Setting Up Practice Preferences for ERA

You can configure the following ERA settings in Practice Preferences.

• Go to Practice Preferences, then Libraries and select Remittance Profile Library to set the default library to be used for all ERA payers that do not have a specific library linked in the practice.

• Go to Practice Preferences, then Transactions and select Default Reason Code Library to set the default library to be used for all payers (ERA and non-ERA) in the practice, that do not have a specific library linked.
  Note: NextGen Healthcare recommends the use of the HIPAA X12 Standard Reason Codes library as the default for a practice for all payers.
• Use settled up status with ERA. You can select this check box to default the Settled moved to Primary transaction status onto ERA payment or adjustment transactions received from the secondary payer before the primary payer. When a secondary transaction is received before primary, a credit balance is normally created in the secondary payer (Ins2 Amt) bucket in Balance Control. This status moves the credit to the previous payer (Ins1 Amt) bucket in Balance Control to reduce the balance in that bucket. The encounter status remains as Billed, so a new claim is not generated during the next billing run. When a payment or adjustment transaction is received from the primary payer, any balance then settles to the tertiary payer (Ins3 Amt) or patient (Pat Amt) bucket in Balance Control.

  If the Use settled up status with ERA check box is not selected, the balance amount moves to the next responsible party bucket, after the secondary payment is posted.

  The following table describes the different settings for posting an ERA transaction when Co-ordination of Benefits (COB) does not match in the ERA file and the Use settled up status with ERA check box is selected.

  Claim Status Indicator in ERA file	Remittance Profile Library Setting	Encounter Payer	Transaction Import Posting Status
  2 (Processed as secondary)	Enable one of the following: Select Payer using Match on Exact Policy Number without Claim Status Select Payer using Claim Status (Default) If no match found with claim status/policy nbr, match on first Payer (Default) Select Payer using Claim Status with Policy Number	Primary payer	The transaction is posted when the insurance amount matches the primary payer and the balance amount moves to the next responsible payer. Note: The Use settled up status with ERA check box is considered only when there are two or more payers.
  3 (Processed as tertiary)	Enable one of the following: Select Payer using Match on Exact Policy Number without Claim Status Select Payer using Claim Status (Default) If no match found with claim status/policy nbr, match on first Payer (Default) Select Payer using Claim Status with Policy Number	Primary and Secondary payers	The transaction is not posted. The application displays the message that the encounter payer was not found, as tertiary payer does not exist in the encounter.