Epayments User Manual R1118

User Manual:

Open the PDF directly: View PDF .
Page Count: 174 [warning: Documents this large are best viewed by clicking the View PDF Link!]

ePayments User Manual

(EDI Lockbox)

User Manual

Version 11.0

November 2018

Veterans Affairs

Product Development (PD)

ii ePayments User Guide (EDI Lockbox) November 2018

(This page included for two-sided copying.)

November 2018 ePayments User Guide (EDI Lockbox) iii

Revision History

Date

Revision

Description

Project Manager

Technical Writer

November 2018

11.0

ePayments Patch updates for

PRCA*4.5*326

Stephanie Kutson

D. Kelly

June 2018

10.0

ePayments Patch updates for

PRCA*4.5*321

Stephanie Kutson

D. Kelly

October 2017

9.0

ePayments Patch updates for

PRCA*4.5*318

Stephanie Kutson

D. Kelly

March 2017

8.0

ePayments Patch updates for

PRCA*4.5*317

Stephanie Kutson

D. Kelly

August 2016

7.0

ePayments Patch updates for

PRCA*4.5*316

Therese Tarleton

V. Dunie

May 2016

6.0

Comprehensive updates throughout

in accordance with PRCA*4.5*303

and PRCA*4.5*304

Therese Tarleton

V. Dunie

March 2015

5.0

ePayments Patch updates:

PRCA*4.5*298

Mary Heath

LongView

July 2012

4.0

Changes for deposit ticket number

patch PRCA*4.5*283 (page 56).

A. Scott

T. Dawson

April 2012

3.0

Patch updates: PRCA*4.5*284

Sookie Spence

Gianni LaRosa

January 2012

2.0

ePayments II updates - patches

IB*2.0*451 and PRCA*4.5*276

Sookie Spence

Berry Anderson

September 2011

1.0

Initial Release

Sookie Spence

Berry Anderson

iv ePayments User Guide (EDI Lockbox) November 2018

(This page included for two-sided copying.)

 
November 2018   ePayments User Guide (EDI Lockbox)  v 
 
Table of Contents 
 
1. INTRODUCTION .............................................................................................................. 1 
1.1. BUSINESS USES’ ................................................................................................................... 1 
1.2. TIMEFRAMES ........................................................................................................................ 1 
1.3. PATCHES ............................................................................................................................... 2 
AR Patch PRCA*4.5*284 ......................................................................................................... 2 
AR Patch PRCA *4.5*303 ........................................................................................................ 2 
AR Patch PRCA*4.5*304 ......................................................................................................... 3 
AR Patch PRCA*4.5*316 ......................................................................................................... 3 
AR Patch PRCA*4.5*317 ......................................................................................................... 3 
AR Patch PRCA*4.5*318 ......................................................................................................... 3 
AR Patch PRCA*4.5*321 ......................................................................................................... 4 
AR Patch PRCA*4.5*326 ......................................................................................................... 5 
1.4. NEW TERMINOLOGY ............................................................................................................ 6 
1.5. PROCESS FLOW .................................................................................................................... 7 
2. GETTING STARTED WITH EPAYMENTS ............................................................... 10 
2.1. MENUS AND SCREENS ........................................................................................................ 10 
2.1.1. ERA LIST – WORKLIST SCREEN ..................................................................................... 10 
2.1.2. ERA WORKLIST/SCRATCHPAD SCREEN ......................................................................... 11 
2.1.3. ERA/835 SCREENS FOR EPAYMENTS ............................................................................. 17 
Action Option: RX ECME Information ................................................................................. 17 
Action Option: AR Account Profile ........................................................................................ 17 
Action Option: CM Comment History ................................................................................... 17 
Action Option: PE Print EEOB .............................................................................................. 17 
Action Option: CI Go to Claim Screen .................................................................................. 17 
Action Option: BC Bill Charges ............................................................................................. 17 
Action Option: IR Insurance Reviews ..................................................................................... 17 
Action Option: AD Additional 835 Data ................................................................................ 18 
Action Option: VP  Policy Benefits ........................................................................................ 18 
Action Option: EL Patient Eligibility ..................................................................................... 18 
Action Option: RP Receipt Profile ......................................................................................... 18 
Action Option: EX Exit .......................................................................................................... 18 
2.2. PARAMETERS...................................................................................................................... 19 
2.2.1. PARAMETERS REPORT – EDI LOCKBOX (EPAYMENTS) PARAMETERS REPORT ............ 22 
2.2.2. PARAMETERS REPORT – EDI LOCKBOX (EPAYMENTS) PARAMETERS AUDIT REPORT . 22 
2.2.3. PARAMETERS REPORT – EDI LOCKBOX EXCLUSION AUDIT REPORT ........................... 23 
2.3. MAIL GROUPS ..................................................................................................................... 25 
2.4. HOW TO READ AN ERA/835 ............................................................................................... 25 
2.5. WORKLOAD NOTIFICATIONS .............................................................................................. 29 
Unmatched ERAs > 30 days ................................................................................................... 29 
PAPER Matched/Not Posted ERAs > 30 Days ....................................................................... 30 
EFT Matched/Not Posted ERAs > 30 days Bulletin ............................................................... 30 
Unmatched EFTs > 14 days .................................................................................................... 31 
Suspense Entry Bulletin .......................................................................................................... 31 
3. PAYMENTS PROCESSING .......................................................................................... 32 
3.1. CHECK EMAIL .................................................................................................................... 32 

 
vi  ePayments User Guide (EDI Lockbox)  November 2018
   
 
3.2. EXCEPTION PROCESSING .................................................................................................... 33 
Transmission Exceptions ......................................................................................................... 33 
Data Exceptions ....................................................................................................................... 35 
Non-Released Prescriptions..................................................................................................... 37 
3.3. WORKING THE EEOB SCRATCHPAD .................................................................................. 37 
ERA List - Worklist Actions ................................................................................................... 38 
Worklist Actions ...................................................................................................................... 44 
Change View ........................................................................................................................... 54 
Research Menu Actions ........................................................................................................... 54 
Example of processing a Paper Check and ERA ..................................................................... 56 
Example of processing a matched ERA and EFT ................................................................... 60 
3.4. AUTO-POSTING CLAIMS ..................................................................................................... 64 
Medical Auto-Posting Candidates ........................................................................................... 64 
Medical Auto-Posting Create and Process Receipt ................................................................. 64 
Medical Auto-Posting Receipts ............................................................................................... 65 
Pharmacy Auto Posting Receipts ............................................................................................ 66 
EEOB Worklist ........................................................................................................................ 68 
Ignore Payment Retraction Pairs ............................................................................................. 68 
Status Change .......................................................................................................................... 68 
AR Display .............................................................................................................................. 68 
3.5. WORKING THE APAR LIST ................................................................................................ 68 
APAR - Actions ....................................................................................................................... 70 
APAR Scratchpad - Actions .................................................................................................... 72 
3.6. AUTO-DECREASE OF MEDICAL CLAIMS ............................................................................ 77 
4. THE EFT HAS BEEN ACCEPTED BY FMS .............................................................. 80 
4.1. FMS.................................................................................................................................... 80 
4.2. THREE DAY EFT CYCLE .................................................................................................... 80 
4.3. EFT DEPOSITS .................................................................................................................... 83 
5. NPI ..................................................................................................................................... 86 
6. ADDITIONAL FUNCTIONALITY ............................................................................... 88 
6.1. AUTO–AUDIT ..................................................................................................................... 88 
Update Rate Types for Auto-audit .......................................................................................... 88 
Process Open Bills/Paper Claims ............................................................................................ 89 
Validate Bill Data and Status .................................................................................................. 89 
Process AR entry ..................................................................................................................... 89 
Required Security Key ............................................................................................................ 89 
6.2. AUTOMATIC MATCH EFTS TO ERAS ACRONYM: MA ...................................................... 89 
6.3. MANUAL MATCH EFT-ERA ACRONYM: MM ................................................................... 89 
6.4. MARK Ø-BALANCE EFT MATCHED ACRONYM: ZB .......................................................... 91 
6.5. UNMATCH AN ERA ACRONYM: UN .................................................................................. 91 
6.6. UPDATE ERA POSTED USING PAPER EOB ACRONYM: UP ................................................ 91 
6.7. REMOVE ERA FROM ACTIVE WORKLIST ACRONYM: REM ........................................ 93 
6.8. EEOB MOVE/COPY/REMOVE ACRONYM: MCR .............................................................. 95 
6.9. REMOVE DUPLICATE EFT DEPOSITS ACRONYM: REFT .................................................. 96 
6.10. EEOB INDICATOR .......................................................................................................... 98 
6.11. RECEIPT PROCESSING ..................................................................................................... 99 
6.12. UNPOSTED EFT OVERRIDE  ACRONYM: OEFT ............................................................. 99 
6.13. IDENTIFY PAYERS ACRONYM: IDP .......................................................................... 100 

