Overview
Possible Causes
Payment Amount Was Entered Incorrectly
Payment for a Claim Was Allocated Incorrectly
A Different Transaction Was Allocated Incorrectly
Payment Amount Was Entered Incorrectly
To review the payment amount:
- Open the ERA.
- Click Payment Entry Mode.
- Click the Edit link at the top.
- The New Payment window will appear.
- The New Payment window will appear.
- Verify that Amount Received in the New Payment window matches the Amount at the top of Payment Entry Mode.
- Payment Entry Mode reflects the payers report as the amount the payer paid.
- If the amounts are different, correct the Amount Received in the New Payment window.
- Note: These amounts should only be different if an ERA contains payments or takebacks for claims that were not billed out of Procentive.
Payment for a Claim Was Allocated Incorrectly
To review payments allocated for this ERA:
- Open the ERA.
- In Payment Entry Mode, click on a Claim number listed on the left.
- The payment information will appear to the right.
- The payment information will appear to the right.
- Verify the following:
- The Paid and Amount Used Below match; the Amount Used Below should be green.
- Note: The Amount Used Below will appear red if Takeback Credits are applied. In this situation, it's okay that the amounts do not match as long as the Takeback Credits match the amount paid for this claim.
- Note: The Amount Used Below will appear red if Takeback Credits are applied. In this situation, it's okay that the amounts do not match as long as the Takeback Credits match the amount paid for this claim.
- The Payment Reference listed on the claim (below) matches this ERA's Payment Reference (above).
- This means the payment posted was from this ERA.
- This means the payment posted was from this ERA.
- Click through each of the claim numbers on this ERA, to verify each for accuracy.
- The Paid and Amount Used Below match; the Amount Used Below should be green.
NOTE: If a correction is needed, the change will need to be done manually in the Payments Module. Click on the payments link to be taken to the Payments module for this client and Date of Service (DOS).
A Different Transaction Was Allocated Incorrectly
To verify the allocations applied on this ERA, compare the Allocation Report with Report Mode.
Allocation Report
While in Payment Entry Mode, click the Payment Reference link at the top.
- The Allocation Report (shown below) will open; it lists all allocations from this payment.
Report Mode
In the ERA, click Report Mode.
- The Report Mode (shown below) is the payer's report; it details how the payer allocated the payment.
- This is the equivalent to a paper EOB.
- This is the equivalent to a paper EOB.
Compare the Allocation Report to Report Mode
If a discrepancy is found, the change will need to be done manually in the Payments Module. Click the pmt link in Report Mode to be taken to the Payments module for this client and DOS.
Helpful Hint: Print out the Allocation Report and Report mode to cross reference and mark off which claims are correct or which claims need to be resolved.