Start the ERA Posting Process

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

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

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

NextGen® Background Business Processor Help 8

Automated Task for ERA File Posting Using ERA Directory Import

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 you post 835/ERA file in NextGen® Background Business Processor using ERA Directory Import option. Note: If there are more ERA files or each ERA has more than one encounter (claim) and it meets the criteria for payment received but not for the contractual reimbursement amount, then separate tasks must be created for each encounter (claim). When you select the Default for Contract <> ERA Payment Amount check box and configure the patient response (PR) codes in the Reason Code Library Maintenance window in File Maintenance, a task will be generated. This will create the reason code during ERA file import. For more information on creating and assigning the automated task, go to NextGen Healthcare Success Community and download the latest File Maintenance Mast

Help Guide for NextGen® Enterprise PM 8

Electronic Remittance Advice

Electronic Remittance Advice (ERA) 835 files can be imported from the File > Processes > ERA Posting menu. This process compares transactions in the ERA 835 file for each claim against the charge information in NextGen® Enterprise PM. When ERA transactions match to charges, a transaction batch is automatically created, and the ERA transactions are added to the batch ledger. Transactions in the ERA file that do not match to charges, or do not post for other reasons, display on the ERA Import Posting report as “Not Posted” and are not added to the transaction batch. The ERA Posting process is designed to increase efficiency. Once the original set up for the process is complete, there is minimal effort required to set up additional payers. It is estimated to take about 15 minutes to post an electronic ERA 835 file for a 30-page Explanation of Benefits (EOB) electronically, compared to approximately two hours to post the same 30-page EOB manually. ERA Automatic Adjustments and Library Sett

File Maintenance Help for NextGen® Enterprise 8

Set Up Task to Track Discrepancy in ERA Payment Amount and the Contractual Reimbursed Amount

When you select the Default for Contract <> ERA Payment Amount option in Reason Code library Maintenance window and select the required patient response (PR) codes in the Patient Responsible Code list in File Maintenance, you have to create and assign an automated task to track the discrepancy in the Electronic Remittance Advice (ERA) payment amount and contractual reimbursed amount. This task is applicable in the following scenarios: When you post the 835/ERA file in NextGen® Enterprise PM by selecting either File Import option or Directory Import option. When you post the 835/ERA file in NextGen® Background Business Processor by selecting ERA Directory Import option. Note: If there are one or more ERA files when using Directory Import option or each ERA has more than one encounter (claim) and it meets the criteria of payment received but not for the contractual reimbursement amount, then separate tasks must be created for each encounter (claim). In File Maintenance, select Master Fil

Start the ERA Posting Process

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Preparing for the ERA Posting Process

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Set Up Task to Track Discrepancy in ERA Payment Amount and the Contractual Reimbursed Amount