How to Handle Missing Acknowledgements and Missing ERA Alerts
- 03 Nov 2023
- 2 Minutos para leer
- Impresión
- OscuroLigero
- PDF
How to Handle Missing Acknowledgements and Missing ERA Alerts
- Actualizado en 03 Nov 2023
- 2 Minutos para leer
- Impresión
- OscuroLigero
- PDF
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These alerts, Missing Response Alerts and Missing ERA Alerts, are notifications provided by Claim.MD to keep users informed about the status of their claims and expected Electronic Remittance Advice (ERA) receipt.
Missing Response Alerts:
Missing Response Alerts: These alerts are triggered when Claim.MD has successfully transmitted claims to the payer, but no response confirming receipt is received within 24-48 hours. Users are advised to contact the payer's Electronic Data Interchange (EDI) department to inquire whether the claims are in the queue to be processed. This department can provide valuable insights regarding the status of the claims.
The option to re-transmit can be found by clicking , selecting the claims to be re-transmitted, and selecting Transmit in the dropdown.
IMPORTANT
If you resend the claim, and the payer indeed has the claim but failed to send an acknowledgment, it could result in a duplicate claim rejection. In this situation, you should consider archiving the claim.
Missing ERA Alerts:
These alerts indicate that an expected ERA has not been received from the payer within the configured timeframe (default: 30 days). Users are encouraged to contact the payer's EDI department for ERA status. Initially, users should inquire whether the ERA has been processed by the EDI department. If the ERA has not made it to the payer's EDI department, they should consider reaching out to the claims adjudication department to explore potential factors causing the delay. It may even be the case that the claim has not been received by either department (see missing acknowledgement of receipt above), users should consider retransmitting the claims.
The option to re-transmit can be found by clicking , selecting the claims to be re-transmitted, and selecting Transmit in the dropdown.
ERA PATH
For some instances of missing ERA, there are instances where individuals may need to revisit provider enrollment. This becomes necessary in cases where the ERA path was unintentionally modified by someone who clicked on an email or link. You'll identify this situation when the payer verifies an altered ERA path or when you receive a new enrollment notice from the payer.
Account Settings Configuration:
Furthermore, it's worth mentioning that users have the flexibility to configure these alerts to display only response alerts, only ERA alerts, or both, depending on their specific needs. By default, both types of alerts are displayed, and the number of days before the ERA alert is triggered can be customized, with the default value set at 30 days. This level of customization allows users to tailor their alert preferences to their workflow and response expectations, ensuring efficient claims management. For more information on how administrative users can update these alert settings, see this article. missing acknowledgement of receipt