Automatic reconciliation of received Electronic Remittance Acceptance (ERA) payments is now available for organizations to use. The “Automatic ERA Reconciliation” section of the Claims module Settings contains configuration options for automation at the organization level where users can enable and configure their settings. Organizations that do not have the Auto ERA Reconciliation feature enabled will not see this settings screen. Please note, it is recommended that only organizations who have agreed rates enabled for billing settings should use this feature.
To set up the Automatic ERA Reconciliation screen, organizations need to:
- Navigate to the Claims module and select Settings
- Click Automatic ERA Reconciliation
- Enable Automatically reconcile fully paid payments for agreed rates. Please note, agreed rates must be enabled for the organization. This will reconcile payments where total agreed charges are equal to the received insurance payment and patient responsibility.
- Enter an optional label in the “Additional billing entry label(s)” search bar. This label will appear once the payment is reconciled to the associated billing entry for fully paid claims only. The list of available labels is pulling from the billing labels set for the organization.
- Enable Automatically reconcile partially and over paid payments. Please note, it is recommended to only use this feature if the organization has agreed rates enabled for billing purposes. This option will reconcile any payments received in the system regardless of amounts received.
- Enter an optional label in the “Additional billing entry label(s)” search bar. This label will appear once the payment is reconciled to the associated billing entry for partially paid payments only.
- Exception: If organizations utilize this feature without agreed rates turned on, but have opted into automation of partially and over paid payments, then all reconciled entries in the billing screen regardless of fully or partially paid payments will utilize the billing labels specified within the settings for partially paid payments. Please note, the list of available labels is pulling from the billing labels set for the organization.
- Optionally, enable Reconcile patient responsibility adjustments. Reconciled patient responsibility will be applied to the patient responsibility amount on billing entries that are posted through the automation process.
- Click Save Changes
The following exclusions apply at either the claim level of payment and service line payments in each claim:
- Claim Adjustment: Claim has an adjustment that needs to be manually reviewed prior to reconciling any service line.
- Combined Service: Currently, combined lines cannot be reconciled and payments cannot be properly distributed across multiple lines.
- Mismatch Service: If the service code or service date does not match the billing entry, the claim cannot be reconciled.
- Orphaned Claim: If the payment’s claim cannot be identified, the claim cannot be reconciled.
- Orphaned Service: If the payment’s service line cannot be identified, the claim cannot be reconciled.
- Voided Billing Entry: If the previous billing entry was voided and therefore, it cannot be identified or tied back to a certain client, it cannot be reconciled.
Claim Module Status Addition to ERA List
Users can then navigate to the ERA List and view the “Auto Reconciled Status” column for a status on what has been processed. The following are statuses in the column:
- Pending: The automation process is still in progress. Claims cannot be manually reconciled until the process is completed.
- Completed: The claim has gone through the reconcile process and per setting configurations, was reconciled into the billing screen.
- Not Applicable: The automation process is either disabled or was not enabled when the ERA was received.
- Unprocessed: The ERA was queued for auto reconciliation, but the process never started or completed and the reconciliation lock on the ERA expired.
Please note, organizations that do not have the Auto ERA Reconciliation feature enabled will not see this new column.

Claim Module Status Addition to Claim Payment View
Users can then navigate to the specific ERA and view the “Auto Reconciled Status” column for a status on each paid service on each claim. The following are statuses in the column:
- Completed: The automation process is completed and the payment was reconciled and posted payment entries on the billing screen.
- Pending: The automation process is still in progress. Claims cannot be manually reconciled until the process is completed.
- Not Applicable: The automation process is either disabled or was not enabled when the ERA was received.
- Unprocessed: The ERA was queued for auto reconciliation, but the process was never started or completed, and the reconciliation lock on the ERA expired.
- Exclusion Status:
- Claim Adjustment: Claim has an adjustment that needs to be manually reviewed prior to reconciling any service line.
- Combined Service: Currently, combined lines cannot be reconciled and payments cannot be properly distributed across multiple lines.
- Mismatch Service: If the service code or service date does not match the billing entry, the claim cannot be reconciled.
- Orphaned Claim: If the payments claim cannot be identified, it will be flagged as orphaned.
- Orphaned Service: If the payments service line cannot be identified, it will be flagged as orphaned.
- Voided Billing Entry: If the previous billing entry was voided, and therefore cannot be identified or tied back to a certain client, it cannot be reconciled.
- Unbalanced Amount: Only fully paid claims are enabled for reconciliation. Anything that has not been reconciled as fully paid will be tagged with this status.
Only the first reason discovered will be tracked and displayed.

Click here to learn more about ERA filters.