Resolving Internal System-Related ERA Errors

Primary Error ERA Message	Message Description	How to Resolve
Insurance not found for this encounter.	The ERA file information for the insurance associated with this encounter does not match the insurance associated with the encounter in the application. It is not likely that the conditions for this message will ever occur.	Please contact Technical Support to resolve this issue.
Secondary ERA Message
Processing of charge ceased due to the insurance for the encounter was not found.	Each line item following the primary error ERA message displays on the ERA Import Posting report with this message. This message indicates that because of the primary error, these line items were not even processed. Because they were not processed, there is no way to know if there are any discrepancies with these line items.	There is no applicable resolution to this ERA message because it is secondary and only occurred because of the primary error.
Transaction detail status improperly set.	The Transaction Detail Status field for the line item on the Charge Posting window that the ERA payment is being posted against was improperly set. This message indicates that the Transaction Detail Status field for the line item on the Payment Entry window was not set to one of the following: Settled to Secondary Settled to Tertiary Forwarded to Secondary Forwarded to Tertiary Settled to Self When this message displays the ERA processing for this encounter stops and none of the line items listed in the encounter are processed.	Please contact Technical Support to resolve this issue.
Processing of charge ceased due to transaction detail status was improperly set.	Each line item following the primary error ERA message displays on the ERA Import Posting report with this message. This message indicates that because of the primary error, these line items were not even processed. Because they were not processed, there is no way to know if there are any discrepancies with these line items.	There is no applicable resolution to this ERA message because it is secondary and only occurred because of the primary error.

Help Guide for NextGen® Enterprise PM 8

Resolving Line Item-Related ERA Errors

The ERA messages outlined below are related to those line items listed on the encounter that the ERA payment is posting against. There are two types of line item related ERA messages: The primary error ERA message This type of message indicates the exact line item on the encounter that caused the ERA posting process for the encounter to be unsuccessful. The secondary ERA message This type of message displays for any line item following the primary error. Because the ERA posting process was stopped due to the primary error, these line items are not processed. Note: Once the line item payments post, a "Line Item successfully posted" message displays. If NextGen® Enterprise PM finds any existing payments for a payer, this message indicates that secondary payments were also found during posting. The following table outlines each of the primary error ERA messages and the associated secondary ERA messages, a description of why the primary and secondary ERA message may have occurred, and the

Help Guide for NextGen® Enterprise PM 8

Resolving Encounter-Related ERA Errors

The following table describes the ERA messages related to the encounter information, and not just a particular line item in the encounter. The ERA message that is associated with the encounter appears next to every line item in the encounter that is reported on the ERA Import Posting report. ERA Message Resolution Line item transaction successfully posted Not applicable. Encounter Not Found You must manually post this ERA claim payment from the EOB. Patient policy nbr does not match the reported nbr from the payer You can compare the patient HIC policy number that is reported from the ERA file to the number entered on theInsurance Maintenancewindow. Payer/Insured combination not found within this encounter You can use the insured's policy number to determine which number the discrepancy is with. You can compare the patient HIC policy number listed at the end of the ERA message to the insured's policy number associated with the encounter. You can get the insured's policy number from the

Help Guide for NextGen® Enterprise PM 8

Resolving System-Related ERA Errors

There are certain system related messages that you might get while trying to process an ERA 835 file. Typically, these are error messages that are related to the database. The table below outlines the system related messages, a description of the message, and any applicable resolution. System ERA Error Message Message Description How to Resolve Error occurred during final update to the database. Processing ceased due to inserting duplicate transaction Ids. Error Code = 9. There was an error during the final update to the database. When you get this message, no information from the ERA 835 file was saved to the database, the ERA Posting process failed. Always keep a copy of the error message. Follow the instructions in the error message: Wait a few minutes and try processing the file again. If you are unable to complete the ERA Posting process and you get this message again, the error has been written to the ODBC Error Log file. Contact NextGen Healthcare Client Support. Error occurred

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

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

Additional Information

If a patient has a payer with the ERA – Create Zero Dollar Total Balance Claims to Selected Subsequent Payer(s) check box enabled, whether the payer is primary or secondary, and the patient’s next payer is one of the selected subsequent payers, then when an ERA 835 file is processed for that payer and an adjustment is posted from the CAS segment, the following occurs: Transaction Detail Status for charge line items associated with the claim default to Settled move to subsequent payer. Charge line items associated with the claim are flagged for rebill. The encounter status changes from Billed to Rebill. When the ERA – Create Zero Dollar Total Balance Claims to Selected Subsequent Payer(s) check box is not enabled for the payer and an adjustment reason code is defined with a Transaction Detail Status of Settled moved to secondary or Settled moved to tertiary, the following occurs when an ERA 835 file with that adjustment reason code is processed: Transaction Detail Status for charge line

Resolving Internal System-Related ERA Errors

Recommendations

Resolving Line Item-Related ERA Errors

Resolving Encounter-Related ERA Errors

Resolving System-Related ERA Errors

Reading the ERA Import Posting Report

Posting an Electronic Remittance

Additional Information

Resolving Line Item-Related ERA Errors

Resolving Encounter-Related ERA Errors

Resolving System-Related ERA Errors

Reading the ERA Import Posting Report

Posting an Electronic Remittance

Additional Information