 
November 2018   ePayments User Guide (EDI Lockbox)  vii 
 
7. EDI LOCKBOX (EPAYMENTS) REPORTS MENU ACRONYM: REP ........... 101 
7.1. EFT DAILY ACTIVITY REPORT ACRONYM: DA ........................................................... 101 
7.2. EFT UNMATCHED AGING REPORT  ACRONYM: EFT .......................................... 104 
7.3. ERA UNMATCHED AGING REPORT ACRONYM: ERA ................................................... 105 
7.4. EFT/ERA TRENDING REPORT ACRONYM: ETR ..................................................... 106 
7.5. UNAPPLIED EFT DEPOSITS REPORT  ACRONYM: UN ........................................... 106 
7.6. ACTIVE BILLS WITH EEOB REPORT ACRONYM: AB ................................................... 106 
7.7. AUTO DECREASE ADJUSTMENT REPORT   ACRONYM: AD .................................. 107 
7.8. AUTO-POST REPORT    ACRONYM: AP .......................................... 107 
7.9. AUTO-POSTED RECEIPT REPORT  ACRONYM: APR ................................................. 108 
7.10. 835 CARC DATA REPORT ACRONYM: CR ............................................................... 109 
7.11. DUPLICATE EFT AUDIT REPORT ACRONYM: DUPR .......................................... 109 
7.12. ERA STATUS CHANGE AUDIT REPORT ACRONYM: ESC .......................................... 110 
7.13. EFT TRANSACTION AUDIT REPORT ACRONYM: ETA ............................................... 113 
7.14. EEOB MOVE/COPY/REMOVE AUDIT REPORT ACRONYM: MCR ............................... 116 
7.15. PROVIDER LEVEL ADJUSTMENTS (PLB) REPORT ACRONYM: PLB ........................... 116 
7.16. ERAS POSTED WITH PAPER EOB AUDIT REPORT ACRONYM: POSR ..................... 120 
7.17. PAYER IMPLEMENTATION REPORT   ACRONYM: PX ................................. 120 
7.18. CARC/RARC QUICK SEARCH ACRONYM: QS ........................................................ 121 
7.19. REMOVE ERA FROM ACTIVE WORKLIST AUDIT REPORT ACRONYM: REMR ........... 121 
7.20. LINK PAYMENT TRACKING REPORT ACRONYM:SR ............................................. 122 
7.21. CARC/RARC TABLE DATA REPORT ACRONYM: TB ............................................... 122 
7.22. VIEW/PRINT ERA ACRONYM: VP ........................................................................... 123 
7.23. EFT DEPOSIT RECONCILIATION REPORT ACRONYM: DEP .................................. 124 
8. NATIONAL REPORTS FOR EPAYMENTS DATA ................................................ 126 
8.1. EDI VOLUME STATISTICS REPORT ............................................................................ 126 
8.2. ERA/EFT TRENDING REPORT ...................................................................................... 127 
8.3. EDI DIAGNOSTIC MEASURES EXTRACTS MENU .............................................................. 132 
9. ENHANCEMENTS TO NON-EDI LOCKBOX MENUS .......................................... 138 
9.1. AGENT CASHIER MENU .................................................................................................... 138 
Extended Check/Trace/Credit Card Search and Link Payment (Acronym: EX & LP) ......... 138 
Link Payment to Multiple Claims ......................................................................................... 139 
Deposit Processing (Acronym: DP) .................................................................................... 140 
Receipt# Lookup for Pharmacy Claims ................................................................................ 142 
Edit a Receipt ........................................................................................................................ 142 
Auto-Posted Receipt Report (Acronym: APR) ................................................................... 142 
10. SECURITY KEYS ......................................................................................................... 144 
10.1. NEW OR MODIFIED SECURITY KEYS ............................................................................ 144 
RCDPE REMOVE DUPLICATES ....................................................................................... 144 
RCDPE MARK ERA ............................................................................................................ 144 
PRCADJ ................................................................................................................................ 144 
RCDPE AGED PMT ............................................................................................................. 144 
RCDPE ERA EXCEPT ......................................................................................................... 144 
RCDPE AUTO DEC ............................................................................................................. 144 
RCDPE REMOVE EEOB ..................................................................................................... 144 
RCDPEAR............................................................................................................................. 144 
RCDPEPP .............................................................................................................................. 145 

 
viii  ePayments User Guide (EDI Lockbox)   November 2018
   
 
PRCFA SUPERVISOR ......................................................................................................... 145 
RCDPE PAYER IDENTIFY ................................................................................................. 145 
11. APPENDIX A – HELPFUL LINKS ............................................................................. 147 
12. APPENDIX B – CLAIM LEVEL ADJUSTMENT CODES ...................................... 149 
12.1. CLAIM ADJUSTMENT GROUP CODE .................................................................... 149 
13. APPENDIX C – PROVIDER LEVEL ADJUSTMENT CODES .............................. 151 
13.1. PROVIDER LEVEL ADJUSTMENT ......................................................................... 151 
Provider Level Adjustment Reason Code ............................................................................. 151 
14. APPENDIX D - DEFINITIONS ................................................................................... 155 
15. APPENDIX E – 3RD PARTY EDI LOCKBOX BULLETINS .................................... 159 
16. SOLVING EPAYMENT PROBLEMS ........................................................................ 163 
16.1. HOW TO REMOVE AGED EFT’S FROM THE EFT UNMATCHED AGING REPORT ........... 163 
 
 

November 2018 ePayments User Guide (EDI Lockbox) ix

(This page included for two-sided copying.)

November 2018 ePayments User Guide (EDI Lockbox) 1

1. Introduction

1.1. Business Uses’

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) or Public Law 101-191

requires healthcare plans and providers who conduct transactions electronically to comply with rules of

standardization. HIPAA has several purposes but defines standards through rules and compliance of

transactions and code sets. National standards allow for compatible formats between providers and third

party payers. PNC Bank in Pennsylvania functions as the VA 3rd Party Lockbox bank and will accept

those standard transactions from payers on behalf of VA. The bank makes a daily deposit of 3rd party

payments to US Treasury. They will also transmit deposit information in the form of an Electronic Funds

Transfer (EFT) and data about the payment in the form of an Electronic Remittance Advice (ERA) to the

Austin Financial Services Center (FSC). The Austin FSC will accept those transactions from the bank

and translate those files into a VistA readable format. The FSC will then forward those files to the

appropriate VistA AR package by way of Mailman messages. In addition, the FSC will also transmit the

ERA and EFT data files to Explanation of Benefits (EOB) Payment Healthcare Remittance Advice

(EPHRA).

VistA, therefore, was enhanced to allow receipt processing and posting of electronic remittance data sent

by payers. Additionally, VistA and FMS were enhanced to accommodate receipt and processing of 3rd

party electronic payment data.

The ePayments software will supplement the current accounts receivable process by eliminating some

data entry and automating the process of entering payments on a field service receipt. The software will

now create an electronic receipt that replaces the paper field service receipt for payments received via the

ePayments software.

1.2. Timeframes

The ePayments software was released to sites on October 10, 2003 with an installation compliance

deadline of October 16, 2003. The payer community is working to make their transactions HIPAA

compliant. Once payers are ready to transmit, they will work with our Lockbox Bank to enroll in the VA

ePayments program. After enrolling, each payer will go through a rigorous transaction testing process

with our Lockbox bank and any Clearinghouse that may be integrated. Testing ensures that the payer’s

835 EFT and ERA transmissions:

1. Conform to acceptable HIPAA and X12 transaction standards and

2. Can be received and forwarded by internal VA processing and messaging systems.

The entire payer community was not expected to be ready to transmit immediately following the HIPAA

deadline of October 16, 2003. Payer implementation is expected to be staggered but initially covered the

payers with the highest VHA claim submission volume across each VISN. Sites should expect to

continue with paper processing as the electronic payers are brought on line.

Since releasing the ePayments system, VHA has been honored by NACHA, the Electronic

Payments Association, for its success in implementing a nationwide electronic health care remittance

and payment processing system that complies with the electronic transaction standards of the HIPAA.

PNC Bank in Pittsburgh, Pennsylvania serves as VHA’s lockbox bank and has partnered with VHA to

enroll payers in this new, electronic business process. VHA’s experience with payers has been positive

with regard to the payer’s capability to produce and transmit ERAs. However, less than one percent of

VHA’s active payers are producing and transmitting an EFT. While VHA’s primary goal is to enroll its

payer community for ERA, VHA believes that additional benefits of HIPAA will be realized through both

ERA and EFT processing. Because HIPAA regulations specify that payers comply with a request for

2 ePayments User Guide (EDI Lockbox) November 2018

ERA in response to a provider’s claim, payers’ business organizations may not be focused on the

development of EFT.

1.3. Patches

AR Patch PRCA*4.5*284

1. Rename existing option – Mark ERA Return to Payer

Per request from the Chief Business Office (CBO), the existing Mark ERA Returned to Payer

option, which is located on the EDI Lockbox parent menu, has been renamed to Remove ERA

from Active Worklist. To accurately reflect the renamed option, the help text associated with the

option has been updated to reflect the removal of an ERA off the ERA Worklist. The basic

functionality of the option remains intact as it will continue to provide the capability to remove an

unmatched ERA off the ERA Worklist.

2. Rename existing option – Mark ERA Return to Payer Audit report

The existing Mark ERAs Returned to Payer Audit Report, which is located on the EDI Lockbox

Reports Menu, has been renamed to Remove ERA from Active Worklist Audit Report.

3. Change default answer in prompt - Update ERA Posted Using Paper EOB

When an automatic update is performed on an ERA, the default response has been changed from

"YES" to "NO". This modification helps prevent accidental updates. An example of the prompt

is below:

“Link to update Remittance entry # 14332 with receipt ERA14332? NO// “

AR Patch PRCA *4.5*303

1. Implement new 835 CARC Data Report option to the EDI Lockbox (ePayments) Reports Menu

to display payers and the CARC codes returned on the 835 transactions.

