Electronic remittance advice (ERA) is the electronic version of an explanation of benefits (EOB) sent from a payer and is routed directly to your TherapyNotes account. Through our assisted ERA payment posting feature, TherapyNotes scans the ERA and guides you through allocating the insurance payment and reconciling appointment billing settings.
While TherapyNotes does a lot of the work for you, you will always have control over posting the payment. Once TherapyNotes scans the ERA, you have the opportunity to review the information and choose to accept the suggested changes.
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 Enroll to Receive Electronic Remittance Advice (ERA). You may also elect to manually upload ERA files that you received outside of TherapyNotes.
You can post both primary and secondary ERA payments through TherapyNotes. See Secondary Insurance Claims for more details.
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- Understanding the ERA Payment Poster
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What if the information on the ERA does not match the information in the ERA Payment Poster?
To post an ERA payment:
- Click Billing ERA OR Click To-Do > Process ERAs
- Click the Post Payment link next to the ERA you want to process
- Match all line items reading No Match Found
- Review the information in the ERA Payment Poster
- Click the Post Payment button
Understanding the ERA Payment Poster
For a video walkthrough, watch our ERA Payment Posting Tutorial.
The ERA Payment Poster looks similar to the Enter Insurance Payment page. However, with assisted ERA payment posting, most of the information is filled in for you automatically. TherapyNotes pulls information for the payer, payment, and claim details directly from the ERA; detects copay, coinsurance, and deductibles; and provides suggestions for potential changes.
To verify any information with the ERA, click the View ERA button in the upper right corner or click any of the hyperlinked claim numbers to scroll directly to that claim on the ERA. If necessary, Payer and Payment information can be changed as needed using the corresponding fields. Patient and Service can be edited using the pencil icon to the right of this information.
Patient Amount / Insurance Amount
The value in the Pt Amt column (for in-network items) or the Ins Amt column (for out-of-network items) can be edited directly in the ERA Payment Poster for the last occurrence of a service on the ERA. Based on the information provided in the ERA, TherapyNotes automatically suggests changes to these amounts. These suggestions are displayed as warnings below each line item.
Suggestions
Whenever TherapyNotes can unambiguously calculate the patient or insurance amount from the ERA, the values in the Pt Amt or Ins Amt columns will be set to the suggested amount automatically. Each suggestion contains a link to open the ERA in a dialog for quick reference, and both the original and the suggested values for a line item are linked in the suggestion. Clicking on either value automatically sets the value of the Pt Amt or Ins Amt field.
In the event of conflicting suggestions, none of the suggestions are automatically applied. Conflicting suggestions display after the final line item. You must review the conflicting suggestions for accuracy and decide which suggestion to apply.
If a value changes as a result of an automatic suggestion or manually adjusting any details, the updated fields will appear with a yellow background, including the inferred values for balances, to bring these changes to your attention. If a suggested value is reverted to its original value, the field will appear with a white background.
Consider the example below:
ERA Payment Poster detects the coinsurance of $54.00 and suggests to set insurance responsibility to $126.00 for this out-of-network payer. Since there is only one suggestion, the suggested amount is set automatically, and the affected fields are highlighted with a yellow background.
Claim-Level Adjustments
Claim-level adjustments create a discrepancy between the payment amount and the Total Allocated value. Alerts for claim-level adjustments display after the corresponding line item.
Claim-level adjustments may apply at the service level or the provider level. To determine how to handle an adjustment, click on the hyperlinked alert message. If the adjustment applies to the service, edit the corresponding Pt Amt or Allocation to reflect the adjustment value. If an adjustment does not apply to the service, enter the description and adjustment value in the Payment Adjustments section.
Consider the example below:
ERA Payment Poster indicates $50.00 in claim-level adjustments. The biller must view the ERA, review the adjustments, and determine where the adjustments apply.
ERA indicates claim-level adjustments totaling $50.00.
The first adjustment does not apply to service, so a non-claim payment adjustment must be entered in the Payment Adjustments section. The second does apply to the service and does not directly affect Pt Amt, so the Allocation for the line item must be edited. Were it a patient adjustment instead, the patient responsibility would be edited.
