ERA Posting to the Post to Voided Charge

Post to voided charge (Enabled/Disabled)	Ignore Claim ID Nbr matching (Enabled/Disabled)	Ref*6R segment in ERA file	Encounter Charge (Active/Voided)	Result
Disabled	Enabled	Present or Absent	Active and Voided charge	The transaction is posted to the active charge, as the Ref*6R segment may or may not be present in the ERA file, the encounter has an active charge, and the Post to voided charge option is disabled.
Disabled	Enabled	Present or Absent	Voided charge	The transaction is not posted and ERA Import Posting Report displays a message that the item is not posted, as Post to voided charge is disabled on the Remittance Profile window.
Enabled	Enabled	Present or Absent	Active and Voided charge	The transaction is posted to the active charge, as the Ref*6R segment may or may not be present in the ERA file, the encounter has an active charge, and Post to voided charge is enabled.
Enabled	Enabled	Present or Absent	Voided charge	The transaction is posted to the voided charge, as Post to voided charge is enabled and the encounter has a voided charge.
Enabled	Disabled	Present (match with active charge)	Active and Voided charge	The transaction is successfully posted to the active charge, as the encounter has an active charge and the Ref*6R segment is present in the ERA file and also matches the active charge.
Enabled	Disabled	Present (match with Voided charge)	Active and Voided charge	The transaction is successfully posted to the voided charge, as the encounter has an active charge, Ref*6R, matches the voided charge, and Post to voided charge is enabled.
Enabled	Disabled	Absent	Active and Voided charge	The transaction is successfully posted to the active charge even though Ref*6R is absent in the ERA file, as the encounter has an active charge.
Enabled	Disabled	Present	Voided charge	The transaction is successfully posted to the voided charge, as the Ref*6R is present in the ERA file, the encounter charge is voided, and the Post to voided charge is enabled.
Enabled	Disabled	Absent	Voided charge	The transaction is successfully posted to the voided charge even though Ref*6R is absent in the ERA file, as the encounter charge is voided and Post to voided charge option is enabled.
Disabled	Disabled	Present (match with Active charge)	Active and Voided charge	The transaction is successfully posted to the active charge, as Ref*6R is present in the ERA file and matches the active encounter charge when Post to voided charge is disabled.
Disabled	Disabled	Absent or Mismatched	Active and Voided charge	The transaction is successfully posted to the active charge, as the encounter has an active charge even though Ref*6R is absent or mismatched in the ERA file.
Disabled	Disabled	Present or Absent	Voided charge	The transaction is not posted and ERA Import Posting Report displays the message that the line item is not posted, as Post to voided charge is disabled on the Remittance Profile window.
Enabled	Disabled	Present	Voided charge	The transaction is successfully posted to the voided charge, as Ref*6R is present in the ERA file, the encounter has a voided charge, and Post to voided charge is enabled.
Enabled	Disabled	Absent	Voided charge	The transaction is successfully posted to the voided charge even though Ref*6R is missing in the ERA file, as the encounter has a voided charge and Post to voided charge is enabled.
Disabled	Disabled	Present or Absent	Voided charge	The transaction is not posted and ERA Import Posting Report displays the message that the line item is not posted, as Post to voided charge is disabled on the Remittance Profile window.

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

Help Guide for NextGen® Enterprise PM 8

Batch Posting for ERA

The following is a list of columns from the Batch Posting window in NextGen® Enterprise PM and their descriptions: Column Description Unnamed Displays an icon to indicate whether a batch is active or inactive . Transaction activity is recorded in the active batch. BBP Displays a green check mark to indicate that the batch has been flagged and will be automatically posted by the NextGen® Background Business Processor once it has been balanced. Date Displays the date when the ERA batch was created. ID Displays batch ID. The first batch of the day is assigned the ID 0001. Additional batches you create the same day are assigned sequential ID numbers (0002, 0003). The numbers restart at 0001 every day. Description Displays the batch name. You can edit the description in the Batch Maintenance window. Members Displays the number of transactions (payments and adjustments) in the Posted section of the ERA Import Posting report. Transactions that have not been posted are not included in this cou

Help Guide for NextGen® Enterprise PM 8

5010 Compliance

The ERA recognizes 5010 compliant claim status codes. It matches on payer based upon the hierarchy of Payer Nbr, Policy nbr, and Claims Status. When the claim status equals 4, the application reads the version number of the 835 and determines if it is a 5010 claim. It then automatically posts the transactions with an Appeal / Skip ERA Adjustment status. The ERA Import Posting report displays the following message: "Line Item Successfully Posted - Patient/Subscriber is not recognized by the Ins". If "Never" is selected in the Remittance Profile Library, the 0.00 payment is not posted. In this case, the ERA Import Posting displays the following message: "Not Posted - Patient/Subscriber is not recognized by the Insurance". When Claim Status does not match the correct COB, the application: Does not post payments when Claim Status Indicator does not match the correct bucket. The ERA Import Posting report displays the following message: "Payment not posted due to Claim Status Indicator not m

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

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

CSC Options Tab - Options and Settings

You can use the following list of options and descriptions to make settings on the CSC Options tab in your Remittance Profile. CSC Tab Options Option Description Consolidated Services Claim payment Posting Enable Posting to CSC Claims Enables matching logic for the following 835 segments during the ERA Posting process: REF*EA Segment REF01 (2100 level)-EA - Medical Record Identification Number identifies the CSC Claim from the superclaim_encounters table. REF*EA - the REF*6R line item control number is used to match to the service line(s) for ERA posting. REF*6R - is used for UB/837I posting of CSC and Non-CSC Claim payments. On the Default tab, in the Charge Matching Options, you must select Use Bundled Payment Processing for UB Claim to this segment. REF*EA - If not returned , the 2100 Service Lines REF6R is used to look for a match. REF6R - identifies a match to a CSC Claim, each payment’s line item is posted to the matching REF*6R. REF*EA and REF*6R - are missing, the normal Remitt

ERA Posting to the Post to Voided Charge

Recommendations

Reading the ERA Import Posting Report

Batch Posting for ERA

5010 Compliance

Posting an Electronic Remittance

Posting Logic for Bundled and Unbundled Payments

CSC Options Tab - Options and Settings

Reading the ERA Import Posting Report

Batch Posting for ERA

5010 Compliance

Posting an Electronic Remittance

Posting Logic for Bundled and Unbundled Payments

CSC Options Tab - Options and Settings