This documentation will help you post your electronic remittance advice or ERA. If you do not currently receive ERAs, please contact MacPractice for more information. Please note that all payers require enrollment. Availability of ERAs is determined by the relationship between the clearinghouse and the Payer.
ERAs appear in the sidebar and in the Managers Ability under the ERA Manager node.
Introduction to the ERA Manager
The ERA Manager, located in the sidebar of the Managers Ability is organized by a bin system. The Manager has bins for ‘Pending’ and ‘Complete’, which are used to organize ERAs. There is also a way to archive ERAs.
- Pending - This is where new ERAs will be imported. Once an ERA is fully posted it will move to the Complete bin.
- Complete - This bin is used to organize ERAs that have been fully posted.
- Show Archived ERA checkbox - This is used to view/hide any ERAs that have been archived.
- An ERA can be archived by highlighting it from the manager and using the dropdown selector to choose ‘Archive’.
- When the box is checked an additional column for ‘Archived’ will appear and it will either say ‘YES’ (ERA is archived) or ‘NO’ (ERA is not archived).
- An archived ERA will remain in the bin that it was archived from.
To change the status of an ERA, highlight the ERA in the table and use the menu to select the new status. Note that while marking an ERA as Complete does not post the payment, it moves the ERA to the Complete bin.
Click on an ERA in the table to display the ERA details. ERA Definitions describes each field on the ERA.
Search for ERAs in the ERA Manager by typing the search term in the search bar within the sidebar. Search criteria include:
- Check numbers
- Patient names
- Account numbers
- Subscriber IDs
- Payer Name
- Check Amount
Click the Reload button in the toolbar or the "X" in the search bar to reload the ERA list after searching.
Posting Payments from ERAs
Below each claim information is a payment line which indicates the status of the ERA.
Payment lines highlighted in red indicate that the payment has not been posted. Click the link that says Post Payment to access the insurance payment window.
Within the insurance payment window the payment information will be pulled directly from the ERA. This would include the Allowed Amount, Payment, Provider, Payer from the Payment From dropdown, Office, write-off (if provider participates), patient liability information, and adjustment reason codes.
If all procedures are not paid with this ERA, the Close Paid Claim checkbox will be unchecked. You can check this box if the claim should be closed when the ERA payment is saved.
A write-off will be calculated if Participate is checked in the Insurance Reference, and "Auto-calculate the write-off when the provider participates with the carrier" is checked in Preferences > Ledger Insurance Payment. The write-off is calculated from the total charge or fee amount minus the carrier's allowed amount. Write-offs can always be changed manually as needed.
The payment will be saved to the patient's ledger when Save or Save/Next is clicked. Clicking the Save button will apply the payment for the selected claim only. Clicking the Save/Next button will apply the payment for the selected claim and open the payment window for the next claim. Pressing the Return key on the keyboard will select Save/Next. If the entire ERA has been reviewed before posting, post the entire ERA by repeatedly pressing the Return key.
When the payment is applied, the payment line will turn blue and will report as "Completed" instead of "Post Payment." Once the last payment has been posted on the ERA, it will be moved to the Complete bin. Click on the "Completed" link and the previously posted payment will open. Previously posted ERA payments can be edited if necessary, but this is not recommended.
Once a payment is applied, and the individual ERA record shows as Complete, a red link will appear next to the (Completed) message. The red link will state (Re-Post). The "Re-Post" link will try to post the payment, even though MacPractice thinks the payment has been complete. Using this link is only necessary if the payer has paid the same amount twice.
Some carriers deliver ERAs before payment is sent. If the payment date is in the future, a pop-up will warn that the payment has a future date. Continue posting the payment but be aware the funds may not be available.
To delete an ERA payment, return to the Ledger and highlight the payment while pressing the Delete key on your keyboard. A deleted payment posted on a previous date will affect reports and the ERA may still report as "Completed." Reload the ERA by clicking the Reload button in the toolbar, and the ERA will list as "Post Payment" again.
When an ERA is denied the status will be "Denied" instead of "Processed." These are usually reported as zero-dollar payments, and may be posted using the ERA manager, however a claim may be corrected and resubmitted instead. Manually mark an ERA as "Completed" by Option-clicking on "Post Payment" or "Post Secondary Payment."
