Overview

Procentive will flag a claim in the Electronic Remittance Advice (ERA) to make it stand out. This article will explain what each flag means.

Circle Flags

Blue Circle = Unbalanced

This flag is letting you know the Paid amount and the Amount used below do not match. The circle was designed to flag claim that are unbalanced to help you resolve an ERA that is not balancing or has unallocated funds.

Red Circle = Mismatched

This flag can alert you when claim information does not match. Specifically, something from Payment Entry Mode (the claim information in Procentive) does not match the Report Mode (the payer's remittance advice). This flag was designed to help troubleshoot problems within an ERA.

This flag is optional. The Procentive default is to not show this flag. If you wish to enable this flag, follow these steps:

Go to the Settings Module
Click on the Billing tab
Scroll to the bottom.
Locate the field Show mismatch flag in the ERA module.
- The default setting is Don't Show.
To enable, change the drop down to Show.
Click Change.

Rectangular Flags

The system will automatically generate red, purple, or green flags based on the rules set up in the Change Rules window. The flags below represent Procentive's default settings. Please note: There is a possibility someone in your organization change these settings.

Purple Rectangle = Takeback

This flag means that the payment line on the remittance was a negative amount, and so the payer is sending a reversal or takeback for the given claim.

Red Rectangle = Zero Payment

This means that the payment line on the remittance was equal to 0.

Green Rectangle = Patients Responsibility

This means the remittance has a CAS (Claim Adjustment Segment) of 1, 2, or 3, so there is a copay, coinsurance, or deductible for this claim. When you save a copay, coinsurance, or deductible, Procentive will automatically create an invoice for the client for the same date of service.

CAS 1: This is a deductible. Procentive will create a Deductible Adjustment for this CAS and Code.
CAS 2: This is a coinsurance. Procentive will create a Coinsurance Adjustment for this CAS and Code.
CAS 3: This is a copay. Procentive will create a Copay Adjustment for this CAS and Code.