2. Implement new TPJI Screen Display redesign for ePayments. The new action option 'EP

ERA/835" shall display only data associated with the 835 transaction.

3. Implement new TPJI Action Option redesign for ePayments.

4. Implement CARC/RARC Data Transfer from FSC.

5. Implement Report Enhancements. The EDI Lockbox (ePayments) Reports Menu includes a new

report entitled "Provider Level Adjustments (PLB) Report to display ERA data with PLB data details.

6. Modification to the Scratchpad to process Efficiency Enhancements.

7. Change EDI Lockbox to EDI Lockbox (ePayments).

November 2018 ePayments User Guide (EDI Lockbox) 3

AR Patch PRCA*4.5*304

1. Implement Auto-Auditing for Paper Bills

2. Enhance Insurance Payment Trend Report

3. Implement ability to Track Dollars through Suspense

4. Implement National Reports for ePayments Data

5. Implement Standardized Deposit Tickets

6. Implement Receipt# Enhancements

7. Implement Site Parameters for Pharmacy/Medical

8. Implement Auto-Posting for Pharmacy/Medical

9. Implement Auto-Decrease for Medical Claims

10. Fix errors and enhancements to APAR

11. Implement Auto-Post Checks for Pharmacy Claims

12. Enhance Exception Error message and filtering

AR Patch PRCA*4.5*316

1. Updates the VistA upload process of CARC/RARC data sent by FSC.

AR Patch PRCA*4.5*317

1. Adds the Unapplied EFT Deposits Report back on the EDI Lockbox (ePayments) Reports

Menu.

2. Updates the ERA Worklist option and the Auto-Post Awaiting Resolution option to ask users

if they want to use their preferred view, when appropriate.

AR Patch PRCA*4.5*318

1. Updates the logic associated with auto-posting.

2. Adds new report Auto-Posted Receipt Report on the EDI Lockbox (ePayments) Reports

Menu.

3. Updates the Auto-Decrease Adjustment report to include CARC details.

4 ePayments User Guide (EDI Lockbox) November 2018

4. Locks several actions within the ERA Worklist (including Scratchpad) and the Auto-Post

Awaiting Resolution worklist (including Scratchpad) with one of two new security keys.

5. Updates EFT Daily Activity Report to include CR and TR numbers and allows for up to 60

characters for the payer name.

6. Removes security key lock from the EDI Diagnostic Measures Reports menu.

7. With a security key, locks several options within the EDI Diagnostic Measures Extracts

Menu.

8. Updates the EFT Unmatched Aging Report and the Unapplied EFT Deposits report.

9. Updates the logic associated with putting money to suspense.

10. Updates the auto-post site parameters logic.

AR Patch PRCA*4.5*321

1. The ‘Move ERA to Suspense’ option has been disabled and is no longer accessible from the

EDI Lockbox menu

2. The ‘Refresh Scratch Pad’ action has been removed from the APAR Scratchpad

3. Receipt comments are now required when part of an account balance is split to suspense. A

standardized set of comments have been added for the user to choose from along with a free

form text comment field.

4. If a receipt line comment has been added, the scratchpad screens in APAR and ERA

Worklists will display the user name and a timestamp.

5. The automatic update of EEOB information to reflect the split/edit of claims will occur at

receipt creation in the PRCA nightly autopost job (for APAR) or at receipt creation in the

ERA Worklist.

6. Updates to the Daily Activity Report including: a prompt to filter for EFTs with debits, a

debit flag added to EFTs, removed matched payment amounts posted from totals, displays the

station number instead of division and various page breaks for ease of use.

7. Updates to Receipt Processing including: new help text when creating new receipts, ability to

change the type of payment on receipts with preexisting lines and the ability to change the

EFT number in certain cases.

8. Eliminated an error when running the EFT Transaction Audit Report

9. Update to the Link Payment Account action that now allows the user to move EEOBs to

claims with payments linked from suspense

November 2018 ePayments User Guide (EDI Lockbox) 5

10. Updates to payer name selection and display: payer names longer than 30 characters can be

selected, names containing ":", "," or "-" can be selected, names with 60 characters display

correctly

11. Updated the Auto-Posted Receipt Report to ensure the correct dates displayed in the report

fall within the range selected at the prompt

12. Enabled VistA to use the start date and ECME # to identify the correct claim # and populate

the ERA

13. Exceptions for pharmacy claims now display correctly and in sequence

14. Updated the APAR worklist to allow greater flexibility to sort and display data

15. Updated receipt headers to show EFT/ERA numbers and totals

16. Claims in CSA status cannot be manually or auto-audited

17. The List of Receipts report now displays in list manager format

18. Manually matched ERAs with CHK payment types can be marked for auto-post

19. Medical, Pharmacy and Tricare Payers can now be indicated, along with access to view in a

list and their types edited when appropriate.

20. EFT/ERA Trending Report added to EDI Lockbox reports menu

21. The Decrease Adjustment function now alerts users if there are pending payments and

displays the payment that is pending.

22. Updated the ERA worklist to allow greater flexibility to sort and display data

23. The RCDPE AUDIT mail group now allows end users to self-enroll and a specific day of the

week can be set for when the bulletins are sent

24. Number of days of unposted medical and pharmacy EFTs to prevent posting have been

changed to 60 and 365 respectively

AR Patch PRCA*4.5*326

1. Adds notifications for changes to auto-post, auto-decrease, payer, and CARC site parameters

2. Adds the ability to see who manually marked an ERA for auto-post in the Auto-Posted

Receipt Report, Receipt Profile, List of Receipts Report, and Transaction Profile.

3. Adds 'matched date’ to the ERA Worklist and Daily Activity Report.

4. Adds a unique EFT identifier to the following reports: Daily Activity Report, EFT

Unmatched Report, Unapplied EFT Report, EFT Audit Report, and Manual Match Report.

6 ePayments User Guide (EDI Lockbox) November 2018

5. Adds display of ‘Percent Collected on Claims’ to the ‘Claim Level Pay Status’ section of the

EP Report (ERA/835 Action).

6. Updates display language in the Link Payment Report

7. Adds ability to filter by receipt number on Link Payment Report

8. Allows user to generate Auto-Post Report by payer TIN

9. Restricts unbalanced ERAs to be auto-post candidates

10. Renames the Payer Exclusion Report to the Payer Implementation Report

11. Modified the 'Distribute Adj Amts' action on the ERA Worklist to allow for negative

distributions to claim lines which do not have a valid claim

12. Adds FMS Document Status to bill/claim profile screens and reports

13. Provides fix to Pharmacy Data Exception Filter on the 3rd Party Exceptions Worklist Scratch

Pad

14. Provides fix to error in the ERA Worklist Manual Match Action

15. Adds an ERA Partial Post Indicator

16. Rewrites auto-posting logic to determine if the ERA is actually matched to an EFT

17. Changes prompt wording of Worklist Delete

18. Removes auto-decrease limit and adds new maximum parameter

19. Adds the ability to auto-decrease zero or no-pays

20. Adds the ability to view all ERA verify lines information on EEOBs

21. Adds the capability to filter all 3rd Party EDI Lockbox reports and options by

Tricare/ChampVA

22. Adds Administrative Cost Adjustment option to allow adjustment to balance and for it to be

recognized

23. Adds fee claims to Auto-Audit (5287.13) Rate type = Fee

24. Allows AM Clerk access to the Admin Cost Adjustment option

25. Fixes duplicate EFT deposits in the Audit Report

1.4. New Terminology

The following table of terms contains vocabulary that are be referenced throughout this document to

describe the ePayments process.

November 2018 ePayments User Guide (EDI Lockbox) 7

CARC

Claim Adjustment Reason Code

EFT

Electronic Funds Transfer; the electronic form of what is currently sent as a paper

check

ERA

Electronic Remittance Advice; the equivalent to a stack of paper Explanation of

Benefits (EOB) statements for many patients from one payer

EEOB

Electronic Explanation of Benefits; one line item within an ERA

RARC

Remittance Advice Remark Code

Trace Number

A number assigned by the insurance company to identify which EFT payment is

associated with what ERA; used to re-associate electronic remittance payment with

data

1.5. Process Flow

The following figure depicts a high level description of the ePayments process.

Figure 1 - ePayments High Level Process Flow

The data flow process functions as follows:

Electronic claims are sent to the payer and the Clearinghouse sends a message to VistA Integrated Billing

(IB), indicating that the claim passed all Clearinghouse validity edits and was forwarded to the payer.

The message initiates the auto-audit functionality that automatically audits the claim and sets it up as a

receivable in VistA.

The payer adjudicates the claim and determines payment. The payment may be sent electronically to

PNC Bank as an EFT or the payer may mail a paper check.

PNC Bank sends:

EFT dollars directly to the U.S. Treasury,

EFT 835 transactions, containing daily total deposit information by payer to the FSC, and

ERA 835 transactions, containing electronic EOBs (EEOBs) to the FSC.

The FSC passes EFT and ERA information on to each VAMC in flat file format via VistA Mailman

messages. These messages are sent to the MLB mail group.

Additionally, the FSC transmits the EFT and ERA flat file information to the EPHRA database

8 ePayments User Guide (EDI Lockbox) November 2018

The FSC also transmits unroutable EEOB data to EPHRA. Unroutable EEOB data does not contain the

appropriate Tax ID information to allow the FSC to route it to the proper VistA AR system. FSC 224-

Unit staff monitors EPHRA for unroutable EEOB data and use other data identifiers, such as the bill

number, to determine appropriate routing and transmit to the correct VistA AR system.

