Overview
In the ERA Module, when the payer returns a Patient Responsibility, such as CARC code of a 1, 2, or 3, indicating that there is a patient's responsibility and you want to forward that patient's responsibility onto a secondary payer, there is a particular way you will want to process this claim. This article will explain the correct order of steps.
Step 1: Review the ERA
- Go to the ERA Module
- Click on the file name to open the ERA
- Select Payment Entry Mode at the top
- Click the Claim number link along the left.
- If the client has another payer, this will appear in red as This client has other payers; this is your indication that the client has more than one payer.
- If the client has another payer, this will appear in red as This client has other payers; this is your indication that the client has more than one payer.
- Verify that the payer is charging a patient responsibility. This will appear with a green flag and will also show in the Patient Responsibility section.
Important: In the ERA's Payment Entry Mode, verify that the Copy COB checkbox at the top is checked. This checkbox will copy the COB information from the Report Mode to ensure it's placed on the claim correctly.
Step 2: Post the Secondary Transaction Type
- In the Transaction (Tx) column click the more
button of the Patient Responsibility line.
- A list of transaction types will appear.
- Select Secondary.
- If there are multiple lines indicating Patient responsibility, select Secondary for each line.
- If there are multiple lines indicating Patient responsibility, select Secondary for each line.
- Click Save.
Step 3: Queue to the Secondary Payer
- In the Payer/Payment column, click the more button.
- A list of the client's payers will appear.
- Select the correct secondary payer.
- The payer you selected will appear in pink text. This indicates that the service line has been queued for billing to this payer. You will see it in the Billing Module > Add window, ready to be invoiced to the secondary payer.
- The payer you selected will appear in pink text. This indicates that the service line has been queued for billing to this payer. You will see it in the Billing Module > Add window, ready to be invoiced to the secondary payer.
NOTE: If a claim that contains a Patient Responsibility is saved without changing the transaction type to Secondary, the system will automatically create a bill line to the client. If that happens and you need to be reverse that bill, you can click on the payments link and adjust the entry.