Overview 

ICANotes+ significantly improves billing efficiency by introducing its Electronic Remittance Advice (ERA) / Auto-posting feature. This feature enables billers to process electronic payments from clearinghouses after submitting claims. With a few simple clicks, billers can process payments and adjustments for multiple claims simultaneously. Upon payment posting in ICANotes+, the system automatically distributes payments and adjustments within the account ledger. Additionally, it provides visibility into the remaining amount to be paid by the client after the insurance payments and adjustments have posted.

Prerequisites

Practices need to establish a connection with the clearinghouse via ICANotes+ to facilitate the processing of ERA / Auto-posting payments.

Basic Workflow

Below outlines the sequential steps involved in utilizing the ERA / Auto-posting feature within ICANotes+.

1. The billers will submit the claims from the Billing Worklist tab.
2. This will trigger the system to send the claim file to the clearinghouse.
3. Clearinghouse will route claims to the payers for processing the payments.
4. The payers will send ERA (835) file back to the clearinghouse.
5. Clearinghouse will process the files received from the payers and upload the ERA (835) file on the SFTP server.
6. ICANotes+ will automatically download the ERA (835) file from the SFTP server at a regular interval.

• • When all the claim details (including overall payment) received in the ERA (835) file match with the ICANotes+ claim details, the system will display them with 'Ready to Post' status. The billers can verify the details, if needed, and proceed to post payment in the system. When they post payment, the status will change to Posted and the payment and adjustment details will be distributed in the account ledger.
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  • When one or more claim details (including overall payment) received in the ERA (835) file do not match with the ICANotes+ claim details, the system will display them with 'Not Ready' status. The billers can rectify the mismatched claims by linking them to the appropriate claims and once the errors are fixed, the status will change to 'Ready to Post'. The billers can then proceed to post payment in the system. When they post payment, the status will change to Posted  and the payment and adjustment details will be distributed in the account ledger.

Payments Worklist 

Upon accessing the Dashboard, you'll notice the 'Payments Worklist' tab. Within this tab, you'll find the 'ERA Worklist' section, enabling billers to manage ERA (835) files received from the clearinghouse.

Roles and Permissions 

Access to the Payments Worklist section is restricted to authorized users only.

To manage permissions, navigate to Settings > Practice Settings > Roles & Permissions, and then click on the Edit button as illustrated below.

On the Update Role screen, within the Dashboard section, select the Access ERA Worklist Dashboard checkbox as shown below.

Electronic Remittance Advice (ERA) Worklist 

Once billers submit claims, they are electronically transmitted to the clearinghouse. Subsequently, the system receives ERA (835) files containing overall payments for the submitted claims.

Within the Payments Worklist tab, you will find a comprehensive display of all electronically received overall payments, conveniently accessible within the ERA Worklist tab, as illustrated below.

The ERA Worklist tab displays overall payment received from all the payers with 'Not Ready' and 'Ready to Post' statuses. Once the biller posts the payments in the system, the status changes to 'Posted'.

• Not Ready: When one or more claim details (including overall payment) received in the ERA (835) file do not match with the ICANotes+ claim details, the system will display them with 'Not Ready' status. The billers can rectify the mismatched claims by linking them to the appropriate claims and once the errors are fixed, the status will change to 'Ready to Post'. The billers can then proceed to post payment in the system. When they post payment, the status will change to Posted  and the payment and adjustment details will be distributed in the account ledger.

• Ready to Post: When all the claim details (including overall payment) received in the ERA (835) file match with the ICANotes+ claim details, the system will display them with 'Ready to Post' status. The billers can verify the details, if needed, and proceed to post payment in the system. When they post payment, the status will change to Posted and the payment and adjustment details will be distributed in the account ledger.

• Posted: When you post 'Ready to Post' overall payment, the status will change to 'Posted'. 

Details within the ERA Worklist Overall Payment 

The ERA Worklist's primary line displays the highlighted details depicted in the screenshot. Detailed explanations for each field's information are provided below the screenshot for clarity.

• Status: Displays the status of the payment received. It can be Not Ready, Ready to Post, and Posted.
• Payer: Displays payer name that appears in the ERA (835) file.
• Payer ID: Display payer ID that appears in the ERA (835) file.
• Date: Displays the date when the payment was generated.
• Posted Date: Displays the date when the ERA was posted in ICANotes+.
• Payment: Displays payment amount received in the ERA (835) file.
• Distributed: Displays total payment amount that was successfully linked with ICANotes+ claims.
• Adjustment: Displays total adjustment amount that was successfully linked with ICANotes+ claims.
• Reference#: Displays the reference number for the source of the payment.
• Source: Display source of the payment. It can be Check, EFT, ACH, or Other.

