How to handle Missing ERA

Searching for ERA in Claim.MD

Prior to contacting Claim.MD to report a Missing ERA please be sure to thoroughly utilize the Claim.MD tools available concerning ERA. We recommend that you first confirm the Provider has enrolled (Prov.Enrollment) with the payer to receive ERA and that the enrollment has a completed status.

To check for enrollment completed status for a payer:

• Navigate to Provider Enrollment page in the left navigation menu,

• Select the correct provider from the Provider List

• Find the payer you are inquiring the ERA enrollment status for, and check to see if the ERA enrollment’s status is “Completed”.

Enrollment Completion Status Exception

• There are some exceptions for ERA enrollment completion status:

  • When Payers return an ERA with NO payer ID or a different payer ID, the enrollment will not show as completed.

  • If the provider only recently enrolled, they may not yet be approved so no ERA would be sent until that approval is granted.

  • Many payer enrollments are dependent upon the provider sending claims within 30 days of having enrolled with the payer.

    • If the provider enrolled more than 30 days ago but only just submitted claims for payment, that enrollment may be rejected and no ERA will be forthcoming. Re-enrollment should be considered.

Once provider enrollment is confirmed for ERA delivery to Claim.MD proceed to View ERA and use the open Search option. There are a number of criteria available. When using the Search feature, the less you put in, the more results you get back. In fact, searching by ONLY the amount is often successful. Entering an ample date range both before and after the check date is advised.

Helpful Views and Filters

• When in View ERA, don't forget that you can change the date range there by using the pull-down in the upper right corner

  

• You might want or need to set the "By:" field in the lower right corner to "Anyone" instead of "Me” to view all the claims.
  

  

• Also important to check under View ERA is the payer's check number format previously received from the payer. Be sure that what you report to Claim.MD as a missing ERA check number is of the same format as previously received ERA check numbers from the payer.

  • Having a different check number format is a tip off you may not have the right number and need to check your source to confirm the ERA check number.

    

ERA Facts & Requirements

• Most payers will not research or provide an ERA if the check is dated more than 30 days ago. Most all Medicare MACs have this limitation. ERA that cannot be retrieved will have to be requested by the provider directly with the MAC to receive a paper EOB.

• Missing ERA should only be reported after 72 hours have passed from the date of the check. This is the amount of time the payer has to provide the ERA.

• Claim.MD only requires one missing ERA example per provider (same NPI/Tax ID) per payer.

• Missing ERA tickets must be opened using the support ticket category Missing Remittance (ERA)/ERA Enrollment.
  

  

  • All information requested must be provided and be accurate. Claim.MD uses the information provided on the support ticket to run a background system search for the ERA before contacting the payer or payer's ERA trading partner.

  • If you are not able to view and/or select a payer for the provider, this is a strong indication that the provider has not enrolled for the payer's ERA which would explain why they are not receiving the ERA. Cigna (62308) and UHC (87726) both require (without exception) the paper EOB and/or DDAR (Direct Deposit Activity Reports). These may be attached to the support ticket once it has been created.

    

EOB Attachment

If an EOB or payer portal screenshot of the ERA information can be supplied, it should be. This saves time from having to ask for and supply later on. Again, this information can be attached to the support ticket once it has been created.

How to attach an EOB document/file to a ticket

Steps for adding a document to an existing ticket:

1. Click on Support Tickets in the left menu.

2. Find your existing ticket in the Support Tickets page.

   

3. Click the paperclip icon on the bottom left, select

   Choose File

   , select the EOB file on your drive, and click

   Attach

   .

   

4. After attaching the document and entering your message, click the

   REPLY

   button.