Payment Advice (ERA)

An ERA (Electronic Remittance Advice, an 835 file) is the payer's electronic explanation of what it paid, what it adjusted, and what is left owing. The Payment Advice section is where you review those files, work individual claim payments, resolve payments that could not be matched to a claim, and create a secondary claim once the primary payer has paid.

If you are looking for how to upload an 835 file, see How to Upload Claim Files.

From the left-hand navigation menu, click Payment Advice. The section has its own sidebar:

• Payment Advice: search whole ERA files, one row per remittance
• Payment Info: search individual claim payments inside those files
• Unmatched ERAs: payments that could not be tied to a claim automatically
• ERA Enrollment: enroll with payers to receive ERAs

You can collapse the sidebar with the toggle at its top. Your choice is remembered the next time you open the section.

This screen works at the file level. One row is one remittance, typically one check or EFT payment from one payer.

You can filter by:

• Check Date Range and Received Date Range
• Check Number
• Payer Number
• Payed Amount Start and Payed Amount End
• Available Accounts, when your login has access to more than one account

Each row offers actions including View, View Claims, Download File, Match, Tag, Quick Reports, Redetermination, and Refresh.

This screen works at the claim payment level, one row per claim inside a remittance. It is the screen to use when you are chasing what happened to a particular patient's claim rather than reconciling a whole check.

You can filter by:

• Received Date Range and Service Date Range
• Check Number and Payer Number
• Patient First Name, Patient Last Name, and Patient Control Number
• Claim Payment Status
• Worked

• Mark As Worked / Mark As Not Worked: track which payments your team has already handled
• ERA Actions menu: Test Classification, Classify & Save, and Add to Denial Workbench
• Create Derived Claim: build the secondary claim, covered in the next section

Add to Denial Workbench hands the payment off to the Denial Workbench when the payer denied rather than paid.

When the primary payer has paid and the patient has secondary coverage, you need to send a second claim to the next payer. That claim has to tell the secondary payer what the primary already did: what it paid, what it adjusted and why, and what is still owing. In EDI terms this is the coordination of benefits (COB) information.

Create Derived Claim builds that claim for you from the original claim plus the ERA, so you do not have to hand-key the COB detail.

The Create Derived Claim button appears on a Payment Info row only when that payment is matched to a claim. If you do not see it, the ERA has not been tied to a claim yet. Work it from Unmatched ERAs first.

On Payment Info, find the payment you want to bill forward and click the Create Derived Claim button (the copy icon) at the end of the row. The screen opens in a new browser tab, so your search results stay where they are.

The top of the screen shows three panels:

• Original Claim Summary: the claim being copied, including the payer it went to
• ERA Payment Summary: what the payer paid and adjusted, with the adjustment reasons
• What This Will Do: a plain-language description of the claim about to be created

Read What This Will Do. It states which payer the new claim goes to and in what position, and it updates as you change the form below.

Under New Payer:

• If the original claim already named the next payer in its other-payer information, that payer is filled in for you, with a note saying it came from the claim. This is the common case, and normally you can leave it alone.
• Otherwise, search for the payer by name or number and select it.
• Payer Responsibility says where this payer sits: Secondary, Tertiary, and so on. It is suggested from the original claim, so a claim that went out as primary suggests Secondary.

Changing the Payer Responsibility re-checks the claim for a payer in that position, so set it before reviewing the subscriber details below.

Under Subscriber Information, confirm who the policy holder is for the new payer. When the payer came from the claim's own other-payer information, these fields are prefilled from it: name, Member ID, Patient Relationship to Subscriber, and the policy fields (Policy Number, Group Name, Insurance Type, Filing Indicator).

Correct anything the payer needs to see differently. The Member ID is the field most often different between two payers.

Under Service Line Matching, check that each paid line on the ERA is lined up with the right service line on the claim. ClaimRev matches them automatically, first on the line control number, then on procedure code and date, then on revenue code. Adjust any that are wrong, because this is what tells the secondary payer how much was paid against each individual line.

Under Control Number you can give the new claim its own patient control number, usually the original with a suffix so the two are easy to tell apart in reporting. A suffix is suggested for you.

Click the create button. ClaimRev builds the new claim, carrying over the original claim's detail and adding:

• the new payer as the claim's destination
• the previous payer recorded as an other payer, in the position it held
• what that payer paid, what it adjusted with the reason codes, and what remains owing
• the paid amounts for each individual service line

You land in the claim editor on the new claim. From there it goes through normal processing and validation, exactly like any other claim, so watch its status afterwards.

The new claim is created in a draft state for you to review. Creating it does not send it to the payer by itself.

Sometimes a payment arrives that ClaimRev cannot tie to a claim automatically, usually because the payer returned a control number that does not match what was sent. Those land on Unmatched ERAs so they do not get lost.

Each row groups what is known about the payment:

• Payer Info: payer name and number, payer control number
• Patient Info: patient and subscriber names and identifiers
• Claim Info: claim control number, total claim amount, match status
• Dates: check date and ERA received date
• Service Info: the service lines and charges on the payment

You can filter by check and received date ranges, check number, payer number, payer control number, claim control number, and patient or subscriber name.

Two actions resolve a row:

• Retry Auto-Match: run the automatic matching again, useful once the claim it belongs to has arrived
• Resolve - Search & Match: search for the right claim yourself and link it

Once a payment is matched it behaves like any other, including being able to create a secondary claim from it.

Before a payer will send you ERAs, you generally have to enroll with them. ERA Enrollment in the sidebar takes you to that process.

When contacting support about a payment advice, it helps to include:

• The check number and payer
• The patient and, if you have it, the patient control number
• Which screen you were on: Payment Advice, Payment Info, or Unmatched ERAs
• For a secondary claim problem, whether it failed while creating the claim or afterwards during processing

See also: How to Upload Claim Files · Claim Search · Denial Workbench · Work Board

Need help? Contact ClaimRev support at help@claimrev.com or call 918-842-9564.