Automated Task for ERA File Posting Using ERA Directory Import

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

NextGen® Background Business Processor Help 8

Automating Background Processes

The NextGen® Background Business Processor assists you in scheduling packages (tasks that require manual execution) for automatic completion. For example, you can create a package that automatically generates and prints the Daily Balance report at the end of each day. You can configure the NextGen® Background Business Processor to send a notification email after it completes an automated NextGen® Background Business Processor process. You can automate the following NextGen® Enterprise PM processes: Reports Statements Billing encounters Claims generation Collection and Recall letter generation Directory Import Stored procedures Person merge processing RTS eligibility and claim status requests RTS eligibility responses In addition, NextGen® Background Business Processor can run NextGen® Enterprise EHR and NextGen® Enterprise PM memorized reports. NextGen® Background Business Processor consists of the following main components: The BBP Manager allows you to create or schedule jobs and pac

Help Guide for NextGen® Enterprise PM 8

Start the ERA Posting Process

The Electronic Remittance Advice (ERA) Posting process is not automatic. You must start it from the Import Remittance window. Note: The ERA Import function uses the CLP02 element to determine which COB to use if both primary and secondary payers have the same ERA Payer Number. The Default for Contract <> Payment Allowed Amount and Default for Contract <> ERA Payment Amount options are applicable only for the primary payer (CLP02=1). Note: 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 835/ERA file is posted in NextGen® Enterprise PM. For more information about creating and assigning the automated task, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise From the File menu, select Processes, and then ERA Posting. The Import Remit

Help Guide for NextGen® Enterprise PM 8

Setting Up Payers for ERA

All payers from whom ERA 835 files will be received must be configured prior to importing the electronic files in NextGen® Enterprise PM. If there are multiple master files for the same payer (e.g. Aetna, Aetna HMO, Aetna PPO, etc.), the setup should be done to all master files for that payer. ERA Payer Number Cross-over Indicator Select All Lines for Bill to Next Insurance Create Zero Balance Claims to Subsequent Payers Set Up Default Transaction Codes for a Payer Set Up Default Transaction Codes for an Alternate Payer You can set up default transaction codes for an alternate payer in File Maintenance. Reason Code Library Remittance Profile Library Parent topic: Setting Up ERA

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

Prerequisites for ERA Processing

Prior to beginning the ERA Posting process, it is necessary to enroll with an ERA trading partner (payer or clearinghouse). The timing of enrollment is critical and must be completed prior to receiving ERA 835 files from payers. Consult with the trading partner on the process required for downloading files from their website. To manage downloaded ERA 835 files, a filing system and naming convention should be determined and set up in advance. For example, a directory for storing unprocessed ERA files could be created as follows: ERA > Medicare > Unprocessed Files. It is recommended to also create a separate sub-folder for storing files that have already been imported and processed in NextGen® Enterprise PM. For example, ERA > Medicare > Processed Files. It is important to place these directory folders in a location that can be accessed by all users responsible for downloading and importing ERA files. It is also important to store only ERA 835 files in the directory folder and not includ

Automated Task for ERA File Posting Using ERA Directory Import

Recommendations

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

Automating Background Processes

Start the ERA Posting Process

Setting Up Payers for ERA

Preparing for the ERA Posting Process

Prerequisites for ERA Processing

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

Automating Background Processes

Start the ERA Posting Process

Setting Up Payers for ERA

Preparing for the ERA Posting Process

Prerequisites for ERA Processing