Posting an Electronic Remittance

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

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

ERA Posting to the Post to Voided Charge

You can post an ERA transaction to the voided charge when the Post to voided charge option is selected on the Remittance Profile window and the encounter has no active charge. When the same CPT® code is rebilled for a charge, the application does not match with the voided CPT code and instead looks for the next active CPT code. Negative billed line items are not considered while posting to voided charges. The following table describes the different settings and results for posting the ERA payment to Post to voided charge. Post to voided charge (Enabled/Disabled) Ignore Claim ID Nbr matching (Enabled/Disabled) Ref*6R segment in ERA file Encounter Charge (Active/Voided) Result Disabled Enabled Present or Absent Active and Voided charge The transaction is posted to the active charge, as the Ref*6R segment may or may not be present in the ERA file, the encounter has an active charge, and the Post to voided charge option is disabled. Disabled Enabled Present or Absent Voided charge The tran

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

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

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

Posting an Electronic Remittance

Recommendations

Start the ERA Posting Process

Reading the ERA Import Posting Report

ERA Posting to the Post to Voided Charge

Resolving Internal System-Related ERA Errors

Resolving Encounter-Related ERA Errors

Electronic Remittance Advice

Posting an Electronic Remittance

Start the ERA Posting Process

Reading the ERA Import Posting Report

ERA Posting to the Post to Voided Charge

Resolving Internal System-Related ERA Errors

Resolving Encounter-Related ERA Errors

Electronic Remittance Advice