TheraNest users with Billing Permissions AND permissions to submit claims to the clearinghouse will be able to perform the actions in this article.
Before You Begin
These are the steps for customers not using Apex Clearinghouse. Please click here for that workflow.
- Click Billing on the Primary Navigation Bar
- In the sidebar menu click Process Claim Payments (ERA)
- The application will automatically check your clearinghouse account for ERA/835 files and will pull them into your TheraNest account to be applied to your client's invoices.
You will see “Checking…” on the screen when the page is loading your files. When loading is finished, claims will automatically populate below the Downloaded ERA Files header. Use the toggles to view files marked as Not Processed, Processed, or all files.
- Click on a file to view its details and the list of payments for its related invoices.
- In the Payer column be sure to select one for each claim where no payer is listed.
- You can update individual payments in the Status column and click Mark as.. Choose Processed or you can use the checkboxes to the left of the client names to select multiple payments.
- Click the Process Selected Payments button or the Adjust for $0 Payments button when applicable. Adjust for $0 Payments means insurance paid nothing but that amount was applied to their deductible. Clicking that button makes the payment amount no longer the insurance's responsibility but now the client's. You'll see this reflected on the ledger. Please note that once a payment has been marked as Processed, it cannot be reverted. To see processed payments, make sure to click the checkbox next to Show Processed Payments.
- If the payment from the insurance company matches the balance due on the invoice, then the claim will be marked as Paid on the Submitted Claims tab automatically.
- If the payment from the insurance company is less than the balance due, you will need to mark the claim as Paid manually on the Submitted tab page.
Manually Upload Files
To manually upload ERA/835 files, click the Manually Upload Files button at the top of the page.