Process ERA Files
Once you have downloaded and stored an ERA file, INSIGHT Billing can process it. When INSIGHT Billing does this, it creates payments and EOB entries based on information in the ERA file that can then be posted to the patients' account.
- Go to the Payments F5tab and then select the EOB Posting sub-tab.
- Click the Enter EOB by ERA button.
- In the Open dialog box, select the ERA file to process, then click Open.
Note: You can select multiple files to process by pressing the SHIFT or CTRL keys while you select the files.
INSIGHT Billing will load and parse the file. A progress bar will display as each claim in the file is processed and placed in the archive folder, as set up in Set Up ERA File Location. If a file of the same name already exists in the archive folder, the new file is renamed by appending an underscore and time stamp to the file name. For example, ZIRMED1000.835 becomes ZIRMED1000_2008072214225.835.
INSIGHT can only process ERA files that come in a ZIP file. Typically ZIP files have a .ZIP extension. After processing a ZIP file, Insight will place it in the archive directory. If there are multiple 835 files in the ZIP file, they are each processed and individually archived. When processing is complete, a message will display indicating the number of payments in the ERA file. For example, “This file contained 2 payments.”
Tip: Once you process an ERA file, it is removed from the directory where it was stored. The next time you click the Enter EOB by ERA button, that file isn’t listed in the Open dialog box. This makes it easy to work through downloaded ERA files—you will always know which files are waiting to be processed.
If the ERA Number Cannot Be Found
If INSIGHT cannot locate a payer with the ERA number in the ERA file, a dialog box displays that you can use to select a payer and assign the ERA number to the payer. The payer name as it appears in the ERA file is listed at the bottom of the dialog box, next to Payer Name in File.
All payers for the claims in the ERA file are listed under Payers in File. The number of claims for each payer is shown, and the payer with the most claims in the ERA file is listed first.
Note: If no claims can be identified in the file, the Payers in File grid does not display. In its place, No Identifiable Claims/Payers in this File displays.
- The payer with the most claims is selected under Select Payer to Assign to. INSIGHT will assign the ERA number from the ERA file (shown in the Assign ERA number text box) to this payer. You can select a different payer by clicking on it in the Payers in File list. The Current ERA Number for the selected payer is shown. This lets you know if you are about to overwrite an existing ERA number for the selected payer. In no ERA number is set up for the payer, it will say None. The ERA number from the ERA file is pre-entered in the Assign ERA Number text box.
- To see the selected payer’s ERA number, group, and address, expand the Select Payer to Assign to drop-down list.
- Click OK to assign the ERA number to the selected payer and continue ERA processing. If you do not want to assign ERA numbers at this time, click the Cancel button. No ERA number will be assigned, and file processing will stop.
Sometimes you may receive both paper and electronic advices for the same payments. INSIGHT checks for these duplicate payments and flags them as it is processing the ERA file:
- If there is a payment in the system with the same payer, an exact match for the check number, and neither payment is for a zero dollar amount, the payment is considered a duplicate. Processing for that ERA file is stopped and the ERA file is not loaded.
- If there is a payment in the system with the same payer, an exact match for the check number, and either payment is for a zero dollar amount, the dialog box below displays and you can choose to continue or stop processing the ERA file.
- If the check number is not an exact match (sometimes paper and electronic EOBs use different formatting for the check number, for example one check number might be shown as 051777, and the other check number might be 51777), a similar dialog box will display the check numbers and amounts. You can choose to either continue or stop processing the ERA file.
Payments and EOB Entries
Each payment in the ERA file is entered as a check or electronic funds transfer (EFT), and includes the check issue date or the EFT effective date.
EOB entries are displayed under the EOB Posting sub-tab, within the Payments F5tab. They are shown in the EOB Contents area. The Print ERA button allows you to print a summary listing of all claims in the ERA file for the selected payment.
The information on the Payments tab is presented in the same way as a manually entered a payment and EOB, shown in the picture below.
All charges that the system was able to process and apply are listed in the EOB Contents area. There may be times where you need to edit the information shown in this area, particularly if rows are shown in pink. Double-click on a row to open it in the Enter EOB dialog box where you can edit the amounts assigned to each category (Paid, Co-Ins, Denied, and so on).
Notice that the Unapplied Receipts tab is active, indicating there is a claim that couldn’t be identified and wasn’t applied. Handle Unapplied ERA Receipts describes how to handle this situation.