Overview
The Payment Batch / Import Exceptions tab displays the distributions in an ERA file received from a payer. The import process populates this tab with the list of imported distributions included in the payment batch.
Use the tab to verify the distributions imported from an ERA file. The exceptions information in this tab is specific to the Payment Batch created from the imported ERA file.
Field Definitions
Field | Type | Required | Description |
|---|---|---|---|
| Batch Exceptions Section | The section contains a list of the exceptions in the PLB segment. Payments listed in this area must be applied manually using the ERA Payment Processing Result (EPPR) report. Use this report to identify the payment information. The information included in the PLB segment is payer specific and will differ from payer to payer. | ||
| ID | Display Only (system-generated) | Yes | The unique identification number assigned to the exception line. |
| Severity | Display Only (system-generated) | Yes | The classification of the exception: WARNING or INFO (informational). |
| Message | Display Only (system-generated) | Yes | The actual warning or informational message that caused the exception. |
| Service Lines Section | This section contains a list of payments by service lines that were imported from the ERA file. | ||
| Show processed distributions | Checkbox | No | If checked, the service lines displayed will include processed distributions. |
| Show unprocessed distributions | Checkbox | No | If checked, the service lines displayed will include unprocessed distributions. |
| Claim ID | Display Only (pulled from ERA) | Yes | The unique identification number assigned to the claim. |
| Patient | Display Only (pulled from ERA) | Yes | The name of the patient on the claim. |
| Payer Control # | Display Only (pulled from ERA) | Yes | The unique identification number issued by a payer that identifies the payment from that payer. |
| Date of Service | Display Only (pulled from ERA) | Yes | The date of service of the procedure. |
| ASA/CPT | Display Only (pulled from ERA) | Yes | The procedure billed on the case. |
| Billed | Display Only (pulled from ERA) | Yes | The amount billed for the procedure. |
| Allowed | Display Only (pulled from ERA) | Yes | The amount the payer will reimburse for the procedure. |
| Deductible | Display Only (pulled from ERA) | Yes | The amount the insured is responsible to pay before the payer is responsible for reimbursement. The deductible amount has no impact on the account balance and is recorded for informational purposes only. This dollar amount is reported by the payer on the EOB. The deductible information is required on the claim for Coordination of Benefits (COB) with a secondary payer. |
| Copay | Display Only (system-generated) | No | The amount of the service for which the insured is responsible. For example, the plan may stipulate that the insured must pay $20.00 for an office visit. The copay amount has no impact on the account balance and is recorded for informational purposes only. |
| Cont WO | Display Only (pulled from ERA) | Yes | The calculated amount being written off due to the contractual agreement between the practice and the primary payer. Contractual writeoffs pertain only to the primary payer on the claim. The contractual writeoff amount is the difference of the billed amount and the allow amount (Billed – Allow = Cont WO). This amount will be recorded as the CWOFF activity code in active AR. |
| Payment | Display Only (pulled from ERA) | Yes | The amount being applied to the service line. This amount cannot exceed the allowed amount. |
| Remarks | Display Only (pulled from ERA) | No | The additional information provided by the payer about the service line distribution. |
| Adjustments | Display Only (pulled from ERA) | Yes | The group and reason codes that describe why the claim is being adjusted by the payer. This information is included on the ERA file as a means of communicating from one payer to another the reason the claim was not paid as it was billed. Group and reason codes are often referred to as denial codes. For example, PR (Patient Responsibility) is a group code that can have a reason code of 1, indicating that the amount of the adjustment is due to a deductible requirement and therefore the responsibility of the patient. Service line distributions can have multiple group and reason codes that are separated by commas, for example, CO-45, PR-2. |
| Service Level Exceptions Section | If the service line includes an exception, the exception messages appear in the Service Level Exceptions section. First, click the service line distribution. If there are exceptions attached to the service line, they appear in the area indicated. Not all service lines will have service level exceptions. | ||
| ID | Display Only (system-generated) | Yes | The unique identification number assigned to the exception line. |
| Severity | Display Only (system-generated) | Yes | The classification of the exception: WARNING or INFO (informational). |
| Message | Display Only (system-generated) | Yes | The actual warning or informational message that caused the exception. |
Button Descriptions
Button | Shortcut Keys | Description | Step-By-Step Guides |
|---|---|---|---|
| [Alt] + [P] | To generate the Batch Exception listing report to review batch exceptions from the imported ERA file. Use this report to reconcile the batch exceptions listed in the PLB segment of the ERA file. |
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| Download | [Alt] + [D] | To download the ERA file from the clearinghouse to output data from the ERA file to the standard Medicare EOB form through the Medicare Easy Print software. |
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| Print Detail | [Alt] + [N] | To generate the Claim Detail report, which mimics the information presented on the Claim Detail tab of the Medicare Remit Easy Print software. This option lists the claim detail for the selected service line only. |
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| Print Remit | [Alt] + [T] | To generate the Remit Detail report, which mimics the information presented on the Claim Detail tab of the Medicare Remit Easy Print software. This option lists the claim detail for all service lines listed. |
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| Print EPPR | [Alt] + [R] | To generate the ERA Payment Processing Result report for reviewing the payment distributions from the imported payments. Use this report to reconcile the service level exceptions and the service line distributions of payments. |
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