ERAs (Electronic Remittance Advice) are the electronic version of your EOBs. If you do not have the 835s set up in your PHI system, you can still do everything related to billing, rebilling and all other actions related to the revenue cycle. 835’s are set up during the onboarding process with PHI.
Note: The data received in ERAs (payments, suggested adjustments/copays, denials, etc.) is directly from the payor. PHI solely makes the data available for your use.
1. To access the 835 ERAs, CLICK on the Practice icon and SELECT “835 ERAs” under the Billing heading.
2. The screen that appears by default lists all unposted ERAs. You may search ERAs by the “Retrieval Date” range, “Billing Source”, “ERA Type”, and “Include Posted”. CLICK “Get Results” to start your search. Retrieval date is the date in which the ERA was downloaded from Optum.
a. There are 2 ERA types, “ERA 835” and “Informational.” Informational ERAs are not associated with a payment, but have specific claim information.
3. An additional way to search 835s is the “Filter” field on the right side of the screen. You can search by identifying information such as Check or EFT number.
4. To open the ERA, CLICK the ID number.
5. After opening an ERA, the service lines are listed. A service line is inclusive of a bill code, date of service, charges, etc. (See below). Exceptions are indicated with a red button on the left side of the service line. Denials are highlighted in yellow so you can work your A/R. More details on exceptions are included further down in the guide.
6. There are 2 amounts under each section, the top amount is the information from the ERA that will be posted against the claim once you’ve accepted the ERA. The bottom amount is the current status of the claim within the invoice.
7. On the right hand side of each service line, is a green “Discovery” button. CLICK the Discovery button 
to access invoice details on the information for the payer.
Exceptions: An exception indicates something on the ERA does not match up with the data entered into the platform. e.g. Copays, Adjustments, etc.
8. To resolve the exception(s), CLICK the red “Exception(s)” button on the left hand side.
9. A window will then pop up to complete the exception. Example window below.
Exception: Title of the exception
Exception Message: Describes the exception.
Acknowledge: Requires you to acknowledge potential changes for this posting.
10. If PHI can’t locate the claim that corresponds to the service line, it will need to be matched manually. If an unmatched line has exceptions, you will get an error message when you click on the “Exceptions” button. Unmatched lines are typically indicated by the Invoice#, Claim#, or Bill Code being red.
11. To manually match a service line to a claim, SELECT the line and CLICK on the “Match” button in the top left.
12. A search window will open. The claim number will be pre-populated. CLICK “Get Results” to search for the service line. (Searching an older claim number will find the most recent claim lines)
If the claim number doesn’t return any results, remove the claim number from its field and type in the service date range and patient name, then CLICK “Get Results.”
SELECT the corresponding line that matches the line in the ERA. Make sure the Bill Code and Claim # match. If the claim number is different, it may have been previously rebilled. If you need to verify the claim history, CLICK on the Discovery button on the right hand side of the line in the search window.
13. Next, back in the 835 ERA window, some service lines may include denials. There will be a $0.00 amount under Payments, and there will typically be an exception under “Adjustments” (see the $40.00 in red below). CLICK “Codes & Reasons” numerical code to see the denial reason.
14. To transfer a claim to secondary/tertiary payor, CLICK on the $0.00 amount under “Transfer.” In the window that opens, choose the appropriate billing source and authorization. The rest of the required information will be filled in for you from the ERA. Please review the data for accuracy before you CLICK “Add.”
15. Next, CLICK on the dollar amount under Patient Responsibility that you have indicated for transfer to a secondary/tertiary payor, and change it to $0.00. Once you are done it will look like the screenshot below.
16. The Detail tab has the general payment information.
17. When all lines are matched and all exceptions are resolved, the ERA is ready to post. CLICK “Accept & Post” to accept all the payments, adjustments, and transfers in the ERA. The ERA will then show as a payment in the Payments screen and posted against the invoices.
18. If at any time you make a mistake, clicking CLOSE will not undo the actions you have taken. Instead, CLOSE the ERA. From the main ERA list screen, with the ERA highlighted, CLICK the … (ellipsis) and select Reprocess. NOTE: the ERA will appear back into the ERA list page once reprocessed.
Proprietary & Confidential