Using ERAs with Helper

Transcription

1 Using ERAs with Helper Table of Contents Introduction to ERAs in Helper... 1 Getting Started with ERAs... 1 Set up Multi-User settings for ERAs... 1 Enter the ERA Payer ID in the Insurance Company Library... 2 Setup ERA Preferences... 2 Setup Facesheet ERA settings (optional, but recommended)... 3 The ERA Processing Screen... 4 The Left ERA Panel... 4 Multiple insurance companies with the same ERA payer ID... 4 The Right ERA Panel... 5 The Procedures Tab... 5 The Issues Tab... 7 Processing ERAs... 8

2 Introduction to ERAs in Helper Helper allows you to submit claims electronically using ClaimsConnect. You can also receive and post Electronic Remittance Advice (ERA) using Helper's ERA processing feature that works with ClaimsConnect. You can use the ERA Payer Id field to identify payers for electronic claims and also set up patient-specific ERA settings on the ERA tab in the Facesheet Default option. New ERAs are sent through ClaimsConnect to the ERA ledger in Helper. Getting Started with ERAs Setting up Multi-Users for ERA. Entering the ERA Payer ID in the Insurance Company Library. Setup your Helper ERA preferences to determine the date used on payments for all patients. Set up your Facesheet ERA settings to control how ERA over and under payments are handled on a patient-by-patient basis. Set up Multi-User settings for ERAs In order to use ERA successfully, your user Multi-user settings must have proper access for ERA. The user you are currently logged in as must be the Administrator user in order to change the settings for the other users. 1. Select Setup in the upper left of Helper then choose Multi-User Setup. 2. Select a user from the list (usernames will varry depending on your system) and click Edit. 1 Note: If the error message listed below appears, exit Helper and login using an Administrator account. 3. Choose the Access to Screens tab across the top of this window. Next, check off the box for ERAs on this check list. Finish by selecting the Save button.

3 Enter the ERA Payer ID in the Insurance Company Library The ERA payer ID will display on each new ERA received by the system. This payer ID will need to be entered on the insurance company section in order to link the ERA with the correct insurance company. 1. Navigate to Setup in the upper left then Libraries. Open the Insurance Companies library. 2. Select the insurance company needed and click Edit. 3. Select the Billing tab across the top and fill in the ERA Payer ID section. Click Save. 2 Setup ERA Preferences The settings in this section will affect how ERAs are entered into your Transactions ledger. The date attributed to each ERA payment can be automatically entered as the payment date or todays date. 1. Navigate to Setup in the upper left of Helper then go to the Preferences section. 2. Select the section for ClaimsConnect. Here there are two self-explanatory options for how payments will logged inn Transactions ledgers.

4 Setup Facesheet ERA settings (optional, but recommended) ERA settings can be setup on the ERA tab in individual patient Facesheets. These options control which party owes or gets a reduced balance in the event of over and under ERA payments on a patient-by-patient basis. These options are automatically applied when you process a payment from the ERA Ledger. 1. Edit a patient s Facesheet. 2. Got to the Defaults section. Select the ERA tab across the top. 3 When the ERA payment is less than the expected amount for the Session: Click the Leave the expected amount as is radio button. The insurance company will owe money on the session. OR Click the Lower the expected amount for the insurance company to the amount paid radio button. This allows you to increase the amount owed by the secondary insurance if the primary paid less than expected, increase the amount owed by the patient, or write off the difference. Simply move the billable party up on the list to automatically move the remaining balance after processing an ERA. When the ERA payment is more than the expected amount in the Session: Click the Leave the amount over the expected amount as an open credit radio button. The insurance company will have an open credit. OR Click the Increase the expected amount for the insurance company to the amount paid radio button. This will allow you to accept the larger payment and decrease the amount owed by the secondary insurance or the patient, based on the order selected. Simply move the billable party up on the list to automatically decrease this party s remaining balance after processing an ERA. Select the Write off the difference between the Full Charge and the Allowed Amount reported in the ERA check box to automatically write off this amount. *Note: Not all ERAs will contain Allowed Amount information.

5 The ERA Processing Screen To view the ERA processing screen click on the ERA button at the top right of the Helper main screen. Your ClaimsConnect login information maybe be needed at this point. The ERA Processing screen is divided into two panels. The left panel displays active ERA files. The right panel displays all of the transactions associated to those ERA files and contains three tabs: Procedures, Adjustment Codes/Remark Codes, and Issues. 4 The Left ERA Panel A. The payer name B. The date of the ERA (received by Helper) C. The payment date D. The Check/EFT number E. The total amount of the payment F. The total number of claims and procedures on those claims G. The errors and warnings Multiple insurance companies with the same ERA payer ID It is possible to have multiple insurance company library entries with the same ERA payer ID. If this is the case, a list of companies that have a matching ERA Payer Id will be displayed in the left panel under the ERA payer name on the ERA list. Select the correct insurance company from the list.

6 The Right ERA Panel The right ERA panel has three tabs: Procedures, Claim Adjustments, and Issues. The Procedures Tab The Procedures tab lists all of the payment transactions associated with the ERA file selected. 5 A. Select All Selects all of the payments on this ERA B. Deselect All Deselects all of the payments on this ERA C. Print EOB Displays a patient selection window to choose what information will display on the EOB. See below. Simply press OK to generate the EOB for all of the patients payment information on this ERA. An example of the generated EOB can be found on the next page.

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8 7 The Issues Tab The Issues tab lists details of any warnings or errors associated with the ERA. A red icon indicates that an error was found that stopped a transaction from being displayed on the Procedures tab (as seen below); a yellow icon indicates a warning. It is recommended that all error/issues be corrected before processing the claim. Common Errors The payer could not be found. This uses the ERA Payer Id to find a payer. The patient could not be found. This uses the patient account number to find the patient. The patient does not have an insurance company with a matching Payer ID. The Provider in the claim could not be found. Helper searches on every ID entered in the Provider Id system, regardless of what type of ID was specified in the ERA. A matching procedure could not be found in the Transactions ledger for the patient. This is typically caused when a session is deleted or changed. Common Warnings $0.00 was paid for a service. If previous payments have already been applied to the service then you get a warning. This could mean you had to resubmit and are getting the remaining money or that you incorrectly applied a previous payment to this procedure. The charge amount in the ERA does not match the charge amount of the procedure in Helper. This typically occurs when a session has been edited after the initial submission.

9 8 Processing ERAs To make sure that you are processing only the payments that you want, make sure that the proper procedures and ERAs are selected. For any ERA that is checked on the list in the left panel, all procedures that are checked on the right hand side will be processed. You do not have to process all of the procedures in an ERA at the same time. If you process the procedures in an ERA over multiple sessions, all of the payments will post into the same batch payment (1 ERA = 1 Batch Payment). In the screenshot below, only the two Blue Cross Blue Shield ERAs will be processed. Additionally, only the payments for the checked off three sessions will be processed from the first ERA. If the other three sessions are processed later, they will be on a separate batch payment.

10 9 Please let us know if you have any questions concerning your Helper software by contacting option 1.