ERA & EFT Setup

Physicians always want to receive payment on the first try. Providers have to get rid of several recurring mistakes to receive compensation in the first attempt. This is only possible If the providers or their billing teams can read and understand Electronic Remittance Advice (ERA). There is always a possibility of getting claims rejected.

In two to three weeks after submitting a claim, the medical practitioner will get a response from the payer in the ERA that will let him know whether the claim will be paid or rejected.

Electronic Remittance Advice (ERA)

The ERA is transmitted electronically. If payment is linked with the ERA, it will be delivered by an electronic funds transfer (EFT) or sent as a check via conventional mail. Even if you are registered for the ERA, you have to give your bank details to initiate a direct transfer.

Why ERA?

The ERA provides the provider with the payment and denials details he would have submitted. It lays out the amounts, for instance, co-payments, co-insurance, and deductibles that the patient has to pay. In the end, the ERA will guide you on how to correctly apply the payments to patients’ accounts to keep an eye on what is outstanding and what is paid.

To keep track of patient responsibility and payment, the biller needs to put all data from the ERA into the practice management software, such as AdvancedMD, Brightree, and others.

The following are the benefits of entering data into the billing software:

  • It aids in understanding taxes and the total reimbursed amount.
  • It helps comprehend patient responsibility amount to be collected.
  • It lays out Incorrect or unpaid claims that need to be followed up.

What is Inside of ERA?

  • Your name or the name of your dependent (whoever got the service).
  • The name of the dentist, doctor, hospital, laboratory, clinic, or specialist who administrated care.
  • The claim number and your (or your dependent’s) policy number or health insurance ID.
  • The type of equipment or service you got, and the date on which you got it. The date range will be provided if the service lasted more than a day.
  • The cost of the service (that your provider billed the insurance company)
  • The percentage of the billed amount your insurance company reimbursed.
  • The outstanding amount that is usually your responsibility

The allowed amount is the maximum payment you can get on each line item. The difference between the charge amount and the insurance’s allowed amount is known as contract adjustment that is a write-off.

The balance of the difference between the payment amount and the allowed amount is on the patient to pay. A patient’s annual out-of-pocket payment before the insurance will start reimbursing is called a deductible.

A co-pay is a small out-of-pocket amount payable per visit. It is paid before consulting the doctor. The patient’s coinsurance is the bill’s share that is usually a percentage of the allowed amount.

If you’re looking for the ERA and EFT setup, BillMyMed is the one you need to turn to.

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