How do I pull in ERAs from the clearinghouse and apply to invoices?
If you are not set up to pull in ERAs from the clearinghouse you can apply an adjustment to a client's invoice manually from the client's ledger.
Please note: currently adjustments do not affect the balance on the invoice.
1. Open the invoice by clicking Select an Action > Details.
2. Click + Adjustment at the top of the invoice.
3. Select the Type of Adjustment that you would like to apply to the invoice: Other, Deductible, Coinsurance, Copayment, Amount Exceeds Contracted Rate, Regulatory Surcharges, Provider Speciality, Sequestration or Other/Misc.
Choosing the adjustment type will autofill the Group and Reason code field.
Here are the adjustment types found in TheraNest, along with their Group and Reason codes and descriptions:
Deductible = PR 1: Amount was not paid due to being client responsibility: deductible.
Coinsurance = PR 2: Amount was not paid due to being client responsibility: coinsurance.
Copayment = PR 3: Amount was not paid due to being client responsibility: copayment.
Amount Exceeds Contracted Rate = CO 45: Amount was not paid as it exceeds the agreed upon insurance contracted rate.
Regulatory Surcharges = CO 137: Amount was not paid due to regulatory surcharges, assessments, allowances or health-related taxes.
Provider Speciality = CO 172: Amount not paid when performed/billed by a provider of this specialty.
Sequestration = CO 253: 2% payment reduction of contracted rate related to Medicare.
Misc/Other = This can be used with other Group and Reason Codes not listed above.
4. After you have selected the adjustment Type, you can enter the amount, adjudication/payment date, select which service to apply it to and mark whether it was paid or not.
Please note: When you submit an electronic claim to secondary you'll want to use the adjustments on the invoice so secondary knows which portions were not paid. The adjustment amounts identified as not paid is everything that the primary insurance did not cover.
Adjustment + Invoice Payments = Original Balance of Invoice
Adjustment = Unpaid amount
The Adjudication (Payment) Date = The date the claim was paid by primary ~ the ERA/EOB date or date on the check (if paid by paper check)
5. The Adjustment will show at the bottom of the invoice and will be pulled in when you submit the claim to the Secondary Insurance provider.