ERAs that were manually marked as Complete will prompt to be Reset and undo the manual override so that the payment can be posted again.
Some carriers may split payment on a claim. ERAs posted on split claims will show payment information only on paid procedure(s) and the Close Paid Claim checkbox will be unchecked. Check Close Paid Claim on-the-fly only if payment is not awaited from the carrier for the other procedure(s).
If the ledger has a patient payment applied to the charge, and the insurance paid amount is greater than the remaining unpaid, the insurance payment will unapply the patient overpayment. The amount can be dispersed as desired in the patient's Ledger.
If the ERA status reports "Processed as Primary, Forward to Additional Payer(s)," the ERA Manager will create a crossover claim in the patient's ledger when the payment is saved.
Manually Posted ERAs
Some payments cannot be automatically posted by the manager and will need to be manually posted instead.
No Match for Claim: No Match for Claim means the claim does not match a claim in the MacPractice database. The claim may have been deleted, sent from another practice management software, or sent on paper. These payments will have to be posted manually. If the ERAs have a claim ID of Paper, this means the carrier received a paper claim.
If a claim has been deleted from MacPractice after it has been sent, an ERA may be returned for that claim. Since that claim ID no longer exists in MacPractice, the returned ERA will not have a valid claim to which it can link. However, the patient name may still show as a link in the ERA. Since the ERA is linked by claim ID, and not account ID, there is a strong chance that the patient link may link to the wrong account. To prevent patient links from linking wrong, enable "Prevent Patient Link on ERA Report" in ERA Preferences. This will change patient names from links to static text if the remittance does not have a matching claim in the MacPractice system.
No Payable Information Included for This Claim: No Payable Information Included for This Claim is typically caused by the carrier not sending procedure information. Either review the patient's ledger and manually post the payment or call the payer for more information.
Please Adjust or Correct: A carrier might send a reversal of a previous payment on an ERA. Review the ledger and handle the reversal appropriately.
Provider Level Adjustments: Provider Level Adjustments are amounts paid to the provider and are not associated with a patient or benefits. Select an ERA that has Provider Level Adjustments to see a warning message at the top of the ERA about the adjustments. Since MacPractice is patient based, the ERA Manager cannot automatically post these amounts.
Provider Level Adjustments are always shown near the bottom of the ERA, right before the Grand Total line. Because of the way the data is sent, a negative provider level adjustment is money paid to the provider, increasing the amount paid, and vice versa. Payers may send provider adjustments for many reasons. Questions about these amounts should be taken to the payer.
Posting ERAs for Secondary Carriers
Secondary ERA payments will differ slightly from primary payments. Instead of displaying "Post Payment," they will display "Post Secondary Payment."
If the claim was crossed over from Medicare, the Medicare claim ID will be listed. When you open the payment window, the Medicare claim will be listed in the Outstanding Claims pop-up menu.
If you do not already have a claim in your ledger for the secondary carrier and you click Save or Save/Next, MacPractice will create a crossover claim for you. The payment will be posted to the crossover claim and the claim will be closed. If you have already created a claim for the crossover carrier, you will be able to select the appropriate claim from the Outstanding Claims pop-up menu. The ERA manager will then post to that claim instead.
- Date Received: The Date Received is the date the ERA was downloaded into MacPractice. This may or may not be the date of the check.
- Name: The Name displayed in the ERA is the filename of the ERA assigned by the clearinghouse. This can be used to match ERAs in the Manager to ERAs in the eClaims ability.
- Credit: The Credit column displays the total of all checks within the ERA. Some ERAs contain information from more than one check, so this will not always match exactly with your check amounts.
- Carrier: The Carrier column displays the payer name. This information is sent directly from the payer and may or may not match the payer in the Insurance Reference.
- Archived: If the Show Archived ERA box is checked, an Archived column appears. This column will display whether the ERA is archived or not.
- Payer: The Payer name is the payer name sent in the 835 data. It may or may not match the payer name in the MacPractice Insurance reference, depending on how the claim was processed by the payer. Questions about the payer name can be taken to the payer.
