Electronic Remittance Advice (ERA) Processor
Users Guide
Brief description of the Electronic Remittance Advice (835) or Electronic EOB
A Remittance Advice (RA) is a notice of payments and adjustments sent to providers, billers, and suppliers. After a claim has been received and processed, a Payer (anyone who pays medical claims) contractor produces the RA, which may serve as a companion to a claim payment(s) or as an
explanation when there is no payment. The RA explains the reimbursement decisions including the reasons for payments and adjustments of processed claims.
Benefits of using Electronic Remittance Advice (835)
More detail EOB information
Paper less remittance advice
Quicker payment notification
Automatic payment into Accounting System (Reconciliation)
Identify problems(adjustments, denials, pends and others) instantly associated with claims and payments
Electronic Remittance Advice (ERA) Processor Professional
The Electronic Remittance Advice (ERA) Processor Professional is the professional version of the ERA, which allows the following functions:
Generate a flat file
Generate a PDF of the ERA(835)
Display the content of the ERA on the screen
Generate a CSV file in a user-friendly format for ease of read and quick analysis. For custom CSV format contact us @ https://openpecs.com/contact
Figure 1
Menu Item – “Generate Flat File”
Generating a flat file – this option allows you to select an ERA (835 5010) EDI file and dump the output in an easier readable format. Please note the EDI file have to delimit in the sense that the individual EDI segment need to be on its own separate line. The file cannot be one continuous line. If the file is one continuous line; the file needs to be delimited by EDI segment. There are several Tools available on the internet to perform this function. Alternatively, you can buy a copy of a EDI delimiter at
http://openpecs.com/store/product-category/edi-delimiter , for approximately $10, that will delimits any EDI file into its individual EDI segments.
When the “Generate Flat File” is completed, you will see a popup that will let you know how many claims the Tool processed. The output file will be located in the same location as the file that was
selected for processing. Two file will be produced by the process:
1) File name “Output835_YYYYMMDDhhMMss.txt” where for example “OutPut835_20130101130523.txt”
YYYY –Year MM- Moth
DD – Day of month HH – Hour
MM – Minutes of the hour SS - Seconds
2) File name “Output835_Error_YYYYMMDDhhMMss.txt”
The output error file contains processing errors if any error occurs during processing.
Menu Item – “Generate PDF”
Generate a PDF – this option generates a PDF of the file that was selected. The output file will be
located in the same location as the file that was selected for processing. Two file will be produced by
the process:
1) File name “Output835_YYYYMMDDhhMMss.pdf” 2) File name “Output835_Error_YYYYMMDDhhMMss.txt”
Contains error if any error occurs during processing.
Menu Item – “Display RA”
The Electronic Remittance Advice (835) processor converts an
Electronic Remittance Advice (835) into a flat file, or display on the screen so that the important pieces of information associated with payment can be easily read. One of the advantages of an electronic version of the EOB is speed. The status of a submitted claim is extreme important, the Electronic Remittance Advice lets you know the status (Paid, Denied, Pended or Other) of a claim. If the claim was denied for whatever reason the user do not have to wait for weeks for the paper EOB to arrive to your office in the mail, the user pull it up on the screen and see each individual check on the screen then click on the claims for a particular check. Displayed on the screen are three separate buckets (Paid, Denied or Pended/Other).
Figure 2 Electronic Remittance Advice(ERA) selection screen
Select input Remittance Advice (835) file.
Please note the file needs to be broken down into the individual segment. A message will pop up if file is not segmented.
Figure 3 – Invalid ERA file selected
The following message wills popup when the Remittance Advice (835) is completed letting you know how many remittance advice records have been processed. For example, the number “14” at the end of the message represent the actual number of records.
Figure 4 Number of records processed
The output of the Remittance Advice file that was processed can be found in the directory where the input file has been selected.
The example below is from a previous run. Output835_20110330100325.txt
Output835_Error_20110330100325.txt
The format of the output file is Output835_yyyyMMddHHMMss.txt (Year, Month, Hour, Minutes, and Seconds)
“Output835_Error_” contains any error that may have occurred and the number of record processed.
1. Click button “Select 835”
The following file browser screen will pop up and allow the user to browse to the directory on your PC where the input file is located.
