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ERAs - Why does the name on my ERA not match the name on my eClaim?

Occasionally an ERA may come back with the wrong person listed as the patient in the remittance. The most common cause for this is the patient relationship to the subscriber, in the patient's record of the Patients Ability.

When the patient's relationship to the subscriber is "Self", what happens is, when a claim is created, it pulls the patient information straight from the guarantor tab (Primary/Secondary Tab) of the patient's record. If the patient and the subscriber are not the same person, the subscriber's information is what actually goes out on the claim.

Since the guarantor is a valid subscriber of the insurance, often the claim will be processed fully. When this happens, a payment and a remittance will be received by the office, with the subscriber's information on the ERA/EOB instead of the actual patient's.

To be confident that claims are processed for the proper patient, make sure that the patient's relationship to the subscriber is set properly in the Patient tab of the associated record. If the information in the Patient Tab doesn't match the information in the associated Primary or Secondary Tab, and the relationship is set to "Self", the name of the guarantor above the Relationship Pop-Up will turn red to indicate the inconsistency.

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