- Remittance Date: The Remittance Date is the date the payer intends for the transaction to be settled. It is usually the same as the check or EFT date. These dates might be future dates if the payer batches the 835 files early. When a future date ERA is posted, a pop up warning indicating that funds are usually not available yet will appear.
- Trace/Check: The Trace/Check number is either the check number for a paper check or the EFT trace number assigned to an EFT. This number is pulled into the check number field into the payment window in MacPractice.
- Below the Trace/Check Number there is more information about the source of the payment. Below are definitions of the payment source terminology.
- Remittance Information Only through Automated Clearinghouse - ACH - This code is used when money is moved electronically through the ACH, or to notify the provider that an ACH (EFT) transfer was requested.
- Remittance Information Only through Check - CHK - This code is used to indicate that a check has been issued for payment.
- Notification Only through Non-Payment Data - NON - This code is used when the ERA is informational only and no dollars are to be moved.
- To: The To area on the ERA displays the pay-to-provider information. This is the payee provider shown on the 835 and is usually the same as the billing provider sent on the original claims. This is to whom the check is made and is typically either the office name or the provider's name. The number in parenthesis next to the name is the ID number that the payer used to adjudicate payment to the payee. This will typically be either the billing provider's NPI or tax ID, but may also be the provider's legacy ID number if the payer is still processing payment from the legacy ID. Most payers now process payments from NPI numbers.
- Name: The Name is the patient name under which that the payment was processed. A blue link means there is a matching patient in the database for the ERA. Click the blue link to find the patient in the Patient ability.
- Account: The Account number is usually the patient control number assigned to the claim by MacPractice when the original claim was created. It is possible that some payers may send their own identifiers in this area. Most payers will report the MacPractice patient control number in this field. The first two sets of numbers are usually the MacPractice account and patient ID, i.e. 1234-1. The last number is the Claim ID from the electronic claim. If the claim was sent on paper there will be no claim ID. The claim ID can be matched back to the original electronic claim in MacPractice in the eClaims ability within the Claim ID column.
- HIC: The HIC or Health Insurance Claim number is the subscriber's ID number.
- ICN: The ICN number is the claim Internal Control Number assigned to the claim within the payer's system. The payer will usually ask for the ICN number if any payment information is contested. The ICN number is also needed to send corrected or voided claims. The ICN number will pull into the payment window in one of the EOB columns in MacPractice.
- Claim: The Claim number is the number assigned to the eClaim within MacPractice upon creation. This information is also usually contained in the account number area. A claim ID with a blue link means there is a matching claim in the database for this ERA. Clicking on the blue link will return to the claim in the patient's ledger. If the claim was sent on paper the claim number field will say Paper. For MacPractice to auto-post any ERAs, the claim number must match a valid claim number in the MacPractice database. If the ERA says No Match for Claim, either the claim was sent on paper, sent from another practice management software, or deleted from MacPractice. If ERAs tie back to incorrect patients, it is generally caused by the claim ID assigned to a claim associated with another patient. MacPractice has no control if payers are not reporting this information correctly.
- Status: The Status of the claim sent from the payer designates how the claim was processed; whether it was processed as primary, secondary, and so on. The status field also indicates if the claim was crossed over to any secondary carriers, which are listed after the status in parenthesis. The crossover carrier name is sent from the primary payer.
- Procedure: The Procedure column lists all procedures that were processed under this ICN number. Typically, payers will pay all procedures submitted on a claim together. Sometimes payers split claims upon receipt to expedite handling. The claim will be assigned new ICN numbers for each separated payment and there will usually be remark codes explaining why the payment was split. See Remark Codes (below) for more information.
- Procedure Date: The Procedure Date column lists the date of the procedure submitted on the claim. If the claim was billed in date ranges the To date should be displayed here. Any discrepancies with the procedure date shown and the procedure date submitted on the claim will need to be taken up with the payer. The procedure dates might be listed in either the claim loop, the service loop, or both. Dates listed in the service line level apply only to the service line where they appear. Service level dates will also "override" dates at the claim level.
- Charge: The Charge column lists the total fee amount for the procedure submitted on the claim. Any discrepancies with the charge amount shown will need to be taken up with the payer. The total charge amounts are typically sent in both the claim and service levels on the 835. The total of all charge amounts sent in service levels on this claim must add up to the total charge amount sent in the claim level. The claim level total is listed at the bottom of the charge column in the colored (blue or red) row.