Figure 6 ERA file selection screen
Figure 7 ERA Claims Header details
Figure 7 display the check number, check amounts, and check date along with some other detail check summaries
The screen is divided into two panes the top pane contain the “Remittance Summary Information” and the bottom pane contain “Other Provider Adjustments” The bottom pane contain any
information on the “PLB” segment on the Electronic Remittance Advice. The amounts listed in this section relates to other provider expenses such as (Recovery Allowance, Interested Penalty Charges etc.) that may not be related to a claim on the current ERA.
3. Click on the line item in the table that relates to the claims associated with the check figure 7. The claims listed below are associated with the check from above. The default tab is the “Paid Claims”
Paid Claims Tab
Please note the numbers on each tab represent the number of claims that falls within that bucket. There are three buckets (paid, denied, pend\other) represented.
Figure 8 Paid Claims Tab
3. Click on one of the line item in the table to see the detail or service lines associated with the claim
Figure 9 Paid Claims Tab details
Figure 9 shows the service detail line item of the charges associated with a claim; include all adjustments if there are any.
Figure 10 show all of the claims associated with a particular check that have “Denied” for whatever reason.
Please Note you will see in the table column name “Claim Status” you will also see claim here that have been processed as a “Paid” claims. The reason why they are listed here is that one or more of the service line have been denied for whatever reason.
Denied Claims Tab
Figure 11 Denied Claims Tab Details
When the user click on one of the rows of a claim in the table the detail service level shows up in red to let the user know there was a problem with this particular claim.
Pend\Other Claims Tab
The “Pend\Other” tab shows all claims that have pended or other claims statuses that do not fit into the denied or paid bucket.
Figure 12 Pend/Other Tab
Figure 13 shows all other claims that has not denied or paid. From the example the “Pend\Other” claims bucket shows the claims status of “Reversal of a Previous Payment”. This status represents claims that have been corrected and resubmitted for payment. The text also shows up in red to focus the users’
Figure 13 Pend/Other Tab details
The Remittance Advice program allows you to open up not only one file but multiple Remittance Advice files by going back remittance advice selection screen in figure 5 and just selecting another file. When the user selects a new file the user will notice that a new line will appear in Remittance Advice Transaction Summary
Menu Item – “Generate CSV”
Generate a CSV (Comma separated Value) – this options generates a CSV file. The output file will be located in the same location as the file that was selected for processing. Two file will be produced by the process:
1) File name “Output835_YYYYMMDDhhMMss.csv” 2) File name “Output835_Error_YYYYMMDDhhMMss.txt” Contains error if any error occurs during processing.
This option can be used to import the ERA(835) information into a database for further processing , open the file directly in Microsoft Excel or import the ERA directly into your internal billing system.
File Layout of CSV file generated from ERA
Record Name – REC01 (File Header Information) Process date
Total Check Amount Check Date
Check Reference
Date Payer Process Check Payer Name
Payee(You) Name
Record Name – REC02 (Patient Header Information) Random Generated Identification
Record Count
Patient Account Number Claims Status
Total Provider Charge Total Payer Paid
Payer Assigned Claim Identification Patient Last Name
Patient First Name
Patient Identification Number Rendering Provider
Rendering Provider Tax Identification Date Payer Received Claim
Record Name – REC03 (Claims Detail Information Service Line Level) Random Generated Identification
Record Count Procedure Code
Amount Provider Charge Amount Payer Paid Date Service Started Date Service Ended
Record Name – REC04 (Claims Detail Information Service Line Level) Random Generated Identification
Record Count
Claims Adjustment Group Code Claim Adjustment Description
Claim Adjustment Difference Amount
Record Name – REC05 (PLB Segments) File Level Information Other Provider Adjustment Reference Number
Other Provider Adjustment Amount
Record occurrence per CSV file
Record 01(REC01) – can occurs 1 time per fileRecord 02(REC02) – can occurs 1 time per claim multiple times per file
Record 03(REC03) - can occur multiple times per claims dependent on the number of service line per claims
Record 04(REC04) - can occur multiple times per claims service line Record 05 (REC05) – can occur multiple time per file
