Electronic Remittance Advice (ERA) Toolkit
Tired of paper remittance statements cluttering your office? Frustrated by the inconsistency of health plans’ proprietary payment adjustment codes? Looking for ways to simplify remittance and payment processing? Consider adopting standard ERA to save your practice both time and money.
Learn how to implement this standard electronic transaction—and make the most of it. Whether you’re just beginning to consider ERA or you’re looking to improve your current ERA processing, this toolkit will give you guidance and helpful tips on ERA implementation.
- Getting started with ERA provides a basic overview of the ERA and its content, describes the advantages of automating remittance processing and offers tips for ERA enrollment. It also describes the standardized code sets used in the ERA by all payers and what they mean to physician practices.
- Critical conversations with trading partners about ERA lists questions to ask health plans, clearinghouses and practice management system vendors about their ERA handling and capabilities and describes how other stakeholders impact practices receiving the ERA. Discussing these topics with your trading partners ensures that your practice has all of the information needed to successfully implement ERA.
- ERA processing tips outlines ERA processing flows and tips for practices and offers information on handling overpayment recovery and non-claim-related adjustments in an automated fashion. This section also discusses the advantages of implementing the ERA with standard electronic funds transfer (EFT). To learn more about EFT, access the AMA’s EFT Toolkit.
Interested in all three resources? You can download a printer-friendly version of the entire toolkit as a single document.
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Claims Workflow Assistant: Check out the AMA's Claims Workflow Assistant, a resource designed to assist physician practices in understanding the codes and contents of ERAs and other health plan payment remittance information.
Appeals Letters: The AMA has a series of letter templates that AMA members can use to appeal health plan payment edits and to address payment concerns with health plans and patients.
Remittance code information:
- Consult additional information from the Washington Publishing Company website about the Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs), which are the standard codes used in ERA transactions.
- Accredited Standards Committee (ASC) X12, a standards development organization for electronic information exchange that develops the electronic transaction standards, has released a Type 2 Technical Report (TR2) identifying usage standards for CARCs and RARCs conveyed in ERA transactions, which is available for purchase through their website.
“ERAse payment issues with ERA” is an archived AMA webinar providing information on effective use of the ERA transaction. The webinar highlights ERA processing tips and features a demonstration of the AMA Claims Workflow Assistant code look-up tool.
AMA Electronic Funds Transfer (EFT) Toolkit
ERA and EFT work hand in hand to streamline remittance and payment processes. Access the AMA's EFT toolkit to learn more about using the EFT transaction for claims payments.
- Medicare Remit Easy Print (MREP) software allows physicians and other health care providers to view and print ERAs and additional information related to Medicare payments.
- CMS education on ERA/EFT: Learn how operating rules for EFT/ERA can speed up payment in your practice by consulting a CMS publication offering guidance on ERA/EFT.
ERA Operating Rules
The ERA operating rules, developed by Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange, are the necessary business rules and guidelines for ERA that are not defined by the regulation or implementation guide.