The information provided below is for ERAs troubleshooting.
After receiving a claim, the X is not showing in the Rec'd column, or the claim cannot be processed in the ERA window.
Highlight the problematic claim and click the Detach button, then process the ERA outside of the ERA window as a bulk check.
After entering payments, patient accounts show a credit.
The plan type is not set to PPO Percentage. An in-network insurance plan must be set to PPO Percentage for write-offs to calculate correctly. See PPO Insurance Plan If using an out-of-network plan (category percentage) you may need to manually zero out write-offs on procedures.
How do I manually download reports?
I have a duplicate ERA.
Double-click the duplicate ERA, then click Delete.
When clicking Send Claims, receive error: Error retrieving. Era request unsuccessful. Error message received directly from ClaimConnect: 150. Service Not Contracted.
This means you are not signed up for the ERA download service with ClaimConnect. You have two options:
ClaimConnect Note: Once ERAs are downloaded they are marked processed on the ClaimConnect website. To mark an ERA as unprocessed (e.g. if there is an error), do so on the ClaimConnect website.
Insurance sent back different code than what was billed (e.g. FMX instead of Pano/BW).
Open Dental will post payment as total. You can leave this as is, or split payment between completed procedures.
Logic: Sometimes EOBs do not itemize payments by procedure. In these cases, paid amounts are assigned to the Total Payment amount. If procedure payments are known (itemized), then those payments will be subtracted from the Total Payment amount, and amounts are indicated in each procedure row. When all procedures are itemized, and there are no claim adjustments, there will be no Total Payment entry because it is unnecessary.
Why won't some of my ERAs download?
Common reasons certain ERAs won't download:
I need to get ERA's for a carrier that is not contracted with a clearinghouse that provides ERAs in the standard 835 format to be used by my Open Dental program. What can I do?
If the payer can provide you with the ERA file (835) it can be manually downloaded into the clearinghouse report path, then processed as usual. If not, you must use paper or other way of getting the EOB. Currently Claimconnect, Electronic Dental Services (EDS) and Dentical are able to provide ERA 835s to you. Keep in mind that most processors are not willing to do 835s only, they also want you to file all of your claims with them to provide this service.
What if the carrier is contracted with Emdeon though, isn't Emdeon a large clearinghouse that should be able to provide 835s?
Emdeon/Change Healthcare may be able to provide 835's in the future, Open Dental has asked and not gotten useful responses.
Primary and Secondary payment from the same insurance is included on the same ERA and is attaching only to the primary claim (Known issue with GEHA and CIGNA flex spending).
If a carrier responds with a primary and secondary payment with the same claimID after a primary claim is sent, the workaround in Open Dental is to manually detach the secondary payment from the primary claim and attach it to the correct secondary claim before finalizing the ERA.
Alert: A matching claim was found, but the patient name the carrier sent does not match the patient on the claim.
This warning lets the user know a matching claim has been found, but the patient name does not match. Only populates for BCBS insurance.