How to Import an Electronic Remittance Advice (ERA)

Steps for processing ERA files.

1. ERA files have to be in the ‘{DATABASE DIRECTORY}\Mailbox\Inbox’ directory in order to be processed. This has to be accomplished by the customer.

2. All files in the ‘{DATABASE DIRECTORY}\Mailbox\Inbox’ directory will be checked to determine if it’s an ERA file. The one exception to this is any file with a ‘.tmp’ extension. The reason for this is the ‘.tmp’ extension is used internally by the program. For example, if ‘ANSI853.ERA’ is an ERA file, the program will process the file into a temporary format. The original file is not modified. A new file is created with the format needed for processing; the new file name is the original file name with ‘.tmp’ appended. In our example, the new file name would be ‘ANSI853.ERA.tmp’. This is a temporary file used for processing the ERA file. In the event the ERA processing failed, the temporary file would not be deleted. Therefore it would exist with the ‘.tmp’ extension.

3. To determine if the files are ERA’s, all files are actually opened. The file is searched for the remit number from the payor, the check date, the payor’s receiver id, and the file type. The ANSI file type is 835. If a file contain ‘ST*835* at the proper location, it’s regarded as an ERA file. Otherwise, the file is ignored.

4. When the user opens the ‘Payments List’ screen, the files in the ‘{DATABASE DIRECTORY}\Mailbox\Inbox’ directory are processed for ERA’s. If one or more ERA files are found, a message will be display to the user showing how many ERA files were found. If a file has been added to ‘{DATABASE DIRECTORY}\Mailbox\Inbox’ while the payments list screen was open, that file will not appear in the list of processable ERA files until the payments list screen is closed then reopened.

5. To import the ERA files, the user needs to click ‘Edit’. Under ‘Edit’, the menu option ‘Import Remit Advice’ exists. Click this menu option to display the ERA file import screen.

6. The ‘Claim ERA List’ screen has five columns. ‘Process, ‘Already Processed’, ‘File Name’, ‘Check Date’, and ‘Payor’.

7. If a record has ‘Already Processed’ checked, the respective ERA file has already been imported into TeamDME!. The ‘CLAIM_ITEM_HISTORY_REMIT’ table in the database is where processed ERA information is stored. Specifially, the ‘REMIT_NUMBER’ field corresponds to the number from the file (TRN02). The ‘Already Processed’ checkbox is set automatically. If this is checked, the file will not process again.

8. For files to process, the ‘Process’ checkbox must be checked. To select a record, double click the ‘Process’ checkbox.

9. Click ‘OK’ to begin file processing.

10. If a file is a test file, a message will appear stating so. It will be processed, and an EOMB report will be generated, but the data will not be saved.

11. If a file is a production file, an EOMB report will be generated.

12. When the report screen is closed for a production file, the user is prompted for the correctness of the report. When prompted with ‘Is the report correct?’ after processing an ERA file, if the user selects ‘Yes’, the data is saved to ‘CLAIM_ITEM_HISTORY_REMIT’ and the payments are saved to ‘CLAIM_ITEM_PAYMENT’. At this point the file is moved from ‘{DATABASE DIRECTORY}\Mailbox\Inbox’ to ‘{DATABASE DIRECTORY}\Mailbox\Archived’. The file is also removed from the list screen that displays the files available for processing. A ‘Processing Successful’ message is displayed. This has not changed. What has changed, if the user selects ‘No’, then no processing takes place. The file remains in the ‘{DATABASE DIRECTORY}\Mailbox\Inbox’, not data is saved to the database, and the file still appears in the list of files available for processing. A message will be displayed showing the user that the file(s) was not processed. The file can be processed again since no data was saved.

13. If the user selects ‘Yes’ to ‘Is the report correct?’, and there is an error, then no processing takes place. The file remains in the ‘{DATABASE DIRECTORY}\Mailbox\Inbox’, not data is saved to the database, and the file still appears in the list of files available for processing. A message will be displayed showing the user that the file(s) was not processed. The file can be processed again since no data was saved. The most likely cause of this error is ‘FK_PAYMENT_CIP’, which is a foreign key violation. In most cases, this is an easy fix. Add a payment type ‘REC’ for recoupment. The database will have this payment type included, but the user can still delete it.

14. After clicking ‘Yes’ or ‘No’ when prompted for the correctness of the report, a message will be displayed to the user showing that processing was successful.

15. If the user clicked ‘Yes’, they must click the ‘Refresh’ button on the payment screen in order to show the payments that have been imported.

16. The only time files in the ‘{DATABASE DIRECTORY}\Mailbox\Inbox’ will be checked for ERA’s is when the ‘Payments List’ screen is opened.

17. Payments imported from an ERA file should ALWAYS mimic what a manual payment entry does.

18. Single EOB can be printed from customer edit screen, under the history tab, under the account tab by clicking on the ‘Print’ button. If the ‘EOMB Date’ column has a date in it, then that invoice has had an ERA file applied to it. If the menu option (Proof Of Payment – ERA) is enabled, then an ERA has been processed for that claim.

19. When importing a file, EOMB prints as it would be received from Medicare.

20. When printing secondary claim, EOMB will print for those claims in which an ERA was received.

21. The payment disbursement in Version 2005.1.0.2 calculation has changed. The secondary responsible is now equal to the primary allowed minus the primary payment. This means the the 80%/20% setup on the payor does not matter. The only exception to this is if there is no secondary payor. In this case, the responsible for the primary payor will be equal to the primary allowed minus the primary payment.

Note: If a file has been processed, it cannot be processed again. In order to process a file again, call technical support for help.

Note: Payment types need to include ‘REC’ for recoupment. A foreign key error will happen if this payment type is not in the your system.

Click here to sign up to enter payment automatically from Electronic Remittance Advice files in ANSI 5010 (835) format.