Resolving Line Item-Related ERA Errors

Help Guide for NextGen® Enterprise PM 8

Resolving Internal System-Related ERA Errors

The ERA messages outlined here are related to internal system errors. These ERA messages are also considered primary and secondary. The primary error ERA message This type of ERA message indicates the exact line item in 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. 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 possible resolution to the primary error message. 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

Help Guide for NextGen® Enterprise PM 8

Auto Balanced Batch Column on the ERA Import Posting Report

If you set the Automatically balance batch when an ERA is imported with no errors option in the Remittance Profile Library to either Auto Balance or Auto Balance and flag for BBP, then the Auto Balanced Batch column on the ERA Import Posting report displays one of the following: Y indicates no errors were encountered during the import and the batch was auto-balanced. N indicates errors were encountered during the import and the batch was not auto-balanced. If the option is not enabled or is blank (default), then the column displays N/A on the report for all batches. Some clearinghouses may use the same ERA payer number for all payers. In this case, if an 835 ERA file contains a single check with multiple payers and some payers use a Remittance Profile library with the Automatically balance batch when an ERA is imported with no errors option enabled and other payers use a profile with the option disabled, then the Auto Balanced Batch column on the ERA Import Posting report will display

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

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

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

Resolving Line Item-Related ERA Errors

Recommendations

Resolving Internal System-Related ERA Errors

Auto Balanced Batch Column on the ERA Import Posting Report

Resolving System-Related ERA Errors

Resolving Encounter-Related ERA Errors

Reading the ERA Import Posting Report

Posting an Electronic Remittance

Resolving Internal System-Related ERA Errors

Auto Balanced Batch Column on the ERA Import Posting Report

Resolving System-Related ERA Errors

Resolving Encounter-Related ERA Errors

Reading the ERA Import Posting Report

Posting an Electronic Remittance