1. EFT data received by VistA initiates an automatic Credit Receipt (CR) document for each

payment received within the deposit and puts the payment information into a separate

appropriation fund that tracks payments not yet posted as part of the A/R nightly processing job.

The Revenue Source Code (RSC) 8NZZ was created specifically for 3rd Party EFTs. (See Error!

Reference source not found.)

Figure 2 - ePayments Nightly Process

2. VistA runs a nightly process (see Figure 2 - ePayments Nightly Process) that matches ERAs to

EFT files using the Trace Number and Insurance Company ID.

a. If the system finds a match, it then verifies the amount matches. If the amount matches,

the ERA and EFT detail records are automatically marked as “matched.”

b. If the amount does not match, the ERA record and the EFT detail record are marked as

“matched with errors.”

c. If the system is not able to match an ERA with an EFT detail record, it is marked as

“unmatched.” It is most likely that this scenario will call for a match to a paper check or

is a zero-payment.

3. When the ERA is received in VistA, it attempts to associate EEOBs with bills in the AR package

and stores the details associated with the payer’s adjudication decisions in Integrated Billing’s

EEOB file. This EEOB data is available for display under the BILL CHARGES action in THIRD

PARTY JOINT INQUIRY.

a. If any EEOBs cannot be associated with bills in VistA, a message will be sent to the

RCDPE PAYMENTS EXCEPTIONS mail group. This message indicates that there is a

problem with the bill number such as belongs to another site or the numbers were

transposed.

November 2018 ePayments User Guide (EDI Lockbox) 9

b. If NONE of the EEOBs included in the ERA can be associated with a bill in VistA, a

message will be sent to the RCDPE PAYMENT EXCEPTIONS mail group indicating

there were no valid bills on the ERA for the site. This ERA is then rejected and is not

stored at the site. Contact your ePayments POC for assistance if needed.

4. Members of the RCDPE Payments mail group receive the nightly processing bulletins.

5. Members of the RCDPE Payment Exceptions mail group will receive all bulletins for exception

conditions or processing issues generated by the EDI Lockbox (ePayments) message processor.

Generally, an ePayments exception occurs when an EDI Lockbox (ePayments) message cannot

be automatically or completely filed into the VistA AR and IB systems. When this occurs, an

exception record is created in Exception Processing. In order to address the transmission issues,

you will access the Exception Processing function.

6. A nightly auto-posting job evaluates the unposted ERAs to determine if an ERA is an auto-post

candidate. If the ERA is not an auto-post candidate, the ERA must be worked by a user from the

ERA Worklist Scratch Pad. If the ERA is an auto-post candidate, the system will process the

receipt if all criteria are met. If the system is unable to create a receipt for an individual EEOB,

the EEOBs must be worked by a user from the Auto-Posting Awaiting Resolution (APAR) list.

7. The user reviews all unposted ERAs and creates the ERA Worklist Scratch Pad entries to make

the necessary adjustments to balance the total of the EEOB with the total on the check or EFT. In

order to use the worklist, ERAs with an unmatched status require matching to a paper check or

marked as a zero pay.

8. Once the adjustments are made in the Worklist, the Receipt can be created automatically through

a Worklist function. The receipt and any total balancing adjustments can be created manually.

9. The receipt can then be processed as normal through PR Process Receipt option.

10. For EFTs related to ERAs:

After the receipt is processed and closed in VistA, the FMS transactions will be initiated. This

means that a transfer (TR) document is generated to FMS to transfer the monies from the new

MCCF RSC 528704/8NZZ to the appropriate MCCF collection accounts under 5287. This TR

document will also transfer any monies needing to be posted to the station suspense account or

other accounts, due to non-MCCF billing/payments.

11. For ERAs related to paper checks:

A CR document is generated to process the monies into FMS. This is the same processing as for

current non-EDI receipts.

12. If the ERA receipt is not created using the Worklist, then the ERA reference must be manually

entered using the EDIT RECEIPT action in Receipt Profile. If the ERA is also associated with an

EFT, the EFT reference must also be manually added using this action. This is extremely

important because the receipt associated with an EFT will generate the appropriate TR documents

to move the money out of 8NZZ and into the proper Fund/RSC whereas a receipt without an EFT

referenced will generate a CR document and will expect the dollars on the receipt to be deposited

by your site.

10 ePayments User Guide (EDI Lockbox) November 2018

2. Getting Started with ePayments

2.1. Menus and Screens

2.1.1. ERA List – Worklist screen

A new list manager screen, the ERA List – Worklist screen has been added in order to display the

selection of ERAs to be worked.

There are features that give the capability to search a greater range of records, with dialogue issued at

intermittent periods during the ERA Worklist record search to indicate that the system is still gathering

records for the ERA Worklist. To exit the ERA Worklist option the user enters the cancel search

character (“^”).

The user-defined sort selections are displayed in the header information on this screen. The following

information is available in the body of the ERA List – Worklist screen:

1. Sequence #

2. ERA #

3. Trace #

4. Payer Name

5. Match Status & Date

6. ERA Paid Date

7. Total Amount Paid

8. Date Received

ERA List - Worklist Dec 09, 2011@15:20:15 Page: 1 of 136

SELECTED: MATCH STATUS: BOTH POST STATUS : UNPOSTED

DATE RANGE : 1/1/11-12/9/11 AUTO-POSTING : BOTH

ALL PAYERS PHARMACY/MEDICAL: BOTH

# ERA # TRACE#

PAYER NAME/MATCH STATUS & DATE ERA PAID DT TOT AMT PAID DT REC'D

1 -112137 00698105

11/9/11 277.10 11/9/11

WOODMEN OF THE WORLD ASSURED L APPROX # EEOBs: 3

UNMATCHED (CHECK PAYMENT EXPECTED)

2 -112200 377746

11/10/11 155.95 11/10/11

MERITAIN HEALTH APPROX # EEOBs: 1

UNMATCHED (CHECK PAYMENT EXPECTED)

3 -112201 385045

11/10/11 270.62 11/10/11

MERITAIN HEALTH APPROX # EEOBs: 1

UNMATCHED (CHECK PAYMENT EXPECTED)

+ |'-' No scratchpad|'x' EXC |'A' autopost complete

Select ERA View/Print ERA Admin Cost Adj

Sort List Change View Exit

Mark for Auto Post Manual Match

Select Action: Next Screen//

November 2018 ePayments User Guide (EDI Lockbox) 11

The list manager ERA Worklist main page allows the user to perform the following actions:

1. Select ERA

2. Sort List

3. Mark for Auto Post (requires the RCDPEPP security key)

4. View/Print ERA

5. Change View

6. Manual Match

7. EXIT

2.1.2. ERA Worklist/Scratchpad screen

The ERA Worklist/Scratchpad is a new option that has been created for the ePayments system. It allows

the user to select an ERA and view the detailed EEOB records associated with the ERA.

The following information is available from the ERA Worklist/Scratchpad:

For the entire ERA:

1. ERA Entry #

2. Payer Name/ID

3. Total Amt Paid

4. Paper Check # or EFT Trace #

5. Total amount to be posted to the receipt

ERA Worklist/Scratch Pad Jul 21, 2010@12:17:58 Page: 1 of 1

ERA Entry #: 9876543210 Total Amt Pd: 123.45 Current View:

Payer Name/ID: IBinsurance Company One/55555555 NO SORT ORDER

PAPER CHECK #: 1003 ALL EEOBs

1 EEOB Seq # On ERA: 1 Net Payment Amt: 123.45

1.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One A/5555

Claim Bal: 0.00 Billed Amt: 0.00 Amt To Post: 123.45

Svc Dt: 6/1/00 COB: NO Rx Copay: UNKNOWN Means Tst: ??

Payment Amt: 123.45 Total Adjustments: 0.00 Net: 123.45

..............................................................................

Enter ?? for more actions

Split/Edit A Line Look At Receipt Mark for Auto Post

Distribute Adj Amts Review Line ERA View/Print ERA

Refresh Scratch Pad Verify RP Receipt Processing

Research Menu Change View EXIT

Select Action: Next Screen//

12 ePayments User Guide (EDI Lockbox) November 2018

For the EEOB detail:

1. Bill number

2. Patient Priority Status (CAT C)

3. Rx Copay exempt status

4. Date of service

5. Billed amount

6. Claim balance (current balance)

7. Patient last name

8. Last 4 digits of the patient’s SSN

9. Paid amount (amt to post)

10. COB status

11. Line item number from the ERA

12. ERA level and Claim level Adjustment totals

13. Comment Date and Time (stamp)

14. (Comment) User Name

ERA Worklist/Scratch Pad Jul 21, 2010@12:17:58 Page: 1 of 1

ERA Entry #: 9876543210 Total Amt Pd: 123.45 Current View:

Payer Name/ID: IBinsurance Company One/55555555 NO SORT ORDER

PAPER CHECK #: 1003 ALL EEOBs

... 1 EEOB Seq # On ERA: 1 Net Payment Amt: 123.45

1.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One A/5555

Claim Bal: 0.00 Billed Amt: 0.00 Amt To Post: 123.45

Svc Dt: 6/1/00 COB: NO Rx Copay: UNKNOWN Means Tst: ??

Payment Amt: 123.45 Total Adjustments: 0.00 Net: 123.45

...........................................................................

