Switching: Claim Administration

Introduction:

ERA: Electronic Remittance Advice is a way of importing receipts captured by the medical aids against debtors or cases into GoodX in a structured way. 

ERA Dictionary Introduction:

• A new development has been done for the ERA functionality to generate a Rejection Dictionary every time matching has been made. This will also be added and ordered by funds and Rejection reason codes.
  
• Consolidation of Medical Aid rejection messages to a local set/dictionary of rejection messages.
  

E.g. 

• Discovery 276 = No Funds
  
• Medihelp M847 = No Funds
  

Local Dictionary:

• NF = No Funds
  
• Map 276 and M847 to NF
  

So that the practice can have a “standard set” of rejection messages.

TAKE NOTE:

• You have to register for ERA's to be able to start using your ERA features.
  
• Remember that you have to set up the ERA's before you can start to use it.

ERA Dictionary Activation and Configuration

System Options:

• GxOptions >> System options >> EDI.
  
• This feature will be on default so the user needs to manually add this Dictionary Feature.

• A normal pop up notification screen will need confirmation from the user to activate the feature, and the configuration path to start the users’ ERA mapping.
  

• After confirming the changes, the user can save the following changes and head to the next module, “GoodXManage” for the mapping setup.

GxManage:

• GxManage >> Global list >> Lists >> ERA Rejection Dictionary.
  
• Local ERA Rejection Dictionary.
• Dictionary Mapping.

• Firstly, the user needs to configure descriptions and or codes for each local environment. This can be done under the “Local ERA Rejection Dictionary”.
  

(eRA Dictionary: Era Rejection codes configuration screen. List all created codes for the local Era Rejection Dictionary feature.)

• The user can simply add/edit codes and descriptions as he/she wishes. After adding codes, the user can now link (map) their local codes to Era codes received from the switch.
  
• To do this, the user can exit the “Era Rejection Codes” screen and head to the “Dictionary Mapping” functionality.
  

Dictionary Mapping: <Link somethings???>

(eRA Dictionary mapping: Era Rejection code Dictionary linking screen. This screen will allow the user to link the local generic codes to an era code.)

1. Search: The search functionality will work on all visible columns (Excluding the Modified column).
   
2. Generic code - Per line: This gives the user the option to link their local code (Created under the “Local ERA Rejection Dictionary”).
   
3. Generic code - Update All: Same as above, but this will update all visible Scheme codes on the list.
   
4. Save data: After mapping each code, the user must save the following changes for the linking to take place.
   
5. Close: Exit the screen.
   

TAKE NOTE: This feature accumulates ERA codes when processing era rejection claims. These list of codes can’t be added manually.

Admittance Management and Statement Report screens:

• After the mapping and configuration have been made, the following screens and features will be visible.
  
• GxDebs >> Admittance >> selected relevant rejected claim >> ERA notes.

(Example of an eRA Dictionary mapping in effect. Please note the example above is just for demonstration purposes only.)

• As seen in Figure above, it will show the mapping done between the ERA and Local codes.

• An option to print the new Local codes has been added under the report configuration setup on statements. This feature can be found under and Statement profile >> edit >> Style >> under Group box “ERA Rejection Messages”.

(eRA Rejection message option: Giving the users the option to specify which reason code should display on each print of a statement.)