Allocation and Adjustment
Enter values in the Allocation column to record how much of the ERA payment is assigned to the corresponding line item. The Adjustment column displays the calculated value of the adjustment based on the allocations and responsibilities. If changes to the Pt Amt, Ins Amt, or Allocation result in an open insurance balance, the adjustment will be calculated automatically.
Payment Adjustments
Payment Adjustments features a blank text field and a numerical Adjustment field, allowing you to manually reconcile claim-level adjustments such as interest or penalties.
Post Payment
Verify that the Payment Amount matches the Total Allocated value. Once you confirm that all payment information is correct, click the Post Payment button. If attempting to post the payment returns an error message, verify that none of the fields in the ERA Payment Poster are highlighted in red. TherapyNotes highlights fields in red for each of the reasons outlined below:
- Responsibility (Pt Amt / Ins Amt) cannot be negative
- Responsibility (Pt Amt / Ins Amt) cannot be greater than the charged rate
- Allocation cannot exceed Ins Amt. This includes both insurance payments from the current ERA and previous insurance payments
- Allocation refunds (negative payments) cannot exceed the current amount paid. This includes both positive payments on the current ERA and previous insurance payments
What if the information on the ERA does not match the information in the ERA Payment Poster?
Occasionally, TherapyNotes may not be able to directly match the information contained in the ERA to the information in your account. Often, this is because the payer has slightly different information for the client or service than what you have entered in TherapyNotes. For instance, the ERA may include the client's middle initial while this field is blank in your client's records in TherapyNotes, or the ERA may include a different service code than you submitted.
When this happens, a red No Match Found link will appear in the ERA Payment Poster.
No Match Found for a Client
If TherapyNotes cannot find a match for a client, click the No Match Found link. TherapyNotes will suggest likely clients already in your account. If the correct client is listed, click on the client's name to associate the service with that client.
If the correct client is not listed, search your client list to find the correct client, or click the Mark Patient as Not Recorded button to mark the service as one not recorded in your TherapyNotes account.
No Match Found for a Service
If TherapyNotes cannot find a match for a service, click the No Match Found link. TherapyNotes will show you the service as it was listed on the ERA and a list of likely appointments for the relevant client. Select the correct date of service from the dropdown and click the Set Service button.
If the service was not one you entered in your TherapyNotes account, click the Mark Service as Not Recorded button.
ERA Overpayment
If one or more payers have already paid for a date or service, it may result in a conflict when posting an ERA, indicated by one or more red boxes in the Allocation column. These red boxes usually indicate that multiple payments exist on the same date of service. Previous payments are visible by clicking on the date of service and clicking the History tab.
One or More Payers Have Already Paid for This Date of Service
You will need to raise the rate of the date of service to accommodate the additional insurance payment.
- Click the Date of Service > Change the Insurance Status to Pending Initial Submission > Click Save Changes.
- Click the Date of Service again > Raise the Rate high enough to include the following dollar amounts. Add all three together for the new Rate:
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(Ins Amount/Coverage) the amount insurance has already paid
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(Allocation) the allocation amount on the payment
- (Pt Amt) the amount the patient is responsible for
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Consider the example below:
ERA Payment Poster indicates that the allocated payment of $130 plus the previous posted insurance payment of $90 is more than the $140 rate.
In order for the red box to disappear, the biller will need to increase the rate for the date of service by adding the $130 and $90 insurance payments together, plus the $10 patient amount. This brings the total rate to $230. Update the rate following the steps outlined above. Once updated, the ERA can be posted successfully.
Post a Payment and Ignore a Date of Service
You will need to either mark the patient or date of service as Not Recorded. This will allow you to post the rest of the ERA without needing to resolve the conflicting date of service(s).
- Click Post Payment > Click No Match Found to edit.
- Click Mark Service / Patients Not Recorded.
Manually Posted Duplicate Payment
Deleting the posted duplicate payment will resolve the conflict and allow you to post the ERA successfully.
- Click the Date of Service > History tab > click the manually-entered duplicate payment.
- Click Edit > Select Delete Payment.