2015 user conference era processing april 23, 2015 & april 25, 2015 presented by: melissa holmes...

2015 User Conference

ERA Processing April 23, 2015 & April 25, 2015

Presented by:

Melissa HolmesTraining Manager

PM Session

2015 Office Practicum User Conference

ERA Processing…What is it?


Objectives

● Different Match Status’s● HIPAA code table● Sending a Balance to a Secondary● Sending a Balance to the Statement Queue● Force Pay Date● Handling Insurance Re-Coupments on an ERA● Processing a Secondary Payment


Open the Billing Center


Click on Adjudications


Auto Approve Boxes


Example A: Box is checked

Example B: Box is not checked


Default Statement Type


Force Pay Date


8/13/12

The deposits are not made until Monday, 08/13/2012, so the user will force the pay date here to match the date of deposit.

Force Pay Date


Ready to Fetch New Adjudications


Ready to Process New Adjudications


Processed Claims Now Show in Adjudications


Open the ERA Tab


Select the ERA Check You Wish to Post


813037490003708

Isolating a Single Check Payment


Review Payments


What’s a Match Status?


What Action Does OP Take With Each Match Status When I Press Post Payment?

•UnmatchedOP will take no action on an unmatched status. Any CPT with this status will remain in the queue until it is manually changed to a Discard status.

•MatchedOP will post the adjudication in the patient’s account.OP will take any Insurance or Patient Actions

•Review or AppealOP will take no action on Review or Appeal statuses. Any CPT with one of these statuses will remain in the queue until it is manually changed to a Matched or Discard status.

•Paid, Repriced or DiscardOP will throw the adjudication away. There is no Recycle Bin.


Posting ERA Payments


Review ERA Payments Totals

100124 Test, Victoria 3/29/2012 73..64 12.39 1495 1495 99213 OFFICE/OUTPATIENT

73..64 12.39


Document Completion of ERA Payment

123456789

4569715313548646178

1336988456300125

120326544

12015649864650

501684

210648940

1231465749865

1352156479

45674894231

564651897

1324165

326547890

01210567498

000001265489

001654987460

1/14/2015 JMN Balanced


Additional Places for Balancing ERA Payments

▪ Current Receipts ▪ Standard Reports▪ Billing Transaction Analysis


Let’s Try It!


Matched vs. Unmatched Tabs


Why Would a CPT Claim be Listed in the Unmatched Tab?

•The claim adjudication is listed under the name of the insured as opposed to the patient

Example: newborn claims

•The claim adjudication is for a CPT/claim that no longer exists

Example: a CPT was deleted or edited to a different code

•The claim adjudication is slightly different than the original claim

Example: the adjudication contains a modifier that did not exist on the corresponding claim in OP


How Do I Match Unmatched Claims?

Test, SallTest, Sally

Test, Joe

Test, Joe

Test, Nick

Test, Megan

Test, Sally

Test, Sally


How Do I Match Unmatched Claims?


How Do I Delete Unmatched Claims?


Discarding Manually Posted Payments (or already processed Adjudications)

Before After


Change Match Status Based on Adjustment Code Reason


Editing Adjudications

At times, an adjudication will apply the incorrect settlement information for a claim, based on payment information received from the payer. If this problem occurs, you can manually edit the adjustment fields on the Adjudication Table to correct the adjustments. Again, this can happen if an adjustment is applied to the incorrect CPT and/or if a CPT is being adjusted on the insurance side when it is actually due by the patient based on the CPT rejection reason. For example, a CPT may be adjusted as a non-covered service that is actually due by the patient but is not listed this way on the incoming adjudication.


Insurance Action - In all selections below, the insurance balance (as identified in the Ins Bal column) will be listed as due by the insurance and the next action will depend on your choice of the following options:

1. Hold on Account - No further action will be taken at this time. You would select this option if the insurance balance is

to be held as outstanding pending claim appeal, review, or reprocessing.

2. Xfr Sec - The referenced insurance balance will be transferred to the insurance you select for submission as a

secondary claim. Once selected, the corresponding claim will be automatically sent to the Claims Queue with its

stage set to Secondary.

3. Xfr Prim - The referenced insurance balance will be transferred to the insurance you select for submission as a

primary claim. Once selected, the corresponding claim will be automatically sent to the Claims Queue with its stage

set to Primary.

Insurance Action


Patient Action - In all selections below, the patient balance (as identified in the Pat Bal column) will be transferred to the patient and the next action will depend on your choice of the following options:

1. Hold on Account - No further action will be taken at this time. You would select this option if the patient

responsibility is a significantly small amount and you do not want to generate a patient statement at this

time.

2. Create Statement - The referenced patient balance will be sent to the Statement queue awaiting

printing by your office.

3. Autopay with PC ($x.xx) - The referenced patient balance will be paid with the patient's available

credit. If there is an available credit, this selection will identify the amount of the available credit.

4. *Autopay with CC only - OP will attempt to utilize a pending credit card on file to pay the referenced

patient balance.

5. *Autopay with PC + CC - OP will attempt to pay the balance with any available Patient Credits first

then proceed to pay any remaining balance with a saved Credit Card on file

Patient Action

*only applicable if user is signed up with Instamed Merchant Services and a Credit Card is saved on patients account.


Option #1 - Posting to Generic Account

1. Change the match status of this adjudication to matched and approve for posting.

Option #2 - Posting to Specific Patient Account

2. Enter an interest charge for the payment amount on the specified account.3. Manually post the Insurance Payment for the interest payment to the specified account and claim created

in step 1 above. 4. On the Adjudications tab of the e-Billing center, change the match status of the interest adjudication (as

assigned to an account by the name of Provider Adj. E-Billing) to Discard, approve and post the transaction.

5. Go to the Account of -5, Provider Adj. E-Billing

5. Click on the Claims tab.

6. Locate and click on the claim with the interest payment so that it appears highlighted.

7. Click on the minus Void button to delete this "claim"

8. Click Yes when prompted "This action will delete the entire claim, Are you Sure?"

Posting Interest Payments

Aetna

0069456


Manually Adding a Credit for an Overpayment


Let’s Try It!


Questions?


We want your feedback!

2015 user conference era processing april 23, 2015 & april 25, 2015 presented by: melissa holmes...

Documents

date slide

boxes slide

era tab slide

secondary payment slide

billing center slide

jmn balanced slide

single check payment

pay date