Preparing for the ERA Posting Process

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

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

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

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

Setting Up ERA

The ERA posting process requires the following set up in File Maintenance: Remittance Profile Library Reason Code Library Payers: Enter an ERA Payer Number Select a Remittance Profile Library for specific ERA payers, if applicable Select a Reason Codes Library for specific payers, if applicable Practice Preferences: Select a default Remittance Profile Library for all ERA payers Select a default Reason Codes Library for all payers Configure Patient Pay Import options, if applicable Set Up a Remittance Profile Library Setting Up Reason Codes for ERA You can use the Reason Codes Library to configure business rules to automate ERA transaction posting. Setting Up Payers for ERA You can define the various parameters in Payers Master File related to ERA. Setting Up Enterprise Preferences for ERA Setting Up Practice Preferences for ERA You can set preferences for all payers in the practice. Parent topic: Electronic Remittance Advice

Help Guide for NextGen® Enterprise PM 8

Setting Up Payers for ERA

All payers from whom ERA 835 files will be received must be configured prior to importing the electronic files in NextGen® Enterprise PM. If there are multiple master files for the same payer (e.g. Aetna, Aetna HMO, Aetna PPO, etc.), the setup should be done to all master files for that payer. ERA Payer Number Cross-over Indicator Select All Lines for Bill to Next Insurance Create Zero Balance Claims to Subsequent Payers Set Up Default Transaction Codes for a Payer Set Up Default Transaction Codes for an Alternate Payer You can set up default transaction codes for an alternate payer in File Maintenance. Reason Code Library Remittance Profile Library Parent topic: Setting Up ERA

Preparing for the ERA Posting Process

Recommendations

Start the ERA Posting Process

ERA Posting Process

Identify the ERA Payer Number from the ERA Posting Process

Prerequisites for ERA Processing

Setting Up ERA

Setting Up Payers for ERA

Start the ERA Posting Process

ERA Posting Process

Identify the ERA Payer Number from the ERA Posting Process

Prerequisites for ERA Processing

Setting Up ERA

Setting Up Payers for ERA