In the ERAs window, double-click on an ERA.

Processing an ERA includes receiving the claim and finalizing the payment.

Double-click on a row. Any claims that were split by the payer will be matched and processed together.

All claims in the ERA list under Claims Paid. Right click a claim and select Go to Account to view patient's account information.

Raw Message: The electronic file sent by insurance. This is used for troubleshooting purposes. See ERA Raw Message.

Provider Adjustments: Double-click a row to open a simple window that can be used to copy text.

Detach Claim: When a claim cannot be processed in the ERA window, or, after processing the Claim an X is still not showing in the Recd column, follow the steps below:

  1. Highlight the problem claim and click Detach Claim. N/A will appear in the Recd column to indicate it has been detached from the ERA.
  2. Right click on the detached claim and select Go to Account.
    Note: If the patient is not found due to a name mismatch or other error, make note of the DateService and Status, then Select Patient manually.
  3. If not previously entered, add payment details on the claim using the standard Receive Claim process.
  4. Repeat steps 1-3 above as needed for any other claims that need to be detached from an ERA. After all the claims on an ERA are Received with an X or detached with an N/A, proceed to the next step to finalize the payment outside of the ERA window.
  5. To finalize payment for an ERA with a detached claim, double-click on any claim in the Account module. Click Batch and follow the normal Finalize Insurance Payment process. Once all claim payments have been processed or detached, the status of the ERA will change to Finalized*. The asterix (*) identifies ERAs with detached claims.

Find Claim Matches For Detached: Click to find claim matches for any detached claim (claims with a received status of N/A).

EOB Claim Details: Highlight a claim and select to view a breakdown of the claim. See EOB Claim Details.

Print: See Print ERA.

Delete: Delete this ERA. All claims must be manually detached.

Verify and Enter Payment

To receive a claim, double-click on it in the Claims Paid grid. If a matching claim is not found, you will be asked to manually locate it in ERA Match with Claim. If a matching claim is found, this window will open.

Verify that payment amounts are accurate. The amounts for EOB totals should match the Totals amounts.

Total Payment - this row will appear when insurance sends back a code or dollar amount that does not match the original claim. It can be left as is or can be manually applied to the appropriate claim items. If that is done make sure to zero out the InsPay field on the Total Payment line.

EOB Claim Adjustments, EOB Procedure Breakdown and EOB Totals are read only and for reference when entering payments.

Include Write-offs for Category Percentage and Medicaid/Flat CoPay plans: Check to include write-off amounts in payment grid for all plan types. Uncheck to zero out write-off amounts on all procedures for Category Percentage and Medicaid/Flat CoPay plans.

Split Claim: To split a claim, mark those to be split off by clicking in the Split column on individual procedures. Click Split Claim to split all selected procedures into a new claim.

Deductible: Click to move all deductible amounts to the selected row (it can be any row, including Total Payment).

Write Off: Click to write-off all unpaid amounts on all procedures.

Note: For in-network plans, if you change insurance paid or deductible amounts, manually change the write-off. If billing out-of-network plans, you may need to manually remove the write-off amounts. To only have write-offs post for PPO plan types, uncheck the option ERAs post Write-offs for Category Percentage and Medicaid/Flat CoPay in Manage Module Preferences.

Click OK to mark the claim as received. An X will show in the Recd column of the main ERA window. For each claim in the ERA, repeat verification process.

Finalize Payment

When every claim in the ERA is marked Received, click Finalize Payment.

Most information will be auto-populated. Enter any other details if needed.

Click OK to open the Insurance Payment window. Verify that the correct claims are attached and the amount is accurate.

If payment is paid via a prepaid insurance card and XCharge (OpenEdge) or PayConnect Window is enabled, use the XCharge of PayConnect button to process the payment. When the transaction is complete, the Edit Insurance Payment window will still be open and transaction details will show in the Note.

Click OK again to finalize the payment.

Secondary Claims: When a payment from a primary claim is finalized, Open Dental will give a message of patient's with secondary claims to send.

Supplemental Payments: Supplemental payments, claim corrections, and claim reversals can be done by processing an ERA as normal.