Overview
Electronic Remittance Advice (ERA) is an efficient way to automate the pre filling of Explanation of Benefits (EOBs) using information from ERA files (sometimes referred to as 835 files) provided by your clearinghouse. While ChiroHD autofills the EOB details, it does not automatically post the EOB. Instead, you review and approve all ERA details before finalizing the posting, ensuring accuracy and control over your billing process.
This guide will walk you through setting up ERA integration, resolving common issues, and managing ERA files effectively in ChiroHD.
Setting Up ERA Integration
Coordinate with Your Clearinghouse
Start by contacting your clearinghouse (e.g., Office Ally or Trizetto) to enable ERA files for your specific payers. Some payers may not support ERA files, so you might need to contact them directly for clarification. Keep in mind that ChiroHD cannot assist with payer-specific setup processes.
*Getting established with ERA files can take a long time depending on the payer, please start this process as soon as you can.*
Request SFTP Credentials
Request SFTP credentials (username and password) from your clearinghouse. These credentials are separate from the ones you use to log in to your clearinghouse portal. Ensure you specifically ask for SFTP credentials.
Configure ChiroHD Settings
Log in to your live ChiroHD location and navigate to:
Settings > Initial Setup > Integrations > Clearinghouse.Select your clearinghouse and enter the SFTP credentials (username and password).
Click the “Test SFTP Connection” button to verify the credentials. If the connection fails, contact your clearinghouse to ensure you have the correct details.
Set the sync start date to specify when ChiroHD should begin pulling ERA files. Note that ChiroHD cannot retroactively retrieve files from before this date.
Save and Activate Sync
Once the credentials are validated, save your settings.
ERA Retrieval Process
ChiroHD retrieves ERA files from your clearinghouse approximately once every hour. There may be a delay of up to one hour between when an ERA file is available in your clearinghouse and when it appears in ChiroHD.
Navigating the Insurance Dashboard
The Insurance Dashboard provides access to all insurance-related tasks, including:
Creating claims.
Posting EOBs.
Processing ERA files.
Key Sections of the Insurance Dashboard:
Accounts Receivable: Displays unsettled services on insurance-related cases.
Addressable Unbilled: This represents the total value of services currently held in greensheets that remain unbillable until the necessary corrections are made.
Pending EOBs: Shows EOBs that have been started manually and saved as drafts, or ERA files awaiting review and finalization.
ERAs: Lists failed ERA files with errors that need to be addressed before processing.
Only users with insurance permissions can access this dashboard.
Managing ERA Files
Automatic Syncing of ERA Files
ChiroHD retrieves ERA files from your clearinghouse approximately once every hour. There may be a delay of up to one hour between when an ERA file is available in your clearinghouse and when it appears in ChiroHD.Manual Upload Option
If needed, you can manually upload an ERA file that was not automatically retrieved by using the Upload ERA button in the Insurance Dashboard.
Pending vs. Failed EOBs:
Pending EOBs: These are files that have either passed automated checks or consist of EOBs—whether manually entered or imported from ERA files—that are saved as drafts awaiting your review.
Failed ERAs: Files with errors (e.g., unmapped reason codes or data mismatches) that need resolution before processing.
Both the Pending EOBs and the failed ERAs sections require attention from the office. ERA files do not post automatically, making it essential for the office to regularly review and manage these sections to ensure timely posting of EOBs.
Reviewing and Posting ERAs - Handling the Pending EOB Section
Posting Options
Review and Post EOB
Proceed with posting an ERA file that has successfully passed validation and is now ready for your review and final posting.
Mark as Manually Entered
Offices may sometimes choose to manually post an EOB instead of relying on the synced ERA file—or there might be instances where an EOB was manually posted without cross-checking the ERA file in ChiroHD. In such cases, the manually posted EOB will still appear as an outstanding task on your insurance dashboard. To clear this, click on "Mark as Manually Entered." Use this option only when the EOB has indeed been manually posted; it should not be used to clear any unaddressed line items.
Resume
When an EOB is saved as a draft, a "Resume" button appears, allowing you to seamlessly continue editing your draft from where you left off.
EOB Posting Process
Click Review and Post EOB.
EOB Posting Screen:
Verify details such as payer name, service dates, payment type, check number, and amounts. If necessary, adjust fields like the memo or payment type.
Make sure to verify every pre-filled line on the EOB before finalizing. This process ensures that the ERA will post as desired. This is why we do not automatically post an ERA file, we pre-fill out the information for your review.
Finalization:
After verifying and correcting any information, click Finalize to post the EOB. The posted data will update the patient’s ledger and your collections.
Additional Tools on the EOB Posting Screen
Summary Button:
Displays every patient listed on the EOB in a scrolling format.
Mark as Incorrect: Use this button to flag issues for backend review if an allocation is incorrect. Be as specific as possible to ensure accurate documentation.
Important Note: This does not mean you should wait for ChiroHD's engineering team to resolve the allocation matter. Flagging simply alerts our engineers for evaluation—it does not request a fix. You are responsible for manually correcting the information, which may involve creating a custom reason code behavior, adjusting column amounts to align with the desired outcome, or other necessary modifications.
Save
Save the EOB as a draft if you are not ready to finalize, keeping it in the Pending EOB section until further review.
Handling Failed ERA Files and Troubleshooting
*The video included at the top shows step-by-step troubleshooting techniques*
Failed ERAs occur when errors such as unmapped reason codes or mismatched data prevent processing. These files are listed in the Failed ERAs section and require action before they can be finalized.
Steps to Resolve Failed ERAs:
Identify the Error
Click “Attempt Reprocess ERA” to expose rejection reasons.
Common issues include mismatched patient names, cannot match services, or unmapped reason codes.
