The ERA Claim Status setup window is used in the Automated Payment Posting process. Once a claim has been ran through the Automated Payment Posting logic, the system will attempt to set the correct Claim Status and Claim Level so that it can be worked through the remainder of the revenue cycle. In the event that the ERA/EOB is posted cleanly (meaning no Adjustment Reasons caused the claim status/level to be set), then the rules on this screen will come into effect. A practice can customize these rules to meet the unique needs of their practice.
Screen Layout and Definitions
Claim Status List
The screen allows a user to change the workflow based on the Processing Level of the ERA/EOB. In the ERA, the Processing Level is provided in the 835 EDI FIle (Loop: 2100, Segment: CLP02) by the payer. In the EOB, the Processing Level is usually listed with the information at the claim level.
Claim Status Values
For each Processing Level, you will be able to set the Claim Status and the Claim Level for 3 specific circumstances:
- Zero Balance: If the entire claim balance becomes 0 after all payments are applied.
- Next Insurance: If a balance remains on the claim and the patient has a subsequent insurance. For example, if processed as Primary and the patient has a Secondary insurance on file.
- No Insurance: If a balance remains on the claim and the patient does not have a subsequent insurance.
NOTE: Some Processing Level options may not allow you to utilize the Next Insurance values. This occurs because we do not have a way of knowing which insurance level was responding, so we can not know what 'Next Insurance' to look for.