Electronic Remittance Advice (ERA)
Electronic remittance advice (ERA) is a digital version of the paper explanation of benefits (EOB) you may receive from payers via mail. Unlike EOBs, however, ERAs are routed directly into your TherapyNotes account, allowing you to maintain your billing records in one secure, centralized location.
An ERA provides details about the payment you receive from a payer for the corresponding claim(s). This may include information about your contracted rate with the payer if you're in-network or the amount paid if you're out-of-network; copay, coinsurance, deductibles; and any other payment adjustments such as interest, penalties, and balance forwarding. A payer may also communicate claim rejections and refunds through an ERA.
TherapyNotes charges just $0.14 per claim, less than the cost of a stamp. In order to receive ERAs in TherapyNotes, you must enroll with each payer you wish to receive ERAs from. Most payers require additional paperwork in order to enroll to receive ERAs. For more information, read Electronic Remittance Advice (ERA) Enrollment.
Receiving ERAs is a straightforward process and allows for a shorter turnaround on claims. If you are enrolled to receive ERAs from a payer, that payer will send an ERA to our clearinghouse, Change Healthcare, whenever they receive and process an insurance claim. Afterwards, Change Healthcare routes the ERA directly into your account. Once the ERA is received, our assisted ERA payment posting will help you process the ERA and record the payment. To learn more about how to post ERA payments, read How To: Post ERA Payments.
In order to receive ERAs, you must have TherapyNotes' electronic billing features enabled for your practice.
To enable electronic billing, EDI claims, and ERAs:
Note: Both Practice Billers and Practice Administrators can complete this step.
- Click the User Icon > Settings > Practice Billing
- Select the Enable Billing Features checkbox
- Select the Enable TherapyNotes EDI checkbox
For more information about setting up your account for billing in TherapyNotes, read Quick Start: Billing.
Understanding the ERA
To view the ERAs you have received from payers:
- Click Billing > ERA OR Click To-Do > Process ERAs
- In the section labeled ERA, TherapyNotes will show all ERAs from the last 30 days that have not yet been processed by default. To expand your search or to locate a specific ERA, edit the optional search filters in the section labeled Search ERA and click the Search ERA button
View the status of the ERAs you have received using the Status column. ERAs that have already been processed will have a link to View Payment, while unprocessed ERAs will have a bold link to Post Payment. To view an ERA, click the corresponding ERA #.
The ERA viewer conveniently displays the most useful information about the payment while hiding extraneous details.
The header of the ERA features the ERA number and status. Whenever you are ready to post an unprocessed ERA, click the Post Payment button in the header to process the ERA using our ERA Payment Poster. Alternatively, click the Mark as Processed button to process the ERA without recording the payment in your account.
Located below the header is information about the insurance payment including the payer, payment amount, check number or transaction ID, and the date and time the ERA was received.
To view additional ERA information, claim details, and remarks, click the Show Additional ERA Information or Show Details and Remarks for All Claims links. To maintain a focus on the information that is most crucial for understanding the payment, the ERA viewer hides these details by default.
Important details about the ERA payment are located below the blue divider and broken down per claim. Each claim on the ERA includes information about the service plus charged rate, patient amount, claim-level adjustments, and amount paid by the payer for that service.
(A) Charged Rate: This value reflects how much you charged for the service. The Charged Rate is equal to the Insurance Rate of the billing line item in TherapyNotes.
(B) Patient Amount: The Patient Amount reflects how much of the Charged Rate the client is responsible for, according to the payer. This may include copay, coinsurance, deductibles, and the client responsibility for out-of-network claims.
(C) Adjustments Amount: The Adjustments Amount reflects the total value of claim-level adjustments such as penalties or interest.
(D) Paid Amount: This is the amount the payer paid for this service. Generally, the Paid Amount for each line item is calculated by the Charged Rate less Patient Amount and Adjustments Amount.
(E) Patient and Adjustments Amount Breakdown: This grey box shows the breakdown of the values that constitute the Patient Amount and Adjustments Amount per service.
In addition to the above values, the ERA indicates how the payer handled each claim in the upper right corner of each of the claim breakdowns. This will read Processed as Primary if the payer is the client's primary insurance. If the client has secondary insurance and the ERA was forwarded to the client's secondary payer, this line will also say Forwarded to Additional Payer(s).
The final section of the ERA lists the total amounts for all claims in the ERA, including the total amount the payer has paid.