This document details how the Electronic Remittance Advice (ERA) is downloaded to CharmHealth from the Clearinghouse in different ways, how it can be viewed in CharmHealth, and how the payments are posted to the Claims.
Electronic Remittance Advice (ERA) is an electronic form of claim payment information from the Payer with the Explanation of Benefits (EOB) details.
ERAs get automatically downloaded to CharmHealth as and when it is available in the Clearinghouse system. Optum users have an option to download the ERAs for a given period.
By default, the ERA download process is automated. You can change the frequency and time of download under the 'Settings > Billing-eClaims > ERA Settings' section.
Choosing the date and clicking the 'Download ERA' button connects to the Optum server and downloads the available ERAs in the selected period. Once the ERAs get downloaded, a summary of downloaded ERAs is shown.
The ERAs get automatically downloaded to the CharmHealth system, and no special configuration is required.
When a payer is not supported by the Clearinghouse, you can get the ERAs ANSI 835 files from the payer portal and upload the same in CharmHealth using the 'Upload ERA (ANSI 835)' option.
When an ERA is uploaded, CharmHealth will process and match the EOBs with the invoices and post the payments.
The ERA download transactions are listed under the 'Billing > ERAs > ERA Download History' section.
The downloaded ERAs can be viewed in the 'Billing > ERAs' section.
A list of ERAs appears with details such as ERA Downloaded Date, Payer name, Payee name, Check/EFT number, and Check/EFT date.
A summary of all ERAs downloaded is shown at the top of the ERA list view with the number of ERAs, EOBs, Mapped and Unmapped EOBs, Successful Payment, and Payment failures.
|Mapped EOBs||EOBs that have Claims in CharmHealth. These EOBs can be viewed against the Claims in the 'Claims' tab.|
|Unmapped EOBs||EOBs for which CharmHealth could not find matching Claims. It means that either the Claim is not created in CharmHealth but submitted from some other system, or the Claims are available in CharmHealth, but our standard algorithm has failed to find it. You can use the filter option to filter the unmapped EOBs.|
|Successful Payment||EOBs for which Claim payments got successfully applied.|
|Payment failures||EOBs for which applying Claim payments failed. Practice can apply these payments manually. You can use the filter option to filter these failures.|
Click on an ERA from the list to see the detailed view. This view shows the following information:
CharmHealth finds a matching Claim for an EOB with the following details of the EOB, such as Patient Control Number, Date of Service, and first CPT in EOB. When the EOB gets mapped to a claim, the respective Invoice ID is shown above the EOB.
Sometimes, CharmHealth may fail to identify the Claim of an EOB. This means, either the Claim for that EOB is created and submitted from some other system, or the logic used for Claim mapping fails to identify the Claim. In such a case, an error message gets displayed above the EOB. Refer to the below screenshot.
If the actual Claim is created in CharmHealth, then the user can find the Claim and map it to the EOB using the 'Select the Claim for this EOB' option. Clicking this option shows a list of Claims matching with the Patient's name shown in the EOB. Users can verify the list, select a particular Claim, and map it by clicking the 'Match Claims' button.
If there is no Claim in CharmHealth for the EOB received, it can be marked as EOB with no matching Claim using the 'Do not show this message. This EOB does not have a matching Claim' option.
If a Claim is mapped to an EOB, and there is an error in applying the payment automatically, a message gets displayed with the reason for failure. In such a case, the user has to apply the payments manually. Once the payments are applied, this error can be cleared by clicking the 'Do not show this message again, Payment was manually applied' option.
To view all the claims that have EOBs, use the 'Has EOB' filter. This will filter all claims that have received EOBs from the payer.
To view EOBs of a claim click on the 'More Options(...) > Show EOB (2)' option. Here, 2 indicates the number of EOBs received for the claim. The EOB Details view has the option to print the EOB and Export it as PDF.
Automatic Claim mapping and payment posting can be controlled under the 'Settings > Billing-eClaims > ERA Settings' section. All the options available under the ERA settings are explained below.
|Map EOB with Claim||The option 'Yes' is selected by default, which maps the EOB with its Claim in the CharmHealth. On selecting 'No', EOBs get downloaded and listed.|
|Apply Payments in EOB to the Claim||The option 'Yes' is selected by default which applies payment to the Claim automatically. When 'No' gets selected, Claim payments would not be applied. This option should be chosen when the Practice needs to add payments manually.|
|If EOB has Reversal payments, then||The 'Do Nothing' option is selected by default, which will not apply any payment when there is an EOB with a negative payment.|
|If any CPT line in EOB has Zero Payment without Copay, Co-insurance, and Deductible, then||The 'Mark CPT as Denied' option is selected by default, which marks the CPT line as denied if it has zero payment without Patient Responsibility types like Copay, Co-insurance, and Deductible. If the 'Apply values as given in EOB' option is selected, a payment amount of zero gets added to the CPT.|
|If any CPT line in EOB has Patient Responsibility other than Copay, Coinsurance, and Deductible, then||The option 'Apply it as Patient Responsibility Not Covered' is selected by default, which marks the Patient Responsibility other than Copay, Co-insurance, and Deductible as Not Covered. Select the 'Do Nothing' option if the above action is not required.|
|If any CPT line in EOB has 'Other Adjustment', and if any CPT line in EOB has 'Payer Initiated Adjustment', then||The option Apply it as Adjustment - 'Provider Adjustment' is selected by default that marks Other Adjustment or Payer Initiated Adjustment in EOB as adjustment with type Contractual Obligations. Select the 'Do Nothing' option if the above action is not required.|
|If ERA has check level 'Provider Adjustment', then||Sometimes ERA may show Check level Provider adjustments which the biller will have to verify and adjust/apply against the respective Invoice. The option 'Apply values as given in EOB, excluding ERA level Provider Adjustment' ignores this check level Provider adjustment and applies payments received against each EOBs to the respective claims. Select the 'Do Nothing / Do not apply ERA Payments' option not to apply the payment if you need to verify and post it manually.|
|If ERA has payments from a Secondary payer, then||When the primary claim is submitted to the secondary payer as a crossover claim along with the EOBs (i.e, COB) by the primary payer itself, the secondary payer will process the claim and send the secondary EOB. In that case, choosing the option 'Apply Payment Always' will apply the payment from the secondary EOB to the available claim if the secondary claim is available, or else to the primary claim. Choosing the other option 'Apply Payment only when Secondary Claim is available' will post the payment only to the secondary claim, if available.|
The EOB from the Payer has the Payment, Adjustment, and Patient Responsibility details for each line item in the Claim. It is also possible that one CPT in a Claim gets paid, while the other CPT gets denied.
It is recommended to enable line item level payments and get the payment & denial information from the Payer for individual CPT. To enable line item level payments, go to the 'Settings > Billing > Billing Settings > Invoice Settings' section and select 'Yes' for the 'Enable Item Level Payments for Invoices' option.
Access to ERA and e-Claim submission are given to the Practice Admin and Biller roles by default. These permissions can also be given to other users using Role-Based Access in EHR.
Navigate to the 'Settings > Facility > Roles' section to grant or revoke permissions.
An option to delete an ERA from the list of ERAs is available under the 'Billing > ERAs(e-Claim)' section. Note that the payment applied to the Invoices or Claims in an ERA cannot be deleted. If required, the Practice can remove the payment applied to the Invoices.