Details within the ERA Worklist at Claim Level 

Expanding the ERA Worklist overall payment reveals the claim details, as depicted in the screen below. Detailed explanations for each field's information are provided below the screenshot for your reference.

• Exclamation icon : Indicates claim details received in the ERA (835) file do not match with the ICANotes+ claim details. 
• Green tick icon : Indicates claim details received in the ERA (835) file are matched with ICANotes+ claim details. Once you have all the claims with a green check icon, the status of the overall payment will change from "Not Ready" to "Ready to Post".
• Client Name: Displays client name received in the ERA (835) file.
• ICANotes Claim#: Displays claim number generated in ICANotes+ when submitting claim details to the clearinghouse.
• Payer Claim#: Displays claim number generated by the payer that identifies the claim for which the payment was received.
• Claim Date: Displays claim submission date when the claim was submitted to the clearinghouse.
• Claim Payment Amount:  Displays total payment amount for the respective claim number. For example, if a check received from payer is of $1000.00 as payment amount that is to be distributed amongst 5 claims each having $200.00, then claim payment amount will appear as $200.00.
• Claim Adjustment Amount: Displays total adjustment amount for the respective claim number. For example, if a check received from payer is of $200.00 as adjustment amount that is to be distributed amongst 5 claims each having $40.00, then claim adjustment amount will appear as $40.00.
• Claim Status Code: Displays claim status code. It can be any of the following:
  • 1 – Processed as Primary
  • 2 – Processed as Secondary
  • 3 – Processed as Tertiary
  • 4 – Denied
  • 22 – Reversal of Previous Payment
• Next Responsibility: Allows you allocate the remaining balance to the primary payer, secondary payer, or client.

Details within the ERA Worklist at Service Line Level 

Expanding the ERA Worklist overall payment for a specific claim reveals the service line level details, as illustrated below. Detailed explanations for each field's information are provided below the screenshot for your reference.

• Link Status: The system verifies service line details received in claims from the ERA (835) file against those in ICANotes+ claims. If a match is found, the column will display the "Automatic" label. If there's no match, the "Link Service" option will be available to associate service line details with an ICANotes+ claim. Further details on this feature are provided in the following section.

  After successfully linking the service, the label will change to "Unlink Service." Clicking on "Unlink Service" allows billers to remove linked overall payment details and associated payments, reverting the label to "Link Service." It's important to note that once a payment is posted, unlinking the service is not possible.

  Note: The system matches service line details based on ICANotes+ claim number, Service Code, Service Date, Modifier(s), First Name, and Last Name.

• Service Codes: Displays service code and description for which payment is received from the payer.
• Modifiers: Displays modifier codes associated with the service code.
• Units: Shows the overall count of units associated with the service code availed by the client.
• Client: Displays client name recorded in ICANotes+ to which payment received from the payer was linked. Please note that this name can be different than the client name in the claim details.
• Service Date: Shows the service date when the client availed the service.
• Clinician: Displays name of the clinician who rendered service to the client.
• Location: Displays location name where the service was rendered to the client.
• Charge: Displays charge amount that was billed for this service line in ICANotes+.
• Allowed: Displays allowed amount that was received for this service line from the payer.
• Payment: Displays payment amount that was received for this service line from the payer.
• Adjustment: Displays total adjustment amount that was received for this service line from the payer.
• Reason Code: Displays adjustment reason codes (CO, OA, PR) along with the adjustment amount that was received for the service line from the payer.
• Client Responsibility: Displays client responsible amount that was received for this service line from the payer.
• Reason Code: Displays client responsible reason codes (PR) along with the client responsible amount that was received in the overall payment from the payer.
• Client Paid: Displays amount that was paid by the client for this service line in ICANotes+.
• Balance: Displays the remaining amount yet to be collected from payer / client considering the payments and adjustments that were received for the overall payment from the payer.
• Remarks: Displays remarks that were received for this service line from the payer.

Matched versus Unmatched Claims 

The payment and adjustment records obtained from the ERA (835) file are cross-checked against the ICANotes+ claim primarily using the ICANotes+ claim number and line item control number. Additionally, secondary verification involves comparing fields such as ICANotes+ claim number, Service Code, Service Date, Modifier(s), First Name, and Last Name.

When a match is identified, the record is designated as "matched." Matched claims will be indicated with green tick .

Conversely, if no match is detected, the record is categorized as "unmatched." Matched claims will be indicated with red exclamation icon .