- Allowed: The Allowed column lists the carrier's allowed amounts for the procedures in the ERA. If no allowed amount is sent, this field is left blank. An allowed amount is the amount the carrier has agreed is an allowable amount to charge for a procedure. Participating providers are required to accept a carrier's allowed amount. Allowed amounts can be saved in the Plan information for an insurance carrier. They are then used in insurance estimating and will also pull into future insurance payment windows for this carrier. Allowed amounts may be sent in either the service level, the claim level, or both, however the service level is expected. If both are sent, the total of all allowed amounts sent in service levels on the claim must add up to the total allowed amount sent in the claim level. The total allowed amount is listed at the bottom of the allowed column in the colored (blue or red) row.
- Patient Portion: The Patient Portion column lists any patient portions of charges. These are usually patient co-pays. A remittance might not always list patient portions. Patient portions are typically sent in both the claim and service levels on the 835. The total of all patient portions sent in service levels on the claim must add up to the total patient portion sent in the claim level. The claim level total is listed at the bottom of the patient portion column in the colored (blue or red) row.
- Deductible: The Deductible column lists any portions that apply to the patient's annual deductible. This information may or may not be sent on the 835. The deductible amounts may be sent in the claim level or the service level, although the service level is expected. Service level adjustments are not repeated at the claim level. The summation of the adjustments at the claim and service levels is the total adjustment for the entire claim. The claim level total is listed at the bottom of the deductible column in the colored (blue or red) row.
- Coinsurance: The Coinsurance column lists any coinsurance amounts sent on the remittance. A coinsurance amount refers to the amount for the given services that the carrier has deemed the patient, or the subscriber's other insurance is responsible for. The coinsurance amounts may be sent in the claim level or the service level, although the service level is expected. Service level adjustments are not repeated at the claim level. The summation of the adjustments at the claim and service levels is the total adjustment for the entire claim. The claim level total is listed at the bottom of the coinsurance column in the colored (blue or red) row.
- Disallowed: The Disallowed column lists any monetarily disallowed amounts for a procedure. Disallowed amounts are any amounts remaining after subtracting all patient portions and payments from a charge. Carriers usually disallow amounts they find inappropriate to pay under plan provisions. Participating providers are typically required to write-off any remaining disallowed amounts. Non-participating providers typically bill their patients for any remaining disallowed amounts. Disallowed amounts must always have a corresponding reason code. See Reason Code (below) for more information. Disallowed amounts may be sent in the claim level or the service level, although the service level is expected. Service level adjustments are not repeated at the claim level. The summation of the adjustments at the claim and service levels is the total adjustment for the entire claim. The claim level total is listed at the bottom of the disallowed column in the colored (blue or red) row.
- Reason Code: The Reason column lists any reason codes associated to a disallowed amount. The reason code gives the reason the carrier denied payment on the disallowed amount. Reason codes and remark codes can give valuable information in determining why a carrier denied a claim. See Remark Codes (below) for more information. Definitions of the reason codes are given in text at the bottom of the ERA. They can also be looked up through the Internet ability in MacPractice by clicking on Claims Adjustment Reason Codes in the sidebar or by visiting the Washington Publishing Company's website. Reason codes must accompany all disallowed amounts. Questions about reason and remark codes should be directed to the payer.
- Paid: The Paid column lists how much the carrier paid on each procedure. Payment information is expected to be sent in both the claim and service levels on an 835. Payment amounts in all service lines under the claim must add up to the total payment amount on the claim level. The claim level total is listed at the bottom of the paid column in the colored (blue or red) row.
- Remark Codes: Remark Codes may or may not be sent on an 835. Remark codes give additional information about claims, given in the claim level on the 835, or procedures, given in the service level on the 835. Remark codes are different from reason codes because they are not directly associated with disallowed amounts, however they might provide useful information in determining the reason a carrier denied a claim or split payment. Questions about reason and remark codes should be directed to the payer. A list of remark codes can be found here.
- Provider Level Adjustments: Provider Level Adjustments are adjustments made on the remittance that are not specific to a particular claim or service. These adjustments can either decrease the payment (a positive number) or increase the payment (a negative number). Some examples are capitation payments, interest or late filing charges. Such adjustments are financially independent from the formula for determining benefit payments on behalf of the beneficiary receiving care.
