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2015 User Conference ERA Processing April 23, 2015 & April 25, 2015 Presented by: Melissa Holmes Training Manager PM Session.

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Presentation on theme: "2015 User Conference ERA Processing April 23, 2015 & April 25, 2015 Presented by: Melissa Holmes Training Manager PM Session."— Presentation transcript:

1 2015 User Conference ERA Processing April 23, 2015 & April 25, 2015 Presented by: Melissa Holmes Training Manager PM Session

2 2015 Office Practicum User Conference ERA Processing…What is it?

3 2015 Office Practicum User Conference Objectives ● Different Match Status’s ● HIPAA code table ● Sending a Balance to a Secondary ● Sending a Balance to the Statement Queue ● Force Pay Date ● Handling Insurance Re-Coupments on an ERA ● Processing a Secondary Payment

4 2015 Office Practicum User Conference Open the Billing Center

5 2015 Office Practicum User Conference Click on Adjudications

6 2015 Office Practicum User Conference Auto Approve Boxes

7 2015 Office Practicum User Conference Example A: Box is checked Example B: Box is not checked

8 2015 Office Practicum User Conference Default Statement Type

9 2015 Office Practicum User Conference Force Pay Date

10 2015 Office Practicum User Conference 8/13/12 The deposits are not made until Monday, 08/13/2012, so the user will force the pay date here to match the date of deposit. Force Pay Date

11 2015 Office Practicum User Conference Ready to Fetch New Adjudications

12 2015 Office Practicum User Conference

13 Ready to Process New Adjudications

14 2015 Office Practicum User Conference

15 Processed Claims Now Show in Adjudications

16 2015 Office Practicum User Conference Open the ERA Tab

17 2015 Office Practicum User Conference Select the ERA Check You Wish to Post

18 2015 Office Practicum User Conference Isolating a Single Check Payment

19 2015 Office Practicum User Conference Review Payments

20 2015 Office Practicum User Conference What’s a Match Status?

21 2015 Office Practicum User Conference What Action Does OP Take With Each Match Status When I Press Post Payment? Unmatched OP will take no action on an unmatched status. Any CPT with this status will remain in the queue until it is manually changed to a Discard status. Matched OP will post the adjudication in the patient’s account. OP will take any Insurance or Patient Actions Review or Appeal OP will take no action on Review or Appeal statuses. Any CPT with one of these statuses will remain in the queue until it is manually changed to a Matched or Discard status. Paid, Repriced or Discard OP will throw the adjudication away. There is no Recycle Bin.

22 2015 Office Practicum User Conference Posting ERA Payments

23 2015 Office Practicum User Conference Review ERA Payments Totals Test, Victoria 3/29/ OFFICE/OUTPATIENT

24 2015 Office Practicum User Conference Document Completion of ERA Payment /14/2015 JMN Balanced

25 2015 Office Practicum User Conference Additional Places for Balancing ERA Payments ▪ Current Receipts ▪ Standard Reports ▪ Billing Transaction Analysis

26 2015 Office Practicum User Conference Let’s Try It!

27 2015 Office Practicum User Conference Matched vs. Unmatched Tabs

28 2015 Office Practicum User Conference Why Would a CPT Claim be Listed in the Unmatched Tab? The claim adjudication is listed under the name of the insured as opposed to the patient Example: newborn claims The claim adjudication is for a CPT/claim that no longer exists Example: a CPT was deleted or edited to a different code The claim adjudication is slightly different than the original claim Example: the adjudication contains a modifier that did not exist on the corresponding claim in OP

29 2015 Office Practicum User Conference How Do I Match Unmatched Claims? Test, Sall Test, Sally Test, Joe Test, Nick Test, Megan Test, Sally

30 2015 Office Practicum User Conference How Do I Match Unmatched Claims?

31 2015 Office Practicum User Conference How Do I Match Unmatched Claims?

32 2015 Office Practicum User Conference How Do I Match Unmatched Claims?

33 2015 Office Practicum User Conference How Do I Match Unmatched Claims?

34 2015 Office Practicum User Conference How Do I Delete Unmatched Claims?

35 2015 Office Practicum User Conference Discarding Manually Posted Payments (or already processed Adjudications) BeforeAfter

36 2015 Office Practicum User Conference Change Match Status Based on Adjustment Code Reason

37 2015 Office Practicum User Conference Editing Adjudications At times, an adjudication will apply the incorrect settlement information for a claim, based on payment information received from the payer. If this problem occurs, you can manually edit the adjustment fields on the Adjudication Table to correct the adjustments. Again, this can happen if an adjustment is applied to the incorrect CPT and/or if a CPT is being adjusted on the insurance side when it is actually due by the patient based on the CPT rejection reason. For example, a CPT may be adjusted as a non-covered service that is actually due by the patient but is not listed this way on the incoming adjudication.

38 2015 Office Practicum User Conference Insurance Action - In all selections below, the insurance balance (as identified in the Ins Bal column) will be listed as due by the insurance and the next action will depend on your choice of the following options: 1.Hold on Account - No further action will be taken at this time. You would select this option if the insurance balance is to be held as outstanding pending claim appeal, review, or reprocessing. 2.Xfr Sec - The referenced insurance balance will be transferred to the insurance you select for submission as a secondary claim. Once selected, the corresponding claim will be automatically sent to the Claims Queue with its stage set to Secondary. 3.Xfr Prim - The referenced insurance balance will be transferred to the insurance you select for submission as a primary claim. Once selected, the corresponding claim will be automatically sent to the Claims Queue with its stage set to Primary. Insurance Action

39 2015 Office Practicum User Conference Patient Action - In all selections below, the patient balance (as identified in the Pat Bal column) will be transferred to the patient and the next action will depend on your choice of the following options: 1.Hold on Account - No further action will be taken at this time. You would select this option if the patient responsibility is a significantly small amount and you do not want to generate a patient statement at this time. 2.Create Statement - The referenced patient balance will be sent to the Statement queue awaiting printing by your office. 3.Autopay with PC ($x.xx) - The referenced patient balance will be paid with the patient's available credit. If there is an available credit, this selection will identify the amount of the available credit. 4.*Autopay with CC only - OP will attempt to utilize a pending credit card on file to pay the referenced patient balance. 5.*Autopay with PC + CC - OP will attempt to pay the balance with any available Patient Credits first then proceed to pay any remaining balance with a saved Credit Card on file Patient Action *only applicable if user is signed up with Instamed Merchant Services and a Credit Card is saved on patients account.

40 2015 Office Practicum User Conference Option #1 - Posting to Generic Account 1.Change the match status of this adjudication to matched and approve for posting. Option #2 - Posting to Specific Patient Account 1.Enter an interest charge for the payment amount on the specified account. 2.Manually post the Insurance Payment for the interest payment to the specified account and claim created in step 1 above. 3.On the Adjudications tab of the e-Billing center, change the match status of the interest adjudication (as assigned to an account by the name of Provider Adj. E-Billing) to Discard, approve and post the transaction. 4.Go to the Account of -5, Provider Adj. E-Billing 5. Click on the Claims tab. 6. Locate and click on the claim with the interest payment so that it appears highlighted. 7. Click on the minus Void button to delete this "claim" 8. Click Yes when prompted "This action will delete the entire claim, Are you Sure?" Posting Interest Payments Aetna

41 2015 Office Practicum User Conference Manually Adding a Credit for an Overpayment

42 2015 Office Practicum User Conference Let’s Try It!

43 2015 Office Practicum User Conference Questions ?

44 2015 Office Practicum User Conference We want your feedback!


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