Enter ?? for more actions

Split/Edit A Line Look At Receipt Mark for Auto Post

Distribute Adj Amts Review Line ERA View/Print ERA

Refresh Scratch Pad Verify RP Receipt Processing

Research Menu Change View EXIT

Select Action: Next Screen//

November 2018 ePayments User Guide (EDI Lockbox) 13

The list manager ERA Worklist Scratchpad allows the user to perform the following actions:

1. Split/Edit A Line

2. Distribute Adj Amts

3. Refresh Scratch Pad (requires the RCDPEPP security key)

4. Research Menu

5. Look At Receipt (requires the RCDPEPP security key)

6. Review Line

7. Verify (requires the RCDPEPP security key)

8. Change View

9. Mark for Auto Post (requires the RCDPEPP security key)

10. View/Print an ERA

11. Receipt Processing (requires the RCDPEPP security key)

12. Exit

ERA Worklist/Scratch Pad Jul 21, 2010@12:17:58 Page: 1 of 1

ERA Entry #: 9876543210 Total Amt Pd: 123.45 Current View:

Payer Name/ID: IBinsurance Company One/55555555 NO SORT ORDER

PAPER CHECK #: 1003 ALL EEOBs

1 EEOB Seq # On ERA: 1 Net Payment Amt: 123.45

1.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One A/5555

Claim Bal: 0.00 Billed Amt: 0.00 Amt To Post: 123.45

Svc Dt: 6/1/00 COB: NO Rx Copay: UNKNOWN Means Tst: ??

Payment Amt: 123.45 Total Adjustments: 0.00 Net: 123.45

..............................................................................

Enter ?? for more actions

Split/Edit A Line Look At Receipt Mark for Auto Post

Distribute Adj Amts Review Line ERA View/Print ERA

Refresh Scratch Pad Verify RP Receipt Processing

Research Menu Change View EXIT

Select Action: Next Screen//

14 ePayments User Guide (EDI Lockbox) November 2018

The expanded Look At Receipt action (previously named PREVIEW RECEIPT) will yield the

Preview/Create Receipt screens, and allows the following actions to be performed. This action requires

the RCDPEPP security key:

1. Select option LOOK AT RECEIPT

2. CREATE RECEIPT (which will allow a link to the RECEIPT PROCESSING function if the

receipt is created without errors)

ERA WORKLIST PREVIEW RECEIPT Jul 21, 2010@08:43:02 Page: 1 of 1

ERA Entry #: 9876543210 Total Amt Pd: 20.59

Payer Name/ID: IBinsurance Company One/55555555

PAPER CHECK #: 1003

LINE # ACCOUNT AMOUNT .

PAYMENTS (LINES FOR RECEIPT):

1.001 XXX-KXXXXXX 20.59

Enter ?? for more actions

Print Receipt Preview Create Receipt Exit

Select Action: Quit//

The new Verify option provides functionality needed to identify and mark unverified EEOBs. This action

requires the RCDPEPP security key:

1. MANUAL MARK AS VERIFIED

2. REPORT OF UNVERIFIED WITH DISCREPANCIES

VERIFY EEOBs:

1 MANUAL MARK AS VERIFIED

2 REPORT OF UNVERIFIED WITH DISCREPANCIES

3 QUIT AND RETURN TO WORKLIST

Select Action: QUIT//

The Research Menu is accessible through the list manager ERA Worklist screen and it allows the

following actions to be performed:

1. Full Acct Prof

2. Admin Cost Adj (requires the RCDPEAR security key)

3. TPJI (Third Party Joint Inquiry)

4. Bill Comment Log

5. Re establish Bill (requires the RCDPEAR security key)

6. View/Print EEOB

November 2018 ePayments User Guide (EDI Lockbox) 15

7. Review Line

8. Scratchpad Menu/Exit

ERA Worklist Research Aug 10, 2004@11:01:33 Page: 1 of 2

ERA Entry #: 5 Total Amt Pd: 509.61 Current View:

Payer Name/ID: IBinsurance Company One/5555555555 NO SORT ORDER

PAPER CHECK #: 55555-55555555 ALL EEOBs

1 (V) EEOB Seq # On ERA: 1 Net Payment Amt: 0.00

1.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One A/5555

Claim Bal: 0.00 Billed Amt: 19.47 Amt to Post: 0.00

Svc Dt: 1/27/03 COB: NO Rx Copay: NON-EXEMPT Means Tst: ??

Payment Amt: 0.00 Total Adjustments: 0.00 Net: 0.00

....................................................................................

2 (V) EEOB Seq # On ERA: 3 Net Payment Amt: 509.61

2.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,Two A/4444

Claim Bal: 509.61 Billed Amt: 559.61 Amt To Post: 509.61

Svc Dt: 2/4/03 COB: NO Rx Copay: NON-EXEMPT Means Tst: NO

Payment Amt: 590.61 Total Adjustments: 0.00 Net: 509.61

....................................................................................

+ Enter ?? for more actions

Full Acct Prof Bill Comment Log Review Line

Admin Cost Adj Re establish Bill Scratch Pad Menu/Exit

TPJI View/Print EEOB

Select Action: Next Screen/

Receipt Processing option allows you to jump to “RP Receipt Processing” with a pre-populated Receipt

number and return to the Scratchpad. This action requires the RCDPEPP security key.

ERA Worklist/Scratch Pad Sep 17, 2015@15:30:24 Page: 1 of 2

ERA Entry #: 43530 Total Amt Pd: 8501.13 Current View:

Payer Name/ID: AETNA/10660X33492 NO SORT ORDER

EFT #/TRACE #: 1135/ABC637X6748X787 ALL EEOBS

*** RECEIPT(S) ALREADY CREATED *** (E15080304A-E15080304B)

Auto-Post Status: Complete Auto-Post Date: Aug 03, 2015

1 EEOB Seq # On ERA: 1 Net Payment Amt: 7000.58

1.001 Claim #: K502VMQ Patient/Last 4: XX-XXXXXX,XXXX/2215

Claim Bal: 0.00 Billed Amt: 7000.58 Amt To Post: 7000.58

Svc Dt: 12/9/14 COB: NO Rx Copay: NON-EXEMPT Means Tst: YES

Payment Amt: 7000.58 Total Adjustments: 0.00 Net: 7000.58

Receipt: E15080304B

..............................................................................

2 (V)EEOB Seq # On ERA: 2 Net Payment Amt: 1500.55

2.001 Claim #: K502VQR Patient/Last 4: XX-XXXXXX,XXXX /2215

Claim Bal: 0.00 Billed Amt: 1500.55 Amt To Post: 1500.55

Svc Dt: 1/21/15 COB: NO Rx Copay: NON-EXEMPT Means Tst: YES

+ Enter ?? for more actions

Split/Edit A Line Look At Receipt Mark for Auto Post

Distribute Adj Amts Review Line ERA View/Print ERA

Refresh Scratch Pad Verify RP Receipt Processing

Research Menu Change View EXIT

Select Action: Next Screen// rp Receipt Processing

Select one of the following:

1 E15080304A

16 ePayments User Guide (EDI Lockbox) November 2018

2 E15080304B

Select Receipt: 1

November 2018 ePayments User Guide (EDI Lockbox) 17

2.1.3. ERA/835 Screens for ePayments

The ERA/835 screens are accessible from the main TPJI screen, by choosing the action option “EP

ERA/835”. The ERA/835 screen will display ERA level summary data based on the claim# selected and

displayed on the previous Main TPJI Screen, EOB/Claim level data and Claim level adjustments; and

EEOB/Claim Line level data and adjustments.

NOTE: For pharmacy claims, the ECME#, Date of Service, Rx/Fill/Release Status shall be displayed. For

medical claims, these data elements will be blank.

The following ePayments actions can be performed from the ERA/835 Screen:

RX ECME Information CI Go to Claim Screen VP Policy Benefits

AR Account Profile BC Bill Charges EL Patient Eligibility

CM Comment History IR Insurance Reviews RP Receipt Profile

PE Print EEOB AD Additional 835 Data EX Exit

Action Option: RX ECME Information

This option allows you to view ECME Claim Information. You can select “EX Exit” to return to the TPJI

Main screen or you can select the action option “VER View ePharmacy Rx” to view detailed prescription

data.

Action Option: AR Account Profile

This option allows you to view payment transaction details including the ERA#, TRACE#, Payer ID and

Receipt# that was used for posting the payment.

Action Option: CM Comment History

This option allows you to view Accounts Receivables comments for the claims account.

Action Option: PE Print EEOB

This option allows you to print EEOBs.You may select either a single EEOB or all EEOBs for a claim.

When the user successfully selects an EEOB(s) for printing, the system prints the EOB/Claim level data

and Claim level adjustments and EOB/Claim Line level data and Claim Line level adjustments for each

EEOB selected for printing then returns the user to the ERA/835 screen.

Action Option: CI Go to Claim Screen

This option allows you to return to the Claim Information screen.

Action Option: BC Bill Charges

This option allows you to view a bill’s charge information as it would print on the bill.

Action Option: IR Insurance Reviews

This option allows you to view all insurance reviews for the episodes of care on a bill.

18 ePayments User Guide (EDI Lockbox) November 2018

Action Option: AD Additional 835 Data

This option allows you to view additional information found in the 835 at the EOB level. if sent by the

payer. The additional 835 data is not mandated by HIPAA so additional information is sent at a payer’s

discretion.

