Bundled Payments

Help Guide for NextGen® Enterprise PM 8

Auto Balanced Batch Column on the ERA Import Posting Report

If you set the Automatically balance batch when an ERA is imported with no errors option in the Remittance Profile Library to either Auto Balance or Auto Balance and flag for BBP, then the Auto Balanced Batch column on the ERA Import Posting report displays one of the following: Y indicates no errors were encountered during the import and the batch was auto-balanced. N indicates errors were encountered during the import and the batch was not auto-balanced. If the option is not enabled or is blank (default), then the column displays N/A on the report for all batches. Some clearinghouses may use the same ERA payer number for all payers. In this case, if an 835 ERA file contains a single check with multiple payers and some payers use a Remittance Profile library with the Automatically balance batch when an ERA is imported with no errors option enabled and other payers use a profile with the option disabled, then the Auto Balanced Batch column on the ERA Import Posting report will display

Help Guide for NextGen® Enterprise PM 8

Resolving Encounter-Related ERA Errors

The following table describes the ERA messages related to the encounter information, and not just a particular line item in the encounter. The ERA message that is associated with the encounter appears next to every line item in the encounter that is reported on the ERA Import Posting report. ERA Message Resolution Line item transaction successfully posted Not applicable. Encounter Not Found You must manually post this ERA claim payment from the EOB. Patient policy nbr does not match the reported nbr from the payer You can compare the patient HIC policy number that is reported from the ERA file to the number entered on theInsurance Maintenancewindow. Payer/Insured combination not found within this encounter You can use the insured's policy number to determine which number the discrepancy is with. You can compare the patient HIC policy number listed at the end of the ERA message to the insured's policy number associated with the encounter. You can get the insured's policy number from the

Help Guide for NextGen® Enterprise PM 8

Resolving Internal System-Related ERA Errors

The ERA messages outlined here are related to internal system errors. These ERA messages are also considered primary and secondary. The primary error ERA message This type of ERA message indicates the exact line item in the encounter that caused the ERA posting process for the encounter to be unsuccessful. The secondary ERA message This type of message displays for any line item following the primary error. Because the ERA posting process was stopped due to the primary error, these line items are not processed. The following table outlines each of the primary error ERA messages and the associated secondary ERA messages, a description of why the primary and secondary ERA message may have occurred, and the possible resolution to the primary error message. Primary Error ERA Message Message Description How to Resolve Insurance not found for this encounter. The ERA file information for the insurance associated with this encounter does not match the insurance associated with the encounter in

Help Guide for NextGen® Enterprise PM 8

Reporting Bundled Payments

The table below outlines how the ERA Import Posting report handles bundled payments. If... Then the ERA Import Posting Report displays the following message: No Encounter Level Payment Distribution method is selected in the Remittance Profile "Bundled payment was not posted because Encounter Level Distribution method was not enabled in the Remittance Profile". Note: To post bundled payments, you must select the Encounter Level Payment Distribution method in the Remittance Profile. The claim is UB/837I and no claim was found for the encounter of the NU bundled payment "Bundled payment was not posted because no claim was identified for this encounter". The claim is UB/837I and no match was found for the NU bundled payment "Bundled payment was not posted because no charge match was found for this revenue code". The claim is NU and a match was found for the NU bundled payment, but the balances of the charges are 0 or credit "Bundled payment was not posted. Charge match(es) found for this r

Help Guide for NextGen® Enterprise PM 8

Posting Logic for Bundled and Unbundled Payments

You can post bundled and unbundled ERA payments for professional or institutional claims. Bundled payments are single ERA payments remitted for multiple charge lines. Unbundled payments are multiple ERA payments remitted for a single charge line with a quantity greater than one. The following table describes the various settings and their results for an ERA file. Encounter Charge Remittance Profile Library Setting ERA File Result Claim REF*6R Segment SVC Segment Single charge, Quantity >1 Single line, Quantity >1 Enable Post Unbundled Payment to Single Charge Present Unbundled payment (an individual payment per unit) The system posts the allowed amount, payment and adjustment amounts against the single charge using REF*6R and adds the individual transactions as one. Note: The Charge Matching Options configuration in Remittance Profile is not considered when using Post Unbundled Payment to Single Charge option. Single charge, quantity >1 Another single charge where quantity = 1 First li

Help Guide for NextGen® Enterprise PM 8

Reading the ERA Import Posting Report

After you have completed the ERA Posting process, the ERA Import Posting report generates. Overall, the report is a complete audit of the ERA 835 file and is grouped by unsuccessful and successful entries. NextGen® Enterprise PM does not, however, report provider level adjustments. The report is sorted by practice with the ERA payments that did not post successfully listed first, followed by all the ERA payments that posted successfully. An ERA message displays in the Description column of the report next to each line item as an indicator for why the ERA claim payment did or did not post against the encounter information. Each of these messages applies to ANSI file formats. The transaction level Reason Codes that are distributed to service lines display on the report, along with their descriptions. Note: The ERA Import Posting report detects and rejects an ERA transaction with a denial reason code and total transaction amount that is not $0.00. Resolving Encounter-Related ERA Errors On

Bundled Payments

Recommendations

Auto Balanced Batch Column on the ERA Import Posting Report

Resolving Encounter-Related ERA Errors

Resolving Internal System-Related ERA Errors

Reporting Bundled Payments

Posting Logic for Bundled and Unbundled Payments

Reading the ERA Import Posting Report

Auto Balanced Batch Column on the ERA Import Posting Report

Resolving Encounter-Related ERA Errors

Resolving Internal System-Related ERA Errors

Reporting Bundled Payments

Posting Logic for Bundled and Unbundled Payments

Reading the ERA Import Posting Report