ERA processing logic - claim level
Path: Transactions>General>ERAs
The system searches for the original claim based on the claim ID from the ERA file.
- If it finds the original closed claim that is not voided, all payments, adjustments, and denial adjustments are applied to this claim.
- If the original closed claim is voided, the system starts searching for the replacement claim by the following parameters: From and Thru dates, Patient ID, and Insurance.
- All parameters should coincide in the original and replacement claims.
- When the replacement claim is found, the payments, adjustments, and denial adjustments are applied to it.
- When the replacement claim is not found:
- If the Apply Payments/Adjustments to voided claim if appropriate replacement is not found check box in Administration>Configuration>Business Units>Settings>Financial is selected, payments, adjustments, and denial adjustments are applied to the voided original claim.
- If the Apply Payments/Adjustments to voided claim if appropriate replacement is not found check box is not selected, no payments, adjustments, or denial adjustments are applied and the voided original claim is shown with the "No closed Replacement claim exists for the Claim ID" error.
Associated pages
- About Electronic Remittance Advice (ERA)
- Electronic Remittance Advice (ERA) processing stages
- About Electronic Remittance Advice (ERA) processing logic
- ERA processing logic - claim details level
- ERA Data tab
- ERA Data tab - Claim level
- ERA Data tab - Service lines
- ERA Data tab - Payments, adjustments, and denial adjustments
- ERA Data tab - Detail errors and warnings
- ERA File tab
- ERA fatal errors
- ERA detail errors and warnings
- About applying payments and adjustments in case of levels conflict
- Process ERA file
- ERA Troubleshooting steps
- About Remittance Advice report
- Remittance Advice report details
- Calculation logic for new balance on ERA report