Identify the ERA Payer Number from the ERA Posting Process

Help Guide for NextGen® Enterprise PM 8

Enter the ERA Payer Number for an Alternate Payer

When you are using the alternate payer functionality, you might find that the main payer on the Payer master file and the alternate payer on the Payers-Alt Payers master file has different ERA payer numbers. In File Maintenance, select Master Files > System > PM > Payers-Alt Payers. The Alt-Payers List window opens. From the Alt-Payers List window , select and open the applicable payer. The Modify Alt Payer Information - Demo Payer window opens. Select the Alt Payer Transaction Option tab. The fields under the Alt Payer Transaction Option tab appear. For the ERA Payer Number , enter the payer number for the alternate payer. To save changes and close the window, SELECT OK. Parent topic: ERA Payer Number

Help Guide for NextGen® Enterprise PM 8

ERA Payer Number

The ERA Payer Number is the electronic remittance carrier number received in the 835 file. Each payer is assigned a unique number. The number is entered on the Payer > Payer Defaults-1 tab. The number is used in NextGen® Enterprise PM to allocate the ERA transactions to the appropriate payer. Identify the ERA Payer Number from the ERA Posting Process You can identify the ERA payer number from the ERA posting process. Enter the ERA Payer Number for a Payer Enter the ERA Payer Number for an Alternate Payer You can enter the ERA payer number for an alternate payer in File Maintenance. Parent topic: Setting Up Payers for ERA

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

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

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

File Maintenance Help for NextGen® Enterprise 8

Add an Alternate Payer

In File Maintenance, select Master Files > System > PM, and then select Payers-Alt Payers. The Payers-Alt Payers List window opens. To add an alternate payer, select open menu and then select New. The Add Alt Payer Information window opens. In the Alt Payer Details section, do the following: Enter the alternate payer name. Enter the NEIC/Payer Number, if applicable. You can enter the number for a specific clearing house and/or a specific payer. Enter the alternate payer alias name, if applicable. Enter the in-line edits payer ID, if applicable. Note: You must have a NextGen® In-Line Edits license to use this option. Note: The alternate payer details are system specific. In the Main Address section, enter the address of the alternate payer. To define the billing options for an alternate payer, do the following on the Alt Payer Billing Option tab: Select the applicable values for the fields in the Libraries section. In the Claim Details section, select the applicable media type (electron

Identify the ERA Payer Number from the ERA Posting Process

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Enter the ERA Payer Number for an Alternate Payer

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Enter the ERA Payer Number for an Alternate Payer

ERA Payer Number

Preparing for the ERA Posting Process

Start the ERA Posting Process

Prerequisites for ERA Processing

Add an Alternate Payer