What is an ERA Split?
Customers can request an ERA Split when multiple submitter accounts share an NPI or Tax ID. An ERA Split ensures that the correct ERA files are routed to the appropriate submitter number.
How Does an ERA Split work?
When a submitter adds an NPI or TIN record in CMD that is already in use by another submitter, the ePS enrollment team will create unique TCN prefixes for all submitters that share this NPI and adds these to the practice records in CMD. TCN prefixes are then added to the claims by CMD on the back end, at the time the claim is generated for transmission (they do not show on the claims in CMD). The system then uses these TCN prefixes to route the ERA file to the appropriate submitter upon receipt.
What do I need to do to request a split?
To request an ERA Split, contact CollaborateMD's support department. They will then create a case with ePS so the ePS enrollment team can create your TCN prefixes and set up your ERA Split.
Can I use my own TCN prefix if I already set up an ERA Split?
CMD has recently put a protocol in place to keep submitters from adding practice records with NPIs/TINs that are already in use by another submitter without proper notification of the ePS enrollment team. Customers will receive an alert telling them to reach out to CMD support, and CMD support notifies ePS, so that a split can be either added or updated.
What are the most common reasons for ERAs to be delivered to the wrong account/submitter?
If an ERA is delivered to a customer who was not the submitter of the claim(s) it means that ePS was not able to properly identify the correct submitter. The most common causes are:
- A submitter/customer that is already part of an ERA split, with assigned TCN prefix, has created a new practice location without a TCN prefix.
- If there are no prefixes on the TCNs within these ERA - the ERA will be delivered to the ‘default’ submitter.
- Another submitter/customer sends claims out using an individual practitioner’s NPI as the billing NPI.
- This happens most frequently with providers that ‘float’ or see patients at multiple locations.
- For example: If practice B bills out under an individual NPI vs. the group, and ePS has that NPI registered to practice A - ERAs will be delivered to practice A.
- If this NPI is going to be used for more than one account, ePS needs to be notified so we can associate this ‘billing ID’ with all practices involved and set up an ERA split for proper routing.
What is a Split Check?
A split check is one where a match was found for multiple submitters using the same NPI/Tax ID and there are multiple TCNs on a single check. When this happens, ePS will separate the transactions using the individual TCN prefixes on each transaction..
How does the Split Check work?
If an ERA with ten claims totaling $100.00 arrives at EPS, and the NPI/Tax ID matches two submitters, the system will process it as follows:
For our example, in CMD, submitter "FRED" has a TCN prefix of "FRD" in their practice setup, and submitter "BARNEY" has a TCN prefix of "BRY." The check includes five transactions with the "FRD" prefix and five transactions with the "BRY" prefix.
EPS will split the ERA into two files. Only transactions assigned to Fred's account will be delivered to Fred's account, and the same applies to Barney's account. EPS will also re-total the payment/adjustment summaries to ensure the amounts at the bottom of each remittance file balance correctly.
How can I recognize a Split Check on an ERA?
If a check is split, below the check total at the bottom of the ERA, an adjustment for "Other Site Payments" will appear.