Switching: Claim Administration

Multiple new features have been brought into the setup screen for the ERA module and will be as follows:

• After the user has completed their changes to the relevant batch and is satisfied, the user must press the "Post batch" button and after posting, the user will receive a prompt window asking if the system can generate a report or not.

• The posted batch can now be found under the "Processed Remittance Advice" tab.

• 100% Resolved = Resolved Payments = Total Payments.

• In System options under the EDI tab, there is a toggle "Can only post batches that are 100% resolved". This feature will prohibit the user from posting ERA batches with a probability percentage lower than 100%. The user will only be able to post the batch after achieving 100% resolved status. (see figure 1.8.1 )

• A new tab has been brought in adjacent to the ERA Setup tab and is labelled the “ERA Matching options” tab, wherein the user can specify how the matching of the ERAs will be handled in terms of the cut-off amounts. Fixed fee settings on the ERA module and also if any shifts/write-offs will be applicable. 

• The final tab on the aforementioned screen will allow the user to choose to automatically resolve any unlinked amounts on the ERA that is = 0.

• Auto allocate fixed fee will only be applicable to Hospital/Clinic environments.

• If the user gets the following error, please see the 2 recommendations:
  

• Do the necessary preparations by saving the batches before posting them. Mark the ERA’s worked on that day and post with using them,  “Post selected ERA’s” button.
  
• This usually happens with extremely large ERA's when a lot of users are busy on the system. Try to post during a quieter time during the day or after hours. If there is more than one batch with this error follow the steps below, using the post selected batches.

Re-Match ERA Button

• Gives the user the option to re-match the ERA before posting of ERA batches.
  

TAKE NOTE: ALL user actions will be deleted from when the batch was originally imported.

Batch Progression Column

• Give the user information when an ERA batch has successfully been matched or inform the user that this batch needs manual intervention.
  

Handling of “Suspense” and “Intervention” ERA’s on the New Method

• On the Imported Remittance Advice tab, the user will notice that any ERA’s with a “batch progress” lower than 100%, the users will manually need to intervene and either link the claim manually or post the ERA to the pre-configured Suspense account.
  

Original Status:

1. Suspense:

Suspense = No debtor match could be found. Usually happens when moving from another PMA to GoodX should decrease with time.

When handling an ERA marked with “Suspense” status, the user needs to link the claim to a possible case/account. To perform this action, the user needs to select the relevant “Suspense” ERA and click on the “Link Account” button. (Please see Figure 2.1)

• Upon pressing the button, the next popup screen will display possible debtors/cases that can be linked to.
• The system will do additional matching on the following: dependant number, invoice date, amount, and surname. The probability percentage will be calculated according to the match “found”.

System showing out possible debtors to link “Suspense” claims 

• The system will query for cases linked to the debtor/cases, excluding the 1 payment it is currently matched to.
  
• When the relevant case is selected and the system confirming the user’s choice, the case will be linked to the ERA where the status was on "Suspense".
  
• When the user confirms that the correct case is selected, the system will do the item matching (as done in the initial matching process), chances are pretty good that items will match-up, and that the status will change from suspense to match.
  
• However if items could not be matched, the user needs to go and match it manually.
  
• After the user is satisfied with the changes, the user needs to press the “Resolve” button, before saving the batch.

(Matching Process = Account matched 1 or more items not matched)

• When handling an ERA marked with an “Intervention" status, the system was only able to find 1 or more matches on the File or Medical aid Number. Reason 2, none of the following fields could be matched: PMA item ID, matching account, file and medical aid.