1. Claim Code/Status

1 = Processed as Primary

2 = Processed as Secondary

3 = Processed as Tertiary

4 = Denied

19 = Processed as Primary, Forwarded to Additional Payer(s)

20 = Processed as Secondary, Forwarded to Additional Payer(s)

21 = Processed as Tertiary, Forwarded to Additional Payer(s)

22 = Reversal of Previous Payment

23 = Not Our Claim, Forwarded to Additional Payer(s)

25 = Predetermination Pricing Only - No Payment

2. Corrected Priority Payer Type

AD = Blue Cross Blue Shield Association Plan Code

FI = Federal Taxpayer’s Identification Number

NI = National Association of Insurance Commissioners (NAIC) Identification

PI = Payer Identification

PP = Pharmacy Processor Number

XV = Centers for Medicare and Medicaid Services PlanID

Action Option: VP Policy Benefits

This option allows you to view patient insurance policy data.

Action Option: EL Patient Eligibility

This option allowallows you to view current information on the patient’s eligibility for care and service

connection status.

Action Option: RP Receipt Profile

This option allows you to view a bill and any of its associated transactions.

Action Option: EX Exit

This option allows you to return to the TPJI Main Screen.

All of the menus are described in detail in Section 3 Payments Processing.

November 2018 ePayments User Guide (EDI Lockbox) 19

2.2. Parameters

The menu option to edit parameters requires the user to hold security key RCDPE AUTO DEC. The

following parameters are part of the ePayments software:

Aging Payments

This parameter allows the user to select the specified number of days that will elapse before an

unmatched payment (for an EFT detail line) will be reported. This parameter will be used when the

report is run as part of the nightly processing. At installation, the Report Aging Payments site parameter

will default to five days.

Aging ERA

This parameter allows the user to select the specified number of days that will elapse before an

unmatched ERA will be reported. This parameter will be used when the job is run as part of the nightly

processing. At installation, the Report Aging ERA site parameter will default to seven days.

Medical Claims Auto-Posting

This parameter allows the user to enable or disable auto-posting of third party medical claims. At

installation, the medical claims auto-posting site parameter will default to yes, which enables auto-

posting.

Medical Claims Auto-Posting Exclusion

This parameter allows the user to exclude specific payers from auto-posting of third party medical claims

by selecting the payer name or payer ID. At the time of installation, no payers are excluded from auto-

posting. This parameter will only display if auto-posting of third party medical claims is enabled.

The Payer prompt acts as a toggle. If a payer is selected, the payer will be added to the exclusion list if

the payer is not already there or removed from the exclusion list if the payer is already there. A comment

is required.

Medical Claims with Payments Auto-Decrease

This parameter allows the user to enable or disable auto-decrease of third party medical claims with

payments. At installation, the medical claims auto-posting site parameter will default to no, which

disables auto-decrease. This parameter will only display if auto-posting of third party medical claims is

enabled.

Medical Claims with No Payments Auto-Decrease

This parameter allows the user to enable or disable auto-decrease of third party medical claims with no

payments. At installation, the medical claims auto-posting site parameter will default to no, which

disables auto-decrease. This parameter will only display if auto-posting of third party medical claims is

enabled.

Medical Claims Auto-Decrease Amount

This parameter allows the user to specify the maximum claim dollar amount of an automatic decrease

adjustment that is made for a third party medical claim. At installation, the amount is not populated and

the value is required to enable auto-decrease of third party medical claims. This parameter will only

display if auto-decrease of third party medical claims is enabled.

Medical Claims Auto-Decrease by CARC

This parameter allows the user to specify an individual CARC code to include in the auto-decreasing of

third party medical claims. The user must select the actual CARC by code to include auto-decreasing

medical claims. Once validated and selected, the user must enter a maximum dollar amount that can be

auto-decreased for the entered CARC. The maximum claim dollar amount displays with an initial default

20 ePayments User Guide (EDI Lockbox) November 2018

value of null and a required response from 1 to 99999 dollars with the default amount being set to 5000.

The dollar amount is represented without cents. This parameter will only display if auto-decrease of third

party medical claims is enabled.

Medical Claims Auto-Decrease by CARC Amount

This parameter allows the user to specify the maximum claim dollar amount of an automatic decrease

adjustment by CARC code that is made for a third party medical claim. At installation, the amount is not

populated and a value between 1 to 1500 dollars is required to enable auto-decrease of third party medical

claims by CARC. This parameter will only display if auto-decrease of third party medical claims is

enabled.

Medical Claims Auto-Decrease Timeframe

This parameter allows the user to specify the number of days to wait before an automatic decrease

adjustment is made for a third party medical claim. The number of days is the time to wait after auto-

posting completes. At installation, the timeframe is not populated and the value is required to enable

auto-decrease of third party medical claims. This parameter will only display if auto-decrease of third

party medical claims is enabled.

Medical Claims Auto-Decrease Exclusion

This parameter allows the user to exclude specific payers from auto-decrease of third party medical

claims by selecting the payer name or payer ID. At the time of installation, no payers are excluded from

auto-decrease. This parameter will only display if auto-decrease of third party medical claims is enabled.

The Payer prompt acts as a toggle. If a payer is selected, the payer will be added to the exclusion list if

the payer is not already there or removed from the exclusion list if the payer is already there. A comment

is required.

Pharmacy Claims Auto-Posting

This parameter allows the user to enable or disable auto-posting of third party pharmacy claims. At

installation, the pharmacy claims auto-posting site parameter will default to NO

Pharmacy Claims Auto-Posting Exclusion

This parameter allows the user to exclude specific payers from auto-posting of third party pharmacy

claims by selecting the payer name or payer ID. At the time of installation, no payers are excluded from

auto-posting. This parameter will only display if auto-posting of third party pharmacy claims is enabled.

The Payer prompt acts as a toggle. If a payer is selected, the payer will be added to the exclusion list if

the payer is not already there or removed from the exclusion list if the payer is already there. A comment

is required.

Pharmacy Claims Auto-Decrease

This parameter allows the user to enable or disable auto-decrease of third party pharmacy claims. At

installation, the pharmacy claims auto-decrease site parameter will default to no, which disables auto-

decrease. This parameter will only display if auto-posting of third party pharmacy claims is enabled.

Pharmacy Claims Auto-Decrease Timeframe

This parameter allows the user to specify the number of days to wait before an automatic decrease

adjustment is made for a third party pharmacy claim. after auto posting of a pharmacy payment. . At

installation, the timeframe is not populated and the value is required to enable auto-decrease of third party

pharmacy claims. This parameter will only display if auto-decrease of third party pharmacy claims is

enabled.

November 2018 ePayments User Guide (EDI Lockbox) 21

Pharmacy Claims Auto-Decrease Amount

This parameter allows the user to specify the maximum claim dollar amount of an automatic decrease

adjustment that is made for a third party pharmacy claim. At installation, the amount is not populated and

the value is required to enable auto-decrease of third party pharmacy claims. This parameter will only

display if auto-decrease of third party pharmacy claims is enabled.

Pharmacy Claims Auto-Decrease Exclusion

This parameter allows the user to exclude specific payers from auto-decrease of third party pharmacy

claims by selecting the payer name or payer ID. At the time of installation, no payers are excluded from

auto-decrease. This parameter will only display if auto-decrease of third party pharmacy claims is

enabled. The Payer prompt acts as a toggle. If a payer is selected, the payer will be added to the exclusion

list if the payer is not already there or removed from the exclusion list if the payer is already there. A

comment is required.

Medical Claims Posting Prevention

This parameter allows the user to set the number of calendar days beyond which unposted medical

payments (EFTs) will trigger an error message that prevents the user from posting newer medical EFTs.

This parameter is used in the ERA Worklist when a user selects an ERA. At the time of installation, the

value will be set to 60 days if the current value is over the new parameter max of 60 days, otherwise it

will remain the same. The value cannot be deleted and valid entries are in the range of 14 days to 60

days.

Pharmacy Claims Posting Prevention

This parameter allows the user to set the number of calendar days beyond which unposted pharmacy

payments (EFTs) will trigger an error message that prevents the user from posting newer pharmacy EFTs.

This parameter is used in the ERA Worklist when a user selects an ERA. At the time of installation, the

value will be set to 365 days if the current value is over the new parameter max of 365 days, otherwise it

will remain the same. The value cannot be deleted and valid entries are in the range of 21 days to 365

days.

Auto Audit for Medical and Pharmacy Bills

Two parameters exist to allow the user to enable or disable automatic auditing of paper and/or electronic

medical or pharmacy bills. At installation, the auto audit site parameter will default to no, which disables

auto auditing for both Medical and Pharmacy claims.

Add Suspense

The parameter allows the user to limit the number of days an entry can remain in Suspense. The

parameter default is initially set at 45 days. The user can to edit the parameter within the range of 1-120

days.

22 ePayments User Guide (EDI Lockbox) November 2018

2.2.1. Parameters Report – EDI Lockbox (ePayments) Parameters

Report

The EDI Lockbox Parameters Report provides a listing of all parameters with current settings. The report

can be run on-demand on an as-needed basis to view or print parameter settings.

2.2.2. Parameters Report – EDI Lockbox (ePayments) Parameters

Audit Report

The EDI Lockbox (ePayments) Parameters Audit Report provides an audit of changes to parameter

questions. The information on the report contains the date and time a parameter was edited, the old value,

the new value and the user who completed the edit.

2.2.2.1. When to run this report

Review the EDI Lockbox (ePayments) Parameters Audit Report on an as-needed basis to view or print

changes to settings. The report can be run on-demand.

2.2.2.2. How to run this report

To run the EDI Lockbox (ePayments) Parameters Audit Report, enter a start date and end date and select

a division. The resulting report will contain parameters that have been changed within the date range.

