ERA - 835

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

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

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

Preparing for the ERA Posting Process

Prior to ERA posting, you need to complete certain pre-requisites in preparation for the ERA posting process. The summarized list of processes to be completed in preparation for ERA are: Enroll for ERA with a trading partner (clearinghouse or payer). Complete the following setup in File Maintenance for ERA posting: Remittance Profile Library Reason Codes Library Payers Master File Payers-Alt Payers Master File Enterprise Preferences Practice Preferences Create a network directory and folder filing structure for ERA 835 files that can be accessed by all users who download/import files. For example: ServerName:\ERA\Medicare ServerName:\ERA\Medicare\Unprocessed_Files ServerName:\ERA\Medicare\Successful_Files ServerName:\ERA\Medicare\Partially_Processed_Files ServerName:\ERA\Medicare\Failed_Files ServerName:\ERA\Medicare\Reports Determine the naming convention to be used for ERA 835 files and reports. Consult with the trading partner for downloading files from their website. Download an ER

Help Guide for NextGen® Enterprise PM 8

Identify the ERA Payer Number from the ERA Posting Process

You can find the ERA payer number in the ERA 835 file that you receive from the trading partner. The ERA payer number can be for a payer or for an alternate payer. The number must be entered on the Practice tab of the Payers master file for the payer and on the Alt payer Transaction options tab of the Payers-Alt Payers master file for alternate payer before importing the ERA 835 file. In NextGen® Enterprise PM select File menu, and then select Processes > ERA Posting. The Import Remittance window opens. Select Directory Import. Select the Open File . The Browse for Folder window opens. Select the folder where the downloaded ERA file saved and then select OK. On the Import Remittance window, select Find. The File Contents section of the window displays ERA files in the selected folder. Select the applicable file to view the Payer number and Check number. Make note of the ERA payer number. To close the window without importing the file, select Cancel. Note: ERA payer number in GS02 is us

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

ERA - 835

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ERA Posting Process

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Start the ERA Posting Process

ERA Posting Process

Electronic Remittance Advice

Prerequisites for ERA Processing

Preparing for the ERA Posting Process

Identify the ERA Payer Number from the ERA Posting Process

Start the ERA Posting Process