Link Service for Unmatched Claims 

The billers can make the necessary corrections to match the claim details to the applicable accounts and charges on the unposted ERA (835) files. Once all service lines are linked, they can post the entire ERA (835) file. After posting the ERA (835) files, the billers can find how the insurance payments are distributed along with denials and adjustment reason codes so that they can prepare further for further billing to the secondary insurance.

When the billers expand the ERA service line, they can see the Link Service option as shown in the screen below for the unmatched claims. The exclamation icon  appears in the Link Status column to indicate that there is some mismatch between the claims received in the ERA (835) file and the ICANotes+ claims.

The Link Service screen shown below allows you to link the unmatched services.

Unmatched Service: The unmatched service received in the ERA (835) file appears on the top on the Link Service screen. It displays client name, Service Date, Service Code, Modifiers, and Amount received in the ERA (835) file.

ICANotes Services: The ICANotes Services section appears beneath the Unmatched Service section on the Link Service screen. You can search for the appropriate client, claim number, and service date in ICANotes+ claim to link with the unmatched service line payment. Based on your search, a list of clients and services appear, you can select the desired client/service and click the Link Service button in the screen below. 

When the unmatched service line payment (from ERA) is linked with the service line in ICANotes+, a message appears as shown below to indicate that the service line payment is linked to the charge successfully.

Once you link the ICANotes+ service to the unmatched service line payment, a green check appears as shown in the screen below to indicate that the claim payment is matched.

When all the claim payments within the overall payment are matched and appear with the green check, the status of the overall payment changes from “Not Ready” to “Ready to Post” as highlighted in the screen below. You can post payment in the system for all such overall payments.

Select the checkbox for the payments with "Ready to Post" status and click the Post Payment link as shown in the screen below.

When you post payment, the system distributes the charges in the respective accounts and displays the success message as shown below:

When there are no potential matches, ICANotes Services section will not show any records.

Post Multiple Payments in Batch 

The system allows you to post multiple payments in a batch.

You can select multiple payments with “Ready to Post” status using the checkbox to post all of them at once. Refer to the screen below:

To post all the payments at once, you can select the checkbox that appears on the top in the grid header, as highlighted in the screen below. It will select all the payments, check the bottom right corner of the screen below. Click the Post Payments link from the header to post all payments at one time.

Automated Entry in the Account Ledger 

Once the payment received from the ERA (835) file is successfully posted for the clients, the system will automatically distribute the payments and adjustments in the Account Ledger section as shown in the screen below.

Let's take a look at the example by posting the ERA for the client.

Locate the screenshot below for the client's Account Ledger before posting the ERA. The Charge Amount is $200.00 and the Total Balance is $200.00.

In the ERA, locate that the Insurance Paid is $70.00, Adjustment is $100.00, and Client's Responsibility is $30.00, as highlighted in the screenshot below.

When you post the payment, the charges will be distributed in the account ledger.

After the ERA is posted, if you take a look at the client's Account Ledger, it appears as shown below.

• Total Paid gets updated from $0.00 to $70.00 that has been picked from the Payment column in the ERA.
• The Client Balance gets updated from $0.00 to $30.00 that has been picked from the Client Responsibility column in the ERA.
• Total Balance gets updated from $200.00 to $30.00, i.e., Charge Amount ($200.00) - Total Paid ($70.00) - Adjustment ($100.00) = $30.00

Within the Account Payments / Adjustments accordion, you can locate the two transactions as mentioned below:

• Insurance Payment appears as $70.00.
• Insurance Adjustment appears as $100.00.

Link Status for Posted Payments (Automatic vs Manual) 

The payments with Posted status will have two types of Link Status: Automatic and Manual (Refer to both the screenshots below.)

Automatic: When all the claim details (including overall payment) received in the ERA (835) file match with the ICANotes+ claim details, the system will display them with 'Ready to Post' status. When you post payments for such claims, the Link Status will appear as Automatic.

Manual: When one or more claim details (including overall payment) received in the ERA (835) file do not match with the ICANotes+ claim details, the system will display them with 'Not Ready' status. You will have to rectify the mismatched claims by linking them to the appropriate claims and once the errors are fixed, the status will change to 'Ready to Post'. You can then proceed to post payment in the system. When you post payments for such claims, the Link Status will appear as Manual.

Ability to Unlink Service Before Payment is Posted 

When one or more claim details (including overall payment) received in the ERA (835) file do not match with the ICANotes+ claim details, the system displays them with 'Not Ready' status. When you rectify the mismatched claims by linking them to the appropriate claims, the status changes to 'Ready to Post'. At this moment, when you expand the claim details, the Link Status column displays the Unlink Service option as highlighted in the screen below. If you have by mistake linked the unmatched claim with an incorrect claim in ICANotes+, you can remove linking using the Unlink Service option.

