At Claim.MD, it's not uncommon for users to see an ERA (Electronic Remittance Advice) available under the "View ERA" section, but not see it reflected in the claim's payment history. This can be confusing—especially when the payer has clearly issued payment, yet the claim appears unpaid in the system. This article explains why this happens and how to interpret these situations.
Understanding the Role of REF 6R (Charge ID)
Each service line on a healthcare claim is assigned a unique identifier known as the REF 6R or Charge ID. This number is crucial because:
It uniquely identifies a specific charge on a claim.
It is used by payers when sending ERAs to match payments back to the original claim data.
It is especially critical for automated payment posting and claim reconciliation.
For direct data entry through Claim.MD, the system typically generates a well-structured and trackable Charge ID. However, when claims are submitted via an external practice management system (PMS) or clearinghouse integration, the Charge ID is usually generated by that system.
This image displays an ERA correctly attached to a claim, as shown in the Claim History view.
Why Do ERA-to-Claim Matching Fail?
The ERA may fail to link to a claim if the REF 6R value returned on the ERA does not exactly match the one originally sent with the claim. This can occur due to:
Truncation or Shortening of the Charge ID by the payer. For example, the claim may have been submitted with a long REF 6R value, but the payer returned only a portion of it.
Modification or Substitution of the Charge ID by the payer, which may assign their own internal value in place of the one originally sent.
Data Formatting Differences, where character encoding or spacing affects how the REF 6R is interpreted.
Claim.MD’s system requires an exact match of the REF 6R values in order to automatically link the ERA to the correct claim and service line. When a mismatch occurs, the ERA cannot be attached to the claim's history, even though the ERA is still available in the general "View ERA" list.
Example: Truncated REF 6R
Imagine a claim was submitted with the REF 6R value:CHGID-ABC1234567890
The payer returns the ERA with a shortened REF 6R:ABC1234567
Despite being logically related, these two values are not identical. As a result, the system cannot link the ERA to the claim because it cannot confidently match the payment to the original service line.
This issue is not correctable by Claim.MD, as the ERA data is received directly from the payer and cannot be altered.
Who Assigns the Charge ID?
For claims entered directly in Claim.MD: The platform typically assigns a consistent and traceable Charge ID that aligns well with ERA matching standards.
For claims submitted from third-party systems: The Charge ID is generated by the sending software. It’s important to ensure that these systems follow consistent formatting rules and avoid overly long or complex identifiers that might get truncated by payers.
What Happens When an ERA Is Not Linked?
The claim will still appear as unpaid in the system, even though payment was issued.
The ERA will be visible under the “View ERA” section but will not show up in the claim’s history.
This may result in confusion for staff, leading them to re-work claims that have already been paid, wasting time and resources.
Some customers discover this when contacting payers who confirm payment, or by noticing that the claim and ERA aren’t linked in the expected way.
You may see the ERA listed on the View ERA screen, but if it is not properly attached to the claim, the Claim History will not display the EFT# indicating payment.
How to Identify an Unlinked ERA
While there is no self-service tool for customers to look up REF 6R mismatches, there are signs that suggest an ERA might be unlinked:
The claim is still marked as unpaid despite confirmed payment.
The ERA appears in the "View ERA" list but is missing from the individual claim's history.
An internal tool or flag (such as a "Missing ERA Alert") might signal that an ERA has been received but could not be linked.
In these cases, support agents may manually inspect the REF 6R values in the claim and ERA files to confirm a mismatch.
This alert on the Manage Claims page can prompt you to investigate further by checking the View ERA screen and then the Claim History. This helps determine whether the ERA was received and whether it is properly linked. If the ERA does not appear in the Claim History, it is often due to a mismatch between the Charge ID number sent by the provider management system and the one used by the payer.
Summary
When an ERA is not linked to a claim in Claim.MD:
It is almost always due to a REF 6R mismatch.
This is typically caused by payer-side formatting issues, not a fault of Claim.MD.
Unfortunately, Claim.MD cannot fix or override this behavior, as it must rely on exact matching for payment accuracy and integrity.
Direct data entry usually avoids this issue, while integrations with third-party software are more susceptible if they use overly long or inconsistent charge identifiers.