The ERA list and reconcile button has an added column to view if items are reconciled, as well as summaries of entire ERAs in a single row. This view has the same data as an EOB.
To use the ERA List:
- Navigate to the Claims module and select ERA List
- This will direct you to the list of ERA payments with 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. The date range can be adjusted.
3. When clicking 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, and the “Payor” column can be filtered.
4. The system will show all of 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. Please 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 you 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 because:
- 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. On the left is the submission information. You can adjust the information to the right-hand 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 the Reconcile checked button is clicked, 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 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 and select View All Billing Entries
19. 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
20. And under each line the ‘story’ or payment history can be displayed with the itemized notes, as well
- 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.
- It will show up here once added
- And on the billing screen
22. Provider level adjustments can also be reconciled
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.
Please note, one of the above fields need to be set up prior to adding the information in this screen.