ERAs and EOBs with PCC

After a payer reviews your electronic claim, they will send your practice an explanation of what charges are paid, adjusted, or denied.

  • On paper, this information arrives as an Explanation of Benefits (EOB) and a check.
  • The electronic version of an EOB is called an Electronic Remittance Advice, or ERA. An ERA usually arrives in coordination with a direct deposit to your practice’s bank account.

You can use PCC software to post payment and adjustment information from both ERAs and traditional EOBs. (Post Insurance Payments, Read ERA 835s from Payers)

How Do I Get Signed Up for ERAs with Carriers?

Some insurance carriers require special registration steps to sign up to receive ERAs. Since an ERA interface is usually required to receive payments electronically and to use PCC’s auto-posting features, you should sign up for ERA with as many of your major carriers as you can.

  • Contact PCC Support for help determining your biggest payers and to find out how to sign up for ERA.
  • Or, contact PCC Support about a specific payer, and we will begin the setup process. It is helpful if you include your name, contact and practice information, and the insurance payer’s national identification number (the “payer ID”).

ERAs and Other Electronic Claim Communication is Part of Your PCC Comprehensive Care Plan: ERA connections, as with electronic claims and other forms of electronic data exchange, are services included with your Comprehensive Care Plan with PCC.

When Will I Autopost ERAs, and When Will I Manually Post Payments and Adjustments?

Your PCC system can automatically receive ERAs from most payers and claim clearinghouses. You can then use PCC’s software to automatically post incoming ERAs against the charge records on your system. While posting, PCC will check for errors or problems that require your intervention, such as a claim rejection or a payment that does not meet your contracted amount. You can review those issues and post payments and adjustments manually.

  • Automatic ERAs: Use Auto-Post Insurance Payments (autopip) to automatically post all the straightforward payments and adjustments from participating carriers who send you an ERA. Then you can review and work directly with only those claim responses that need special attention.

  • Manual: You can post unusual payer responses on ERAs and paper EOBs in the Post Insurance Payments Program (pip).

  • Print Out an ERA: You can print out any ERA from the ecsreports program and post it manually in pip[/pip].

    • When My PCC System Receives ERAs and EOBs, How Do I Review and Post Them?

    You can learn how to automatically or manually post ERAs and EOBs by reading the following article:

    PCC Support can also train you and your practice billing staff on how to generate and send claims, post payments, and follow up on outstanding balances. Contact us at any time for help.

    What Can PCC Automatically Post from Incoming ERAs, and What Will Need My Special Attention?

    You can use Auto-Post (autopip) to automatically post standard payments and adjustments from ERAs from participating carriers that fully pay off a claim, meet all contractual allowable amounts you have configured, and match all claim information (such as patient DOB and copay amount).

    Autopost will not post any denials or other messages, payments or adjustments that do not match up with the claim information. Autopost will create a special Manual Post report for insurance incentive payments, “take backs”, capitation payments, claim responses that do not account for the full claim amount, payments without a matching Claim ID# in Partner, or payments that suggest a different copay amount than was indicated in billing.

    Partner is very cautious with claim response information. When reviewing ERAs, Autopost will “err on the side of caution” and send the details to a Manual Report.

    You can also customize which CARCs (Claim Adjustment Reason Codes) will autopost and which will drop directly to the Manual Post Report. In PCC 9.4, you can customize whether RARC codes can cause claims to drop to the Manual Post Report or not.

    View CARC and Business Scenarios on ERAs

    When you review ERAs that require manual posting, you will see an explanation of the payer’s response. ERAs include CARC as well as the new “Business Scenarios”, which you can review to understand the status of a claim’s charges.

    What is a Business Scenario?: Insurance payers add CARCs (Claim Adjustment Reason Codes) to your EOBs and ERAs to explain payments and adjustments. There are hundreds of CARCs. New Affordable Care Act regulations group these codes into four straightforward “Business Scenarios” which use everyday language to clarify CARCs. When you view ERAs in PCC, you will continue to see CARC codes, now with the addition of their associated Business Scenarios as well as any related CPT codes.

    • Last modified: February 20, 2023