ERA Billing Options Tab

Follow the steps below to view and edit the billing options for ERAs associated with this payer.

1. Select Customer Setup > Payers.

2. Use the Show All button to view all payers. Or use the Search field to further drill down your search.

3. Select the Payer.

4. Click the Billing Options tab from the side panel. 

5. Make your selections by referencing the Billing Option Descriptions below. 

6. Process PR-45 (patient responsibility amount in excess of fee schedule/maximum allowable) as an Adjustment when an ERA is posted, rather than as Unpaid?

   1. If set to Yes, the system will adjust the PR~45 (patient responsibility adjustment due to a contractual overage) when an ERA is posted, rather than setting it as Unpaid. 

7. Process PR-242 (services not provided by network/primary care providers) as an Adjustment when an ERA is posted, rather than as Unpaid?

   1. If set to Yes, the system will adjust the PR~242 (services not provided by network/primary care providers) when an ERA is posted, rather than setting it as Unpaid. 

8. Electronic Remittance Advice Automation Options

   1. Allow this payer's ERAs that fully apply with no errors to auto-post without review.

      1. Check this box if you would like to automatically apply ERAs that are free of issues ("clean")  with no interaction or review required. Please note that this option requires additional configuration:

         1. Show a dialog with the payment details before auto-posting: Check this box if you would like to show a dialog box with the payment details before auto-posting them.

         2. Commit the payment after it has been applied: Check this box if you want to automatically commit the payment after it has been applied. 

         3. Allow secondary payments to auto-post: Check this box to allow the auto-posting of secondary insurance payments.

         4. Allow payments that do not match the contract amounts to auto-post: Check this box to allow payments that do not match the contracted amounts to auto-post.

         5. Allow payments with denials or $0.00 allowed amounts to auto-post: Check this box to allow auto-posting payments with a $0 allowed amount or with denials.

         6. Allow duplicate payments (remit code 18) to auto-post: Check this box to allow payments for duplicate claim/service to auto-post.

         7. Allow payments with refund/reversals to auto-post: Check this box to allow payments with a refund/reversal to auto-post.

         8. Allow payments to Patients/Claims with Payment Alerts to auto-post: Check this box to allow auto-posting of payments when the patient or the claim has an existing Payment Alert.

         9. Allow payments with Provider Adjustments that were not applied to claims to auto-post: Check this box to allow payments that include an unapplied Provider Adjustment to auto-post. 

9. Click Save.