ERA List

Claims / ERA List How to Post Orphaned ERA Data in CentralReach

CentralReach has the ability to post orphaned data from your ERA.

To do so:

  1. Navigate to the Claims module and select ERA List
  2. Select the ERA, when it opens, you will be presented with any data that matches billing entries, as well as any data that is Orphaned
    • Click here for a refresher on ERA posting in general
    • Quick overview on Orphaned Data: When CentralReach exports your EDI claims, a small reference value is added to every claim line, this is very common to all software submitting EDI claims. This reference data is typically returned in the 835/ERA file. This is what CR uses to create a 100% match to a line or combined lines on the billing screen. If this reference value is not returned in the 835/ERA file, this data is Orphaned, since CR is not able to find the exact entry it applies to on the billing screen
  3. If you have Orphaned data in your ERA it will appear like this:

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4. As you can see, every claim and line is noted as Orphaned. What is being read at this time is simply the ERA information. Now CentralReach will assist you to post the data

5. The first step, if the client is not there, is to select the client. Click on Orphaned Client. You will be shown an edit screen, as well as the name of the Client that is listed in the ERA:

 

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6. The ERA patient will show the name that appears on the ERA. Now, you will want to find that client in CR. Clicking in the Search Clients field, you can type in the client’s name. Then, select the payor if it does not populate correctly. In this case, it will grab the first payor in alphabetical order from the client’s payor list

7. Click the checkmark and it will then be attached to the claim

8. Navigate to the first claim line. Similar to above, click on the line and you will be presented with potential matches:

  • The top line in yellow is what the ERA reads, in the charge amount, CR will default to that day and client, and pull up all of the potential billing entries. Select the entry that you want to match this item to from the list. Once selected, move on to the next one, if needed, and repeat the process

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9. If you have questions about any ERA, download the file from the payor, your clearinghouse, or CentralReach. That is always the ‘raw’ data stream and most correct

 

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Claims / ERA List How to Use the ERA List and Reconcile Button

There are several highlights of the ERA list and reconcile button, including an added column to view if items are reconciled, summaries of entire ERAs in a single row, and more.

This view displays a lot of information. If you are utilizing the ERA list and reconcile button, you are likely already familiar with an EOB and all of the data in it, this view is the same information.

To use the ERA List:

  1. Navigate to the Claims module and select ERA List
  2. Clicking on it will take you to the list of your ERA payments. This list provides all of the information for your ERA files
    • By default, it will take you to the last 7 days of ERA’s, and is sorted by the CR Payment ID number. You can adjust the date range

3. If you click on the small grid on the top right, you can use the grid column headers list to add/remove columns. You can rearrange the columns the way you want them to appear on the screen. It all works very similar to a spreadsheet, you can even filter the payor column

4. The system will now show all the itemized columns. The one on the far right will display the reconciliation status

  • None: nothing has been posted
  • Partially: some of the data has been posted, but the Paid amount is less than Insurance paid amount
  • Fully: all of the payments, have been posted. Note: this will only refer to the Insurance Paid Amount vs the amount you have posted in CR, (i.e. if those 2 amounts are equal, you will see ‘Fully’. IF any amounts in CR are ‘Orphaned,’ or partially posted in a manual fashion, those ERA’s will not show ‘Fully.’) In those cases we recommend using a label/tag to let staff know what has happened. If you manually post, and the check number is an exact, character for character match, the Paid amount will reflect it
  • Over: the amount posted is greater than the amount of the ERA

5. To select a payment to reconcile, click on the blue CR payment ID number in the first column

6. A new tab will open and you will be in the ERA payments reconciliation screen

7. The system will default to the Payments data, with only the payments lines, checked for application

8. Here we can see the client, CR claim ID number and payment information, with sales adjustments and/or activity, as applicable

9. The 835 Details tab contains all of the data, regarding the summation of the payment data

  • Please note, if all of the data was not imported, there will be a sum of the amount of the Orphaned data. Orphaned data is data that cannot be matched to any original submission information
    • This can happen for a few different reasons:
      • The data was never in CentralReach (E.g. The dates of service pre-date your transition to CR)
      • The data was entered on a web portal, or sent via a paper claim
      • The data represents reprocessing and the payor did not return the correct reference data for each line item
      • The payor is not returning the reference information for whatever reason

10. Now, let’s break it down into sections. On the left is the submission information. You can adjust the information to the right side of the screen: payor, payment type. The next section is the billing entry information, this comes from the billing screen

11. After that are adjustments, and the corresponding coding, followed by the ERA/835/EOB information. This data is not interpreted, it is what appears in the data file. The adjustment reasons will post to the entries, if you choose to post them

12. The far right section shows the amounts posted in CentralReach

  • If the font is black, it means those lines have not been posted, if the font is blue, not only is it a hyperlink to the data on the billing screen, it also means that line has been reconciled. If the Reconcile checked button is clicked, the system will post all of the line items that the user has checked off with the selection boxes on each line

13. The Reconcile checked button only reconciles the one claim above the button. We do recommend clicking the individual reconcile buttons, until you get the hang of it. The Reconcile All button at the top of the page does the same thing as the reconcile checked button, just that it does the entire open page

14. Once you click the Reconcile checked button, the screen will drop-down what you are about to reconcile. If you just check the Insurance payment amounts you will see 100.00, in this case

  • If you have applied the payment previously from the ERA, the system will warn you

15. If you select all of the items, including the adjustments/activity, you will see this instead

16. The system shows a sum of what it is about to update. Patient responsibility activity just updates the Patient Resp. column, and does not post the data as a payment

17. Now that we posted the Sales Adjustment and Payment, the screen shows us the applied amounts and changes the font color to let us know the items are posted in CR

18. In the billing screen, you can use a hyperlink under the Actions drop-down, up by the CR Claim ID

19. Click View All Billing Entries and a new tab will open from the billing screen with the CentralReach ID as the search term, and displays all of the line items from the claim

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20. And under each line the ‘story’ or payment history can be displayed with the itemized notes, as well

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  • If you have more to post, move back to the ERA List and continue

21. You can also post the copay amounts to the copay boxes with the ERA tool, with a new status called Activity. If you select those line items when you reconcile, the copay will be entered into the box, and the action will be stored under the billing entry

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  • It will show up here once added

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  • And on the billing screen, too

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22. Provider level adjustments can also be reconciled

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23. As you can see the first step is to set the billing entry information (i.e. You need to create the timesheet to apply the payment toward). Once you click on set billing info, you can add the client, select the payor (based on that client), the code, and the date for reconciliation

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Please note, you have to have one of the above fields set up before you can add the information on this screen.