Billing, Statements, Claims, and ERA

Help Guide for NextGen® Enterprise PM 8

Electronic Remittance Advice

Electronic Remittance Advice (ERA) 835 files can be imported from the File > Processes > ERA Posting menu. This process compares transactions in the ERA 835 file for each claim against the charge information in NextGen® Enterprise PM. When ERA transactions match to charges, a transaction batch is automatically created, and the ERA transactions are added to the batch ledger. Transactions in the ERA file that do not match to charges, or do not post for other reasons, display on the ERA Import Posting report as “Not Posted” and are not added to the transaction batch. The ERA Posting process is designed to increase efficiency. Once the original set up for the process is complete, there is minimal effort required to set up additional payers. It is estimated to take about 15 minutes to post an electronic ERA 835 file for a 30-page Explanation of Benefits (EOB) electronically, compared to approximately two hours to post the same 30-page EOB manually. ERA Automatic Adjustments and Library Sett

Help Guide for NextGen® Enterprise PM 8

Claims

A claim is a request by the insurance holder to their insurance company for payment towards services rendered in a practice for the patient. Setting Up Claims You must configure valid claims to meet regulatory and commercial insurance requirements. Transaction Flow Claims Processing Generating and Submitting Claims UB Claims Consolidated Service Claims Claim Status Claim Status shows you the status of claim requests submitted in batch mode or real time for electronic claims that are archived. Parent topic: Billing, Statements, Claims, and ERA

Help Guide for NextGen® Enterprise PM 8

Statements

A statement is generated for all accounts where the guarantor has an outstanding unpaid balance. An account can be for a person, patient, parent, or spouse who is the guarantor on one or more encounters. An account may also be for an employer who is the guarantor on one or more encounters. Each statement shows encounters with their associated charges, and any transaction activity (payments, adjustment, refunds) that is posted against those charges. Both outstanding insurance balances and patient balances are shown. The purpose of a statement is to keep the guarantor informed of their account activity, and to bill them for their outstanding patient balance. The patient balance is comprised of self-pay encounters or encounters with a remaining balance after insurance is paid. Encounters on a Budget Plan and encounters in Bad Debt status are not normally included on statements. However, they can be included if desired. Bad Debt encounters can be included by selecting Include bad debt enco

Help Guide for NextGen® Enterprise PM 8

ERA Posting Process

You must follow the steps to prepare for Electronic Remittance Advice (ERA) and the process for importing ERA 835 files received from a trading partner, such as a clearinghouse or payer, into NextGen® Enterprise PM. Note: You can now successfully import more than 500,000 single or multiple large ERA files, with or without Microsoft® Excel reports, in a short time. Preparing for the ERA Posting Process You must complete certain pre-requisites before ERA posting. Start the ERA Posting Process You must start the Electronic Remittance Advice (ERA) Posting process from the Import Remittance window. Posting an Electronic Remittance Parent topic: Electronic Remittance Advice

Help Guide for NextGen® Enterprise PM 8

ERA - 835

This section explains the ERA 835 file. The basic steps in working with the 835 file include: Download the file from the payer or clearing house. Set up an ERA Remittance Profile library. Select File > Process > Import ERA. Print the report. Verify the batches. Post the batches. Reference: For more information on the ERA 837 files, go to the NextGen Healthcare Success Community and download the latest Electronic Remittance Advice (ERA) User Guide for NextGen® Enterprise PM. Parent topic: Coordination of Benefits Electronic and Manual Processing

Help Guide for NextGen® Enterprise PM 8

Posting an Electronic Remittance

This section provides information about the process of posting an electronic remittance. When posting the ERA, the system compares the ERA payment information for each claim in the file against the encounter information in your system that the claim was originally created for. In order for the ERA payments for each claim to post successfully, the ERA payment information for a claim must match the encounter information the ERA is posting against. If there is a discrepancy between the ERA information and the encounter information, the ERA payment for that claim does not post and an error message displays on the ERA Import Posting report. In addition, if an ERA payment is posting against multiple line items in an encounter, all the line items must be error-free for the ERA payment to post successfully. The ERA process only calculates and posts adjustments for encounter primary and secondary payers. If the primary ERA pays a charge off, it is settled to the secondary and is included on the

Billing, Statements, Claims, and ERA

Recommendations

Electronic Remittance Advice

Claims

Statements

ERA Posting Process

ERA - 835

Posting an Electronic Remittance