The report can also be exported to Excel.

The EDI Lockbox (ePayments) Parameters Audit Report follows:

Select Site Parameter Edit <TEST ACCOUNT> Option: EDI Lockbox Parameters Audit Report

(M)EDICAL, (P)HARMACY, OR (B)OTH: BOTH//

START DATE: T-40 (JUN 11, 2014)

END DATE: Jul 21, 2014// T (JUL 21, 2014)

Export the report to Microsoft Excel? (Y/N): NO//

DEVICE: HOME// UCX/TELNET Right Margin: 80//

EDI Lockbox Parameter Audit Report Page: 1

RUN DATE: 7/21/2014@09:35:26

DATE RANGE: 6/11/2014 - 7/21/2014

LOCKBOX PARAMETER UPDATES

------------------------- Values

Parameter Date/Time Edited Old New User

================================================================================

AUTO-POST MED CLAIMS ENABLED 6/23/14@16:36:09 No Yes USER,ONE

AUTO-POST MED CLAIMS ENABLED 6/24/14@10:03:04 Yes No USER,ONE

AUTO-POST MED CLAIMS ENABLED 6/24/14@10:19:14 No Yes USER,ONE

AUTO-DECREASE MED ENABLED 6/24/14@14:22:10 No Yes USER,ONE

AUTO-DECREASE MED DAYS DEFAULT 6/24/14@14:22:10 7 USER,ONE

AUTO-DECREASE MED AMT DEFAULT 6/24/14@14:22:10 1 USER,ONE

AUTO-POST MED CLAIMS ENABLED 6/24/14@15:36:17 Yes No USER,ONE

AUTO-POST MED CLAIMS ENABLED 6/24/14@15:36:38 No Yes USER,ONE

AUTO-DECREASE MED AMT DEFAULT 6/24/14@16:49:05 1 100 USER,ONE

AUTO-DECREASE MED AMT DEFAULT 6/24/14@16:49:34 100 1 USER,ONE

November 2018 ePayments User Guide (EDI Lockbox) 23

2.2.3. Parameters Report – EDI Lockbox Exclusion Audit Report

The EDI Lockbox Exclusion Audit Report provides an audit of changes to excluded payers. The

information on the report contains the date and time a payer was added or removed from the exclusion list,

the user who completed the edit and a comment.

2.2.3.1. When to run this report

Review the EDI Lockbox Exclusion Audit Report on an as-needed basis to view or print changes to payer

exclusions. The report can be run on-demand.

2.2.3.2. How to run this report

To run the EDI Lockbox Exclusion Audit Report, enter a start date and end date and select a division.

The resulting report will contain payer exclusions that have been changed within the date range. The

report can also be exported to Excel.

(M)EDICAL, (P)HARMACY, OR (B)OTH: BOTH//

START DATE: T-40 (JUN 11, 2014)

END DATE: Jul 21, 2014// T (JUL 21, 2014)

Export the report to Microsoft Excel? (Y/N): NO//

DEVICE: HOME// Virtual Right Margin: 80//

EDI Lockbox Exclusion Audit Report Page: 1

DIVISIONS: ALL

RUN DATE: 7/21/2014@09:40:39

DATE RANGE: 6/10/2014 - 7/21/2014

AUTO-POSTING PAYER EXCLUSION LIST

---------------------------------

Change Date/Time Edited User/Payer/comment

================================================================================

Added 6/24/14@14:21:32 USER,ONE

INSURANCE ONE 1111111111

Add insurance company to file to test

Removed 6/24/14@14:42:49 USER,ONE

INSURANCE ONE 1111111111

Removing insurance company after testing

Added 6/24/14@14:57:53 USER,ONE

INSURANCE ONE 1111111111

Add insurance, last time

AUTO-DECREASE PAYER EXCLUSION LIST

---------------------------------

24 ePayments User Guide (EDI Lockbox) November 2018

Change Date/Time Edited User/Payer/comment

Added 6/24/14@16:57:54 USER,ONE

INSURANCE TWO 2222222222

Add insurance company to file to tes

Removed 6/24/14@17:01:59 USER,ONE

INSURANCE TWO 2222222222

Removing insurance company after testing

November 2018 ePayments User Guide (EDI Lockbox) 25

2.3. Mail groups

Seven mail groups are associated with EDI Lockbox. The names of these mail groups are:

RCDPE PAYMENTS: This group will receive all reports and bulletins generated by the nightly

processing job and from all other EDI Lockbox jobs, except for those resulting from exceptions found

when storing the EDI Lockbox transmission records.

RCDPE PAYMENTS EXCEPTIONS: This group will receive all bulletins for exception conditions

generated by the receipt of all EDI Lockbox electronic messages. Exceptions occur when the software

cannot identify a bill number in the site’s VistA system. This group also receives error bulletins generated

by the receipt and processing of the CARC/RARC date from the FSC.

RCDPE PAYMENTS MGMT: This group previously received the bulletin that is sent when an EEOB

transferred out of the site is accepted by another site. Transfer functionality is no longer available.

RCDPE AUDIT: This group will systematically notify management of critical outstanding workload

related to aged ERAs and EFTs. This includes

• Unmatched ERAs greater than 30 days

• Matched/not posted ERAs greater than 30 days

• EFTs greater than 14 days

The AR application will flag the above-mentioned bulletins as high priority. These bulletins can be

scheduled weekly, biweekly or monthly and the specific day of the week can be set in the EDI Lockbox

parameters. All bulletins will be scheduled for the same cycle. End users can self-enroll in this mail

group.

RCDPE MOVE COPY: This mail group previously received bulletins sent by the AR nightly process.

The bulletins are no longer sent.

MLB: This mail group receives all transmission messages relating to EDI Lockbox. These messages

contain the detailed transmission data.

It is a local decision as to who will be members of these mail groups. It is recommended at a

minimum that the MCCF Supervisor or Lead AR be included. Important: The electronic data is

sent to VistA thru these mail man messages. If no one is assigned to these mail groups, the

electronic data will not be stored in VistA. These messages also help with trouble shooting and

problem solving. Appendix E contains a list of the bulletins and recommendations on how to handle

each message.

CARC_RARC_DATA: This mail group receives all transmission messages related to CARC/RARC

data sent by the FSC. These messages contain the detailed transmission data that automatically updates

CARC/RARC data in VistA.

It is a local decision as to who will be members of this mail group. It is recommended at a minimum

that the local IRM be included. Important: These messages may help with trouble shooting and

problem solving that may be needed; any error messages will be sent as an error bulletin to

RCDPE PAYMENTS EXCEPTIONS group containing all errors discovered in the entire

message.

2.4. How to read an ERA/835

The 835 is a transaction set created by HIPAA standards. The transaction format defines what data

should be included in the Electronic Remittance Advice (ERA) for use in the world of Electronic Data

Interchange (EDI). ‘835’ is the technical term used in the healthcare industry when referring to an ERA –

Electronic Remittance Advice. ERAs or 835’s can be found in the ePayments software in the worklist,

26 ePayments User Guide (EDI Lockbox) November 2018

view/print options, or under Billed Charges (BC) in the TPJI menu. ERA’s are sent in a standard format

as defined by HIPAA and include standard Claim adjustment reason codes (CARC’s).

EDI LOCKBOX EEOB DETAIL FROM WORKLIST 7/22/10 Page: 1

ERA NUMBER: 9876543210 ERA DATE: Jul 21, 2010

INS COMPANY: IBinsurance Company One/555555555

ERA TRACE #: 123456789012345678901234567890123456789

================================================================================

CLAIM #: XXX-KXXXXXX

EOB GENERAL INFORMATION:

Type : NORMAL EOB EOB Paid DT : 12/21/07

Entry Dt/Tm :12/24/07 4:33 pm Claim Status : PROCESSED

Entry Dt/Tm :12/24/07 4:33 pm Review Status: ACCEPTED-COMPLETE EOB

Entered By : Insurance Seq: SECONDARY

Last Edited : 12/24/07 7:06 am Last Edit By : POSTMASTER

Patient Name: IBpatient,One Pt. Relation : PATIENT

Insured Name: IBpatient,One Insured ID : SUBSC ID XXXXXX

Claim Rec'd Date :

Other Subscriber Name:

Enter RETURN to continue or '^' to exit:

The example above shows the user the ERA number, trace number and date, and payer information. This

is on page 1 of the ERA.

EDI LOCKBOX EEOB DETAIL FROM WORKLIST 7/22/10 Page: 1

ERA NUMBER: 9876543210 ERA DATE: Jul 21, 2010

INS COMPANY: IBinsurance Company One/555555555

ERA TRACE #: 1234567890123456789012345678901234567890123456789

================================================================================

CLAIM #: XXX-KXXXXXX

EOB GENERAL INFORMATION:

Type : NORMAL EOB EOB Paid DT : 12/21/07

Entry Dt/Tm :12/24/07 4:33 pm Claim Status : PROCESSED

Entry Dt/Tm :12/24/07 4:33 pm Review Status: ACCEPTED-COMPLETE EOB

Entered By : Insurance Seq: SECONDARY

Last Edited : 12/24/07 7:06 am Last Edit By : POSTMASTER

Patient Name: IBpatient,One Pt. Relation : PATIENT

Insured Name: IBpatient,One Insured ID : SUBSC ID XXXXXX

Claim Rec'd Date :

Other Subscriber Name:

Enter RETURN to continue or '^' to exit:

Also included on page 1 are the bill number, patient name, ID number, claim status, and patient

relationship.

