ERA Automatic Adjustments and Library Settings

Help Guide for NextGen® Enterprise PM 8

ERA Automatic Adjustments and Library Settings

Additional adjustments may or may not occur during the ERA Posting process. These adjustments are determined by options selected in the Contract library, or the Remittance Profile library and the Reason Codes library. Additional Adjustments do not Post When a Contract library that is setup to automatically adjust charges during charge posting is attached to an ERA payer. The ERA Posting process will not post additional adjustments. The Automatically adjust charges option is selected in File Maintenance > Libraries > Contracts on the General tab. Additional Adjustments Post When a Contract library that is setup to not automatically adjust charges during charge posting is attached to an ERA payer. The ERA Posting process will post adjustments according to settings in the Remittance Profile library and the Reason Codes library. Parent topic: Electronic Remittance Advice

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

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 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.

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

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

ERA Automatic Adjustments and Library Settings

Additional Adjustments do not Post

Additional Adjustments Post

Recommendations

ERA Automatic Adjustments and Library Settings

Electronic Remittance Advice

Setting Up ERA

Setting Up ERA

Posting an Electronic Remittance

Posting an Electronic Remittance

ERA Automatic Adjustments and Library Settings

Additional Adjustments do not Post

Additional Adjustments Post

ERA Automatic Adjustments and Library Settings

Electronic Remittance Advice

Setting Up ERA

Setting Up ERA

Posting an Electronic Remittance

Posting an Electronic Remittance