menu option.
D. Search for the ERA by Check Date or use the Advanced Search tool for other options.
E. Be sure to check the box labeled "Show Archived (Previously Downloaded) Remittances" to search for ERAs that may have already been sent to PracticeAdmin.

If you cannot locate the ERA through the search tool, it has not yet been received by the clearinghouse or PracticeAdmin. Please wait one or two days and search again.

 

I see the ERA in the clearinghouse portal, why is it not yet in ProviderSuite as either an “Unprocessed ERA” or a “Posted, Pending Review” batch?

If the ERA is listed and has no “Download Date” or a “Download Date” of less than two days in the past, it may be already be awaiting processing in the ProviderSuite system. ERAs received by PracticeAdmin are processed within 24 to 48 hours of download.

If the ERA has a “Download Date” older than one day but you do not see it in ProviderSuite, it may have failed during the download or a subsequent processing step.

2. Requesting an ERA to be downloaded into ProviderSuite again:
A. In the list of ERAs, check the box for each ERA you want downloaded again.
B. Click the green "Download Selected" button.*
C. A screen showing "The remittances you have selected have been created." should appear 
D. The ERAs will be automatically downloaded by PracticeAdmin. It is not necessary to click the link that says "click here to download existing remits".
C. Wait 24 to 48 hours for the ERA to be downloaded and processed into ProviderSuite

If after 24 to 48 hours, the ERA still does not appear in ProviderSuite, there may be an issue with the ERA data. Please open a support ticket and the PracticeAdmin support team will conduct additional research to determine the issue and next steps.

 I received a "ERA Processed" alert email, but I cannot locate the ERA in ProviderSuite. What should I do?

The "ERA Processed" emails are only generated after ProviderSuite has completed processing an ERA. If you received an email, the ERA is in ProviderSuite. If you are unable to locate it using the ProviderSuite > Billing > EDI Payments or the Billing Manager > Accounting > Payment Application > Batch > ERAs search screens, please open a support ticket with the Payer, Amount, and Check Number from the "ERA Processed" email.

 

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