Insurance Payment - ERA Processing

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Managing HIPAA Code Tables
This page will help you with managing HIPAA code tables.
Default Adjudication Match Status
If the characteristics of an ERA line item match, Office Practicum next determines the Match Status. Any line item that is matched, and whose numbers match perfectly (i.e., the full charge amount is accounted for, you received the amount of money you expected to receive, the patient paid the correct amount at time of service, and there is otherwise nothing unusual about the claim) is qualified for auto-approval.
Adding Adjustment Codes used in Office
Office Practicum has quite an extensive list of adjustment code reasons for patient and insurance adjustments.
Fetch and Process ERA Files
Before posting ERA (Electronic Remittance Advice) payments, the ERA files (835) are retrieved from supported clearinghouses or those clearinghouses with which OP has vendor relations using a process called Fetch and Process.
Purpose of Using Force Pay Date
The Force Pay Date can be used to match the posting date with the deposit date. When posting an ERA it will post with the ERA Date not the Pay Date.
Categorization of Adjudications
The Adjudications tab of the Billing Center displays all pending claim adjudications that have been processed through ERA (835) files but have not yet been posted to patient claims.
Post ERA Payments
After Adjudications have been processed into OP using the Fetch and Process workflow, the user is ready to post ERA payments. This payment posting is completed from the ERA Payments tab of the Billing Center.
Process Adjudications on the Unmatched Tab
You must match these adjudications against existing transactions so that they move to the Matched tab for review and processing as follows.
Editing Standard Adjudications when Posting ERA Files
At times, an adjudication will apply the incorrect settlement information for a claim, based on payment information received from the payer.
Additional Actions before Posting a Pending Adjudication
When processing pending adjudications, you can request OP take further action on any unpaid balance by clicking on the dropdown in the Patient Action or Insurance Action fields.
Processing a Primary Adjudication for Submission to a Secondary Payer on File
When a user is posting ERA's payments back in to Office Practicum, there may be instances where there is a patient responsibility due.
Process an Adjudication from a Secondary Payer or an HSA Account
Please be advised that automating this process through the adjudication tab is currently being addressed for a future release.
Add a Miscellaneous CPT, eg. Interest, for the Purpose of Posting a Payment
Interest payments can be added into a patient account by entering a charge for the interest amount and then applying the interest payment.
Processing e-Bill Adjudications for Interest Payments
Interest payments received through an ERA adjudication will automatically process to a generic account setup for payments/retractions that OP cannot specifically trace to a specific patient account.
Adjudications that have been Manually Posted to an Account
Adjudications will need to be manually posted under special circumstances.
Processing Reverse Adjudications Assigned to the E-bill Provider Adjustment Account
Payers will, at times, reverse previous adjudications for numerous reasons (e.g. plan termed, duplicate charge, etc).
Process a Retraction or Offset for the Purpose of Issuing a Refund
Payers will, at times, reverse previous adjudications for numerous reasons (e.g. plan termed, duplicate charge, etc).
Manually Add a Credit for an Overpayment
Overpayments can be received by a patient and/or an insurance payer via an EOB or an ERA.
Balance all Payments on an ERA, EFT or ACH
After posting an ERA, it is important to make sure that the postings balance to the ERA payment amount. This ensures that there are no posting errors and that all adjudications received for the ERA have been reviewed and posted.
Indicate ERA Payment Funds Were Received
An indication may be made on a specific ERA Payment to confirm that funds for the corresponding ERA Payment have been received by the practice.