ERA Enrollments

• I have finished the ERA registration process, but I haven't received the ERAs yet. What should I do?
• I have stopped receiving ERAs from the payer. What could be the reason and what should I do?
• We receive most ERAs from Aetna, but a few are missing. How do we get those ERAs?
• What are the possible reasons for not receiving ERAs and how do I resolve them?

I have finished the ERA registration process, but I haven't received the ERAs yet. What should I do?
After completing the ERA registration, it may take a few days for the payer to process your request and begin sending ERAs. If you haven't received them within 7 to 10 business days, we recommend the following steps.

1. Check whether any online enrollment is required for the payer. If enrollment is required, review the enrollment form and ensure all steps are completed.
2. Check the estimated turnaround time (TAT) for the specific payer in the enrollment form.
3. Confirm whether a Salesforce ticket is required. If required, ensure that you have received the Payer Approval and shared it with CharmHealth. Once shared, CharmHealth will create the Salesforce ticket in Optum.
4. Review the Enrollment Status and take action accordingly.

If you still need assistance, contact CharmHealth Support.

I have stopped receiving ERAs from the payer. What could be the reason and what should I do?
If you have stopped receiving ERAs from a specific payer, follow the steps below to identify the cause and take action accordingly.

1. Verify last ERA Receipt in Optum:
   1. Log in to optumprovider.optum.com and go to 'Utilities > Enrollments > ERA Enrollments'.
   2. Select the payer and click the arrow icon on the left-hand side.
   3. Check the last ERA received date.
2. Check your CharmHealth account or payer portal to see if any claims were processed after the last ERA received date and if payments were made for those claims. Wait a couple of weeks from the effective date of the claim submission.
3. Download the ERA Enrollment Form from Optum and compare the current details with your previous copy to identify any recent changes or updates made to the enrollment. If there are changes, submit a new enrollment.
4. If there are no changes to the enrollment, and the claims have been processed and paid, and ERAs are still not received, send a recent remittance advice (EOB) to CharmHealth via the secure upload portal. Once uploaded, send an email to support@charmhealth.com

We receive most ERAs from Aetna, but a few are missing. How do we get those ERAs?
If you are receiving most ERAs from a payer but notice that a few are missing, follow the steps below to troubleshoot.

1. Sometimes, there may be a delay from the payer's side in transmitting certain ERA files. It is recommended to wait for up to two weeks to see if the missing ERAs are delivered.
2. If the ERA is still not received after the waiting period, then check if a paper remittance was received for the claim. Alternatively, you can log in to the payer's portal to verify that the remittance is available for download.
3. Verify that the NPI and TIN associated with the missing remittance are enrolled in Optum prior to sharing it with CharmHealth.
4. If the paper remittance or a copy of it from the payer portal is available, upload it to the secure link. Once uploaded, notify our support team at support@charmhealth.com.

What are the possible reasons for not receiving ERAs and how do I resolve them?
If you are not receiving Electronic Remittance Advices (ERAs) from a payer, it could be due to one of the reasons listed below. Please review the following checklist to identify and resolve the issue:

1. Incorrect Payer ID used during Enrollment: Ensure that the correct Payer ID supported by Optum was used during the ERA enrollment.
2. Mismatch between Billed and Enrolled TIN/NPI: Confirm that the TIN and NPI used in the claims (Box #33 on HCFA) match the TIN and NPI enrolled in Optum.
3. Enrollment Status: Check the enrollment status.
   1. If Pended or Moved to Another Customer, contact CharmHealth support. A COV letter must be submitted.
   2. If Rejected, identify the rejection reason and submit a new ERA enrollment. Contact CharmHealth if you need further assistance.
   3. If To Payer, refer to the enrollment form and check if a Salesforce (SF) ticket is required. If yes, share the Payer Approval letter with CharmHealth.
   4. If Approved, ensure claims are being actively submitted to the payer and allow the estimated TAT specified in the enrollment form.

If all the above checks are complete and ERAs are still missing, upload a recent EOB or remittance (for a claim submitted after the enrollment approval date) to the CharmHealth secure portal. CharmHealth will review and create a support ticket with Optum.

Eligibility FAQ

While I am doing eligibility checks, it fails and returns an error code, such as 'Entity Not Found', 'Invalid Provider', or 'AAA Error'. How can I resolve them?

1. Check whether the payer requires eligibility enrollment before submitting eligibility requests. Ensure that all required enrollment and credentialing steps have been completed successfully.
2. Ensure that the correct Payer Name and Payer ID are selected. Also, verify the patient's demographic and insurance information, including Member ID, Patient Name, and Date of Birth. If any information is incorrect, update the payer or patient details and retry the eligibility check.
3. Ensure that the appropriate provider is selected for the eligibility request. The provider must be credentialed with the payer either individually using an Individual NPI, or as part of a Group/Organization NPI.
4. Use the appropriate NPI based on credentialing.
   • If the practice or legal entity is enrolled with the payer (Medicare or most commercial payers) as a group, eligibility requests and claims should be submitted using the Group NPI.
   • If the provider is enrolled individually, eligibility requests and claims should be submitted using the Individual NPI.
5. Ensure that the correct Service Type Code and Date of Service are selected before running the eligibility checks.
6. After updating the required information, rerun the eligibility check to verify whether the issue has been resolved.