Correct the Error
Mapping Insurance Aliases:
Error message - "Unable to find a matching patient name or patient insurance alias.
If the patient's name varies slightly between the payer and ChiroHD (e.g., a missing hyphen), create an insurance alias to link the names.
Setting up an insurance alias is covered in the above video. Timestamp 12:07.
Mapping an Insurance Alias:
If the discrepancy is minor:
Create/Map an alias to link the name from the ERA file with the corresponding patient record. This creates a reference so that future ERA files using the alternate name will automatically be recognized.If the patient’s name is incorrect:
Update the patient’s record in ChiroHD to reflect the correct name. Only map an alias if you prefer not to change the patient’s official record.
View Insurance Alias:
To see if a patient has an insurance alias set up, or to view the specific of the alias, navigate to the patient’s insurance case and open the Insurance Coverage tab.Reprocess the ERA
Once corrections are made, click “Attempt Reprocess ERA” again to validate the changes. Successfully processed files move to the Pending EOBs section.
Cannot match service:
Error message - "Service not found with matching date of service"
If a service was billed out, but then afterward voided or moved to another case, the ERA will fail because there are mismatched services. We have made adjustments in ChiroHD so this is not possible moving forward, but previously billed services may have been allowed to be moved.
Troubleshooting mismatched services is covered in the above video. Timestamp 14:23.
Identify the Error Message:
Note the exact error message provided by the system. For example, it may say, “Service not found with matching date of service for Mickey Mouse on 10/30/24.”
This indicates that the service information in the ERA file doesn’t match the corresponding data in ChiroHD.
Download and Open the ERA File:
Click on the ERA file in question. It will typically download as a ZIP file containing two files: an 835 file and a text file.
Open the text file for a clear, readable version of the ERA details.
Review the ERA File Details:
Search for the Patient's Name: Use the text file’s search function to locate the patient’s name.
Identify Service Codes and Dates: Look for the list of services (for example, service codes like 98941 or 97012) and the corresponding date(s) of service mentioned in the file.
Compare with the ChiroHD Ledger:
Access the Patient’s Ledger: Navigate to the Transactions Ledger in ChiroHD.
Locate the Relevant Date: Scroll to the date indicated in the error message (e.g., 10/30/24).
Match Service Details: Compare the service codes and details listed in the ERA file with those in the ledger.
Check Voided or Adjusted Items:
If a service code from the ERA file appears in ChiroHD as voided, this indicates the service was voided after the ERA file was generated. To view voided items on the ledger, click “Show Voided Items”; these items will be highlighted in red.
Occasionally, services may be transferred—for example, from an insurance case to cash billing—which can also lead to discrepancies. Please note that the ability to move billed services between cases is now disabled in ChiroHD.
Determine and Apply Corrections:
If a Service Was Voided:
Verify if the voiding was correct. If it wasn’t intended, update the ledger to reflect the correct status.
If There’s a Data Mismatch:
Ensure that the service details (codes, dates, amounts) in ChiroHD match those in the ERA file.
Make any necessary adjustments in ChiroHD so that the ledger accurately reflects the services billed.
Reconcile Discrepancies:
Consult with your billing or accounting team if you need to confirm why a service was altered after being built in the system.
Reprocess the ERA
Once corrections are made, click “Attempt Reprocess ERA” again to validate the changes. Successfully processed files move to the Pending EOBs section.
Unmapped Reason Code:
Error message - "No defined group code/ reason code pair"
Although we have numerous reason codes mapped, there may be a reason code that is not mapped. To resolve this, the office will need to create a custom reason code behavior.
Setting up a custom reason code behavior is covered in the above video. Timestamp 17:23.
Pre-Mapped Codes:
ChiroHD comes with extensive mappings for common reason codes (e.g., reason code 3 mapping to a write-off, reason code 35 mapping to Other Patient Amount, and reason code 197 mapping to Rejection).When to Create Custom Behaviors:
If you encounter a reason code that is not mapped, or is not mapped to your preference, you can create a custom behavior to ensure that ERA files pass validation.
Steps to Create Custom Reason Code Behaviors
Access System-Level Dashboard:
You must have system-level admin permissions. Click the green box in the top right corner to navigate to the system-level dashboard.Navigate to Reason Code Behaviors:
Select the Insurance tab and click on Reason Code Behaviors.Creating a Behavior:
Click Create Behavior.
Enter the reason code number and define its behavior (e.g., does it map to co-insurance, Other Patient Amount, or is it a rejection?).
Decide the appropriate action (e.g., if a rejection, should the item remain under insurance responsibility or be shifted to patient responsibility?).
Apply the Custom Behavior:
Once created, the custom reason code behavior will serve as the default mapping for all offices under your system dashboard, affecting all relevant locations and payers.
Finalizing Changes:
Return to the Insurance Dashboard and click Attempt Reprocess ERA to recheck ERA files with the new mappings.
Manually Post if Necessary
If time-sensitive, manually post the EOB and mark the ERA as “Manually Entered” in the dashboard to clear the line item.
Additional Tips for Managing ERAs
Save as Draft: If you’re not ready to finalize an EOB, save it as a draft. Drafts remain in the Pending EOBs section until finalized.
Manual Oversight:
While ERA posting automates data entry, manual review remains crucial. Always verify the prefilled EOB details before finalizing.Regular Monitoring:
Regularly check the Pending EOBs and Failed ERA sections for action items that need attention.Stay Updated:
Ensure that your SFTP credentials and sync start date are correctly set up to prevent any disruption in ERA file retrieval.
Conclusion
ERA integration in ChiroHD combines automation and manual review to streamline the EOB posting process while maintaining accuracy. By setting up ERA correctly, addressing errors, and leveraging tools like custom reason code mapping, you can manage ERA files efficiently and ensure accurate billing.