Note: Once you post the payment, you cannot unlink services.

Omit Claim Payment from ERA 

ICANotes+ allows you to omit the claim payments that are not yet posted. When you expand overall payments, you can locate the Omit Claim checkbox at a client level as shown in the screen below. When you select the Omit Claim checkbox, the payment amount, distributed amount, and the adjustment amount are subtracted from the total amount that appears in the header. When the claim amount is posted, payment amount, distributed amount, and the adjustment amount are not included.

Notes:

• When you clear the Omit Claim checkbox, the payment amount, distributed amount, and the adjustment amount are added back to the total amount.
• If the ERA contains a single claim and that has been omitted, the system still allows you to post the payment with $0.00 payment, distributed, and adjustment amounts.

When the claim payment is omitted, you can locate the info icon as shown in the screen below. When you hover your mouse over the info icon, you can locate the Original Payment and Omitted amount details.

If there are any adjustments omitted, an info icon also appears in the Adjustment column. When hovering mouse over the info icon, you can locate the Original Adjustment Amount and Omitted amount as shown in the screen below.

When you expand the client-level details, you will notice that the service line details for the omitted claims appear grayed out, as shown in the screen below.

Omit Adjustments from ERA 

ICANotes+ provides the option to exclude adjustments for payments that have not yet been posted. When expanding payment details at the client level, you can find an option to omit adjustments at the service line level. Look for the minus sign in red color in the Reason Code column, as illustrated in the screen below.  

When you click the red minus sign to omit the adjustment, the system excludes the adjustment amount and displays the code and amount in gray color, as demonstrated below. Conversely, if you wish to include the adjustment again, simply click the highlighted plus sign.

Selecting an adjustment for omission prevents its posting to the claim charge when payment is posted. The omitted adjustment amount is deducted from the adjustment column and added to the Client Responsibility column. However, the balance remains unaffected in this scenario.

Note: PR adjustment codes cannot be omitted.

When you hover over the amount in the Adjustment column, you can find details about the Original Amount and Omitted Amount, as displayed on the screen below.

Ability to Delete ERA 

ICANotes+ allows you to delete ERA payments when they are not posted yet. Once posted, you cannot delete them.

In the ERA Worklist tab, when you select the ERAs with "Ready to Post" or "Not Ready" status, you can locate the Delete Payment link as highlighted in the screen below.

Note: The Delete Payment link will not be available for Posted  ERAs.

When deleting the ERA file, the system displays the confirmation message as shown below. Only upon your confirmation, the system deletes the ERA file.

Once the payment is deleted successfully, the following message appears.

Review Denials and Negative Balances on Claims 

The ERA Worklist alerts billers about denials and negative balances on claims. In the ERA Worklist, expanding payer details reveals an info icon next to the client name. Hovering over this icon notifies you to review denials/negative balances on the claim. Similarly, expanding client details reveals the info icon next to services with denials/negative balances. Billers can then review and make necessary corrections before resubmitting claims.

What does Negative Balance mean?

When the ERA payment is applied, it might lead to a negative charge balance. This could happen due to various reasons like duplicate or manually posted payments. In such situations, you have the choice to refund the manual payment before posting the claim payment or exclude (omit) the claim payment to avoid a negative charge balance. Alternatively, you can opt to proceed with the claim payment as it is which will produce a negative charge balance when the ERA is posted.

Refer to the following screens to review Denials:

Find the information icon positioned next to the client's name and hover over the icon to review a tooltip regarding denials that require review. 

When expanding the client section, look for the information icon next to the service code and hover over the icon to review a tooltip about denials that require review. 

Refer to the following screens to review Negative Balances:

Find the information icon positioned next to the client's name to receive notifications regarding negative balances that require review. 

When expanding the client section, look for the information icon next to the service code to receive notifications about negative balances that require review. Upon scrolling to the right, you'll find the negative balance highlighted in the screen below: 

FAQs 

You can find the Frequently Asked Questions (FAQs) on our Knowledge Base page.

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Need additional assistance?

Phone: 443-203-5857 

Text: 866-301-0085

Email: ticket@icanotes.com

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Proprietary Notice Information: This article is provided for informational purposes only, and the information herein is subject to change without notice. While every effort has been made to ensure that the information contained within this article is accurate, ICANotes cannot and does not accept any type of liability for errors in, or omissions arising from the use of this information.