Electronic Remittance Advice

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

Prerequisites for ERA Processing

Prior to beginning the ERA Posting process, it is necessary to enroll with an ERA trading partner (payer or clearinghouse). The timing of enrollment is critical and must be completed prior to receiving ERA 835 files from payers. Consult with the trading partner on the process required for downloading files from their website. To manage downloaded ERA 835 files, a filing system and naming convention should be determined and set up in advance. For example, a directory for storing unprocessed ERA files could be created as follows: ERA > Medicare > Unprocessed Files. It is recommended to also create a separate sub-folder for storing files that have already been imported and processed in NextGen® Enterprise PM. For example, ERA > Medicare > Processed Files. It is important to place these directory folders in a location that can be accessed by all users responsible for downloading and importing ERA files. It is also important to store only ERA 835 files in the directory folder and not includ

Help Guide for NextGen® Enterprise PM 8

Billing, Statements, Claims, and ERA

Billing is the process where claims are submitted by a practice to an isurance company for the services rendered. A statement is a medical bill that lists all the treatments undergone by a patient in a practice. Electronic Remittance Adive (ERA) is an electronic communication that explain in detail the EOB (Explanation of Benefits) for a particular service. This section discusses in detail about the billing process, statements, insurances, and claims. Billing Statements A statement is generated for all accounts where the guarantor has an outstanding unpaid Balance. Claims Electronic Remittance Advice You can set up and process HIPAA ASC X12N 835 Electronic Remittance Advice (ERA) transaction files in NextGen® Enterprise PM.

Help Guide for NextGen® Enterprise PM 8

ERA Automatic Adjustments and Library Settings

Additional adjustments may or may not occur during the ERA Posting process. These adjustments are determined by options selected in the Contract library, or the Remittance Profile library and the Reason Codes library. Additional Adjustments do not Post When a Contract library that is setup to automatically adjust charges during charge posting is attached to an ERA payer. The ERA Posting process will not post additional adjustments. The Automatically adjust charges option is selected in File Maintenance > Libraries > Contracts on the General tab. Additional Adjustments Post When a Contract library that is setup to not automatically adjust charges during charge posting is attached to an ERA payer. The ERA Posting process will post adjustments according to settings in the Remittance Profile library and the Reason Codes library. Parent topic: Electronic Remittance Advice

Help Guide for NextGen® Enterprise PM 8

Start the ERA Posting Process

The Electronic Remittance Advice (ERA) Posting process is not automatic. You must start it from the Import Remittance window. Note: The ERA Import function uses the CLP02 element to determine which COB to use if both primary and secondary payers have the same ERA Payer Number. The Default for Contract <> Payment Allowed Amount and Default for Contract <> ERA Payment Amount options are applicable only for the primary payer (CLP02=1). Note: You must create and assign an automated Encounter task in Task Types master file in File Maintenance along with the custom user-defined reason code to track the discrepancy in ERA payment amount and contractual reimbursed amount when 835/ERA file is posted in NextGen® Enterprise PM. For more information about creating and assigning the automated task, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise From the File menu, select Processes, and then ERA Posting. The Import Remit

Help Guide for NextGen® Enterprise PM 8

Posting Transactions

In NextGen® Enterprise PM, a payment is considered posted only if has gone through the posting process. You can add or modify payments for an encounter only until it is posted. The posting process is a way of telling the application that everything has been done correctly and is ready to be committed to the system. Payment posting could be manual in paper format as Explanation of Benefits (EOB) or electronically as Electronic Remittance Advice (ERA). In NextGen® Enterprise PM, there are two sources for transactions, patients or payers. Payments may come from primary, secondary or tertiary payers. Transaction Posting Process You can create a batch to enter relevant information for payments and posting the payments. Viewing Transaction Dates You can view different dates associated with all transactions in the Batch Maintenance window. Recording Transactions to a Batch You can create a transaction batch header to enter payments or transactions. Posting Encounter and Account Level Payments

Electronic Remittance Advice

Recommendations

ERA Posting Process

Prerequisites for ERA Processing

Billing, Statements, Claims, and ERA

ERA Automatic Adjustments and Library Settings

Start the ERA Posting Process

Posting Transactions

ERA Posting Process

Prerequisites for ERA Processing

Billing, Statements, Claims, and ERA

ERA Automatic Adjustments and Library Settings

Start the ERA Posting Process

Posting Transactions