Auto-Posted Claim ERA Payments

Auto-Posted Claim ERA Payments

The Payment Ledger will auto-post ERAs from Private Insurance whether they are for primary, secondary, or tertiary payers - as long as the ERA can be matched to a claim generated in the system. 

See Unmatched ERA Payments for handling ERAs that cannot be matched to a claim.

When an ERA (835) is received and is successfully mapped to a claim, the following are automatically posted to the charge line:

• Private Insurance payment amount
• Client Responsibility (if present) on the ERA, including
  • Client Deductibles
  • Client Coinsurance
  • Client Copay
• Line Status is determined as follows:
  • Short Pay: Carrier payments were less than expected (Expected Reimbursement Amt > sum of all FS payment(s) Client Responsibility)
  • Overpaid: Carrier payments were more than expected (Expected Reimbursement Amt < All FS payments Client Responsibility)
  • Client Responsibility: When all Carrier(s) payment(s) are applied and Copay, Coinsurance, Deductible, or Miscellaneous values have been transferred to Client Responsibility
  • Denied: If the claim was denied
  • Complete: Paid in full (Expected Reimbursement Amt = sum of all Carrier Payment(s) + all Client Responsibility Payments)
• If the client has secondary insurance, any balance that was not paid by the primary is automatically transferred to the secondary. The secondary funding source is set up in the client contract’s Order of Precedence.