The ERA Manager cannot automatically post any provider level adjustments and they will require manual posting. Questions about provider level adjustments should be directed to the payer. PLB04 is the monetary amount of the adjustment, with the reason for the adjustment sent in PLB03. Reason code descriptions are listed at the bottom of the ERA.
- Grand Total: The Grand Total line totals up all the amount columns from all claims on the ERA. The total charge, allowed, patient portions, deductible, coinsurance and disallowed amounts are not sent on the 835 and this calculation is done within the ERA manager. The total paid amount should be equal to the total check amount.
Definitions of all reason and remark codes are listed below the Grand Total line at the bottom of the ERA. Questions about these codes should be directed to the payer.
Multiple Instances of a Claim in an ERA
The top of the ERA record may contain the following message: Please note that the following claims appear more than once and may require manual posting:
This message indicates that a claim or number of claims have been reported on twice in the same ERA record. This can occur as a result of a number of situations. In any situation it is always best to manually post the payments for claims that appear in more than one ERA.
Reversal of Previous Payment
A payer may send a reversal of a claim in a couple of ways. A payer may send a reversal of a claim that was previously paid and also report payment of a new claim within the same ERA record. A payer may also send a reversal of a claim on an ERA record that is separate from any additional payment for that particular claim. The claim number will be the same in either case and both types of reversals will need to be posted manually.
Click the blue 'Claim number' from the ERA manager. This will highlight the associated claim on the patient ledger. From here the original payment that was tied to the claim can be found.
Highlight the payment in question and go to Other > Unapply Selected Payment, or open the payment and remove all affected charges. This will now show on the ledger as an unapplied payment. Next highlight the newly unapplied payment and go to Other > Refund, and post the refund. The ledger should now have a line item reflecting the refund.
From here, navigate back to the ERA manager and option+click 'post payment' on the refunded amount to complete that line item. MacPractice should ask you if you want to mark this item as complete. The red 'post payment' key will now show a blue 'completed' message.
If the payer sent a new payment for that particular take back, it is now possible to post that payment from the ERA manager, but make sure the claim in question is showing as outstanding. If the claim is still marked Paid/Closed, the claim will need to be re-opened via the ledger dropdown Other > Mark Claim as Accepted.
A claim may be sent out with multiple procedures, however the payer may process procedures separately. When procedures are processed separately, a separate remittance will be sent for each procedure or set of procedures that was processed apart from the others.
Because all procedures were sent on the same claim, each remittance will be associated with the same claim control number (claim ID). Sometimes this will come across on a single ERA as a separate claim record. Sometimes procedures from the same claim will come across on separate ERAs altogether.
When separate procedures from the same claim appear on separate ERA records, it is best to only apply the payment to the procedure or procedures that are reported on in the ERA being posted. Do not apply $0.00 to procedures that have not been reported on in an ERA. Leave those open to apply payments that will come later.
When separate procedures from the same claim appear in the same ERA, it is best to manually apply each payment to the claim. Again, do not apply $0.00 payments to procedures that haven’t been reported on a remittance. Manually apply payment for a procedure as you come to an ERA record that reports payment to that procedure.
There are many situations in which a user may wish to print ERAs. The purpose for which a user needs a printed ERA may determine just how the user wishes for the ERAs to print. ERA Preferences allow the user to change the manner in which ERAs print. The "Print New Page Per Patient" checkbox will most affect the printing of ERAs.
If "Print New Page Per Patient" is enabled, what this will do is keep all remittances for each patient separated per page. This allows the user to select the page they wish to print, and only print out the remittances for the patient on that page. A user may wish to select this option if a patient has a secondary insurance, but the secondary only accepts paper claims. This will allow the user to print out the remittance to send with a secondary paper claim as the EOB information.
If "Print New Page Per Patient" is left unchecked, what this will do is print out all remittance information continuously, and not separate out one patient's remittances from all other patient remittances. A user may wish to use this option if they need to have a copy of all remittance information to use as informational reference for other manual data entry. This will save paper, if hard printed. It will save computer storage space, if saved as a PDF file.