A Practice can receive ERA information from Claim.MD electronically and automatically which will update the invoices in TherapyMate for insurance clients.
Enrollments
Prior to this happening, the Practice must set up their Provider Enrollments by logging into Claim.MD and accessing the Provider Enrollment area and submitting the enrollments for each insurance provider they are going to bill. Submitting enrollments and having them completed by the insurance provider can take days to weeks to complete on their end. If you have questions about whether or not your enrollement with a provider is completed, contact them.
Submitted Claims
When a claim is submitted to Claim.MD, the claim is processed and sent to the insurance provider with a unique identifier. The insurance provider processes the claim and sends the results back to Claim.MD. Claim.MD will then send the claim results back to TherapyMate. If the unique identifier that was sent originally is received back, the patient's invoices will be updated with the claim results to the Practice doesn't need to do that manually.
Here is an example of an invoice that was updated after the results of a claim was received from Blue Cross Blue Shield:
In this example, the insurance payment was $97.43 and an insurance adjustment line was added to the invoice to account for the different of what was billed ($180.00) and what was paid.
BCBS indicated that the client is responsible for a $15.00 copay. A patient charge line was added. The copay was collected and now the invoice is finalized.
Normally that is all you have to do. You don't have to view the actual ERA since the invoice was updated for you automatically. Occasionally view an ERA is necessary it the ERA didn't post or you have questions about the details involved. Looking directly at an ERA will give you the details and more information as needed.
If a claim is lacking the unique identifier or there are other processing issues when the claim comes back from the Insurance Provider, an Exception will occur. To learn more about exceptions search for the article in the Help Center.
Viewing ERAs
There are a couple of ways to view the actual ERAs.
Option 1
Login to Claim.MD and click on the menu option called View ERA on the left. A list of all un-viewed ERA will be listed by insurance provider. After an ERA is viewed a little eyeball will appear next to it.
Here is an example of the ERA that shows viewed:
Option 2
Login to Claim.MD and click on the search menu option.
Type the client's last name in the box and/or other data as necessary to find a particular client's ERAs.
Click the Search button.
A list will appear showing all of the claims that were submitted for the client.
Click on the claim you have a question about. The claim will appear in CMS-1500 format. Next, click on the Show History/Notes button at the bottom.
When the claim history window opens, click on Full ERA to view the actual ERA.