EDI LOCKBOX EEOB DETAIL FROM WORKLIST 7/22/10 Page: 2

ERA NUMBER: 9876543210 ERA DATE: Jul 21, 2010

INS COMPANY: IBinsurance Company One/555555555

November 2018 ePayments User Guide (EDI Lockbox) 27

ERA TRACE #: 1234567890123456789012345678901234567890123456789

================================================================================

PAYER INFORMATION:

Payer Name : IBinsurance Company One

Payer Id : 5555555555

ICN :

Contact Phone : 555-555-5555

Contact e-Mail : XXXXX@XXXXXXX.com

Payer Web Site : http://www.WebSite.com

Policy Reference: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Cross Ovr ID : XXXXXXXXX

Cross Ovr Nm: XXXXXXXXXXXXXXX

Enter RETURN to continue or '^' to exit:

The User sees the Payer Information including payer name, payer ID number, and the payers Internal

Control Number (ICN) and any other claim level contact information on page 2. The claim level contact

information can also be viewed from the Claim Information -> Comment History option available under

TPJI. TPJI is available through many menu paths, such as EDI Lockbox -> ERA Worklist -> Select ERA

-> Research Menu -> TPJI.

EDI LOCKBOX EEOB DETAIL FROM WORKLIST 7/22/10 Page: 3

ERA NUMBER: 9876543210 ERA DATE: Jul 21, 2010

INS COMPANY: IBinsurance Company One/555555555

ERA TRACE #: 1234567890123456789012345678901234567890123456789

================================================================================

CLAIM LEVEL PAY STATUS:

Tot Submitted Chrg: 102.95 Covered Amt : 0.00

Payer Paid Amt : 20.59 Patient Resp. Amt : 0.00

CLAIM LEVEL ADJUSTMENTS:

NONE

MEDICARE INFORMATION:

NONE

LINE LEVEL ADJUSTMENTS:

# SV DT REVCD PROC MOD UNITS BILLED DEDUCT COINS ALLOW PYMT

1 06/01/10 510 99213 1 102.95 0.00 0.00 102.95 20.59

ADJ: CO 23 Payment adjusted because charges have been paid by another payer.

ADJ AMT: 82.36

The top of page 3 shows the user the submitted charges, covered amount, and amount paid in the Claim

Level Pay status section of the ERA.

EDI LOCKBOX EEOB DETAIL FROM WORKLIST 7/22/10 Page: 3

ERA NUMBER: 9876543210 ERA DATE: Jul 21, 2010

INS COMPANY: IBinsurance Company One/555555555

ERA TRACE #: 1234567890123456789012345678901234567890123456789

================================================================================

28 ePayments User Guide (EDI Lockbox) November 2018

CLAIM LEVEL PAY STATUS:

Tot Submitted Chrg: 102.95 Covered Amt : 0.00

Payer Paid Amt : 20.59 Patient Resp. Amt : 0.00

CLAIM LEVEL ADJUSTMENTS:

NONE

MEDICARE INFORMATION:

NONE

LINE LEVEL ADJUSTMENTS:

# SV DT REVCD PROC MOD UNITS BILLED DEDUCT COINS ALLOW PYMT

1 06/01/10 510 99213 1 102.95 0.00 0.00 102.95 20.59

ADJ: CO 23 Payment adjusted because charges have been paid by another payer.

ADJ AMT: 82.36

Enter RETURN to continue or '^' to exit:

At the bottom of page 3, the user can see the Claim Adjudication details which include the HIPAA

standardized justification codes. Adjudication details can be continued on page 4 depending on the

number of procedures included on the claim to the payer.

November 2018 ePayments User Guide (EDI Lockbox) 29

2.5. Workload Notifications

The AR application systematically notifies management of critical outstanding workload related to aged

ERAs and EFTs. There are 4workload notifications. They are the Unmatched ERA’s > 30 days, the

Paper Matched/Not Posted ERAs > 30 days, the EFT Matched/Not Posted ERAs >30 days, and the

Unmatched EFTs > 14 days. The notifications are sent to a mail group, RCPDE Audit, and can be

queued for weekly, bi-weekly, or monthly notifications. All the notifications will be flagged as high

priority.

Unmatched ERAs > 30 days

A warning bulletin is sent to the RCDPE AUDIT Mail Group for unmatched ERAs greater than 30 days.

Subj: EDI LBOX-STA# 442-ACTION REQ-Unmatched ERAs > 30 days [#139751]

11/17/11@11:20 142 lines

From: POSTMASTER In 'IN' basket. Page 1 Priority!

-------------------------------------------------------------------------------

The listed ERAs were received more than 30 days ago and have not yet been

matched.

Total # of ERAs - 134

Total Dollar Amount - $53,638.41

ERA# PAYER NAME FILE DATE AMOUNT PAID

97 AETNA 4/21/04 $0.00

289 UNITED HEALTH CARE 6/10/04 $749.61

14126 GREAT-WEST LIFE 2/22/07 $320.94

14131 MUTUAL OF OMAHA COMPANIES 2/22/07 $9.76

14147 MAIL HANDLERS BENEFIT PLAN 2/22/07 $29.25

14153 NALC HBP 2/22/07 $463.67

14154 NALC HBP 2/22/07 $12.21

14163 GREAT-WEST LIFE 2/23/07 $489.92

14164 GREAT-WEST LIFE 2/23/07 $65.37

14165 GREAT-WEST LIFE 2/23/07 $65.37

14168 MUTUAL OF OMAHA COMPANIES 2/23/07 $4.66

Subj: EDI LBOX-STA# 442-ACTION REQ-Unmatched ERAs > 30 days [#139751]

11/17/11@11:20 142 lines

From: POSTMASTER In 'IN' basket. Page 1 Priority!

-------------------------------------------------------------------------------

The listed ERAs were received more than 30 days ago and have not yet been

matched.

Total # of ERAs - 134

Total Dollar Amount - $53,638.41

ERA# PAYER NAME FILE DATE AMOUNT PAID

97 AETNA 4/21/04 $0.00

289 UNITED HEALTH CARE 6/10/04 $749.61

14126 GREAT-WEST LIFE 2/22/07 $320.94

14131 MUTUAL OF OMAHA COMPANIES 2/22/07 $9.76

14147 MAIL HANDLERS BENEFIT PLAN 2/22/07 $29.25

14153 NALC HBP 2/22/07 $463.67

14154 NALC HBP 2/22/07 $12.21

14163 GREAT-WEST LIFE 2/23/07 $489.92

14164 GREAT-WEST LIFE 2/23/07 $65.37

14165 GREAT-WEST LIFE 2/23/07 $65.37

14168 MUTUAL OF OMAHA COMPANIES 2/23/07 $4.66

Subj: EDI LBOX-STA# 442-ACTION REQ-Matched/Not Posted ERAs > 30 days [#139752]

11/17/11@11:20 58 lines

From: POSTMASTER In 'IN' basket. Page 1 Priority!

-------------------------------------------------------------------------------

The listed ERAs were received more than 30 days ago and have been matched but

have not been posted

Total # of ERAs - 50

Total Dollar Amount - $75,710,095,295.75

ERA# PAYER NAME FILE DATE AMOUNT PAID

14338 BCBS of WY and Affiliated Companies 9/28/10 $1,077.86

14290 SF MUTUAL 3/2/07 $75.48

14337 BCBS of WY and Affiliated Companies 9/28/10 $1,077.86

14339 BCBS of WY and Affiliated Companies 9/28/10 $1,077.86

13909 UNITED HEALTH CARE 2/12/07 $715.99

14041 MAIL HANDLERS BENEFIT PLAN 2/16/07 $129.26

14043 MAIL HANDLERS BENEFIT PLAN 2/16/07 $123.48

14044 MAIL HANDLERS BENEFIT PLAN 2/16/07 $18.53

14056 GREAT-WEST LIFE 2/20/07 $8.32

14082 MAIL HANDLERS BENEFIT PLAN 2/20/07 $285.60

14084 MAIL HANDLERS BENEFIT PLAN 2/20/07 $160.00

30 ePayments User Guide (EDI Lockbox) November 2018

PAPER Matched/Not Posted ERAs > 30 Days

A warning bulletin is sent to the RCDPE AUDIT mail group for Paper Checks Matched/Not Posted that

are matched to ERAs >30 days but not yet posted.

From: POSTMASTER@XXXXX.MED.VA.GOV

Sent: Thursday, July 31, 2014 6:01 AM

To: "G.RCDPE AUDIT"@XXXXX.MED.VA.GOV

Subject: EDI LBOX-STA# 504-ACTION REQ-PAPER:Matched/Not Posted ERA>30 days

Importance: High

The listed ERAs were received more than 30 days ago and have been matched but

have not been posted

Total # of ERAs - “MATCHED TO PAPER CHECK” - 4

Total Dollar Amount - $2,076.49

ERA# PAYER NAME FILE DATE AMOUNT PAID

78596 CONNECTICUT GENERAL LIFE INSURANCE 4/4/12 $2.04

79195 WOODMEN OF THE WORLD ASSURED LIFE A 4/19/12 $1,831.22

79917 THRIVENT FINANCIAL FOR LUTHERANS 5/7/12 $102.20

80484 NALC HBP 5/18/12 $141.03

** END OF REPORT **

EFT Matched/Not Posted ERAs > 30 days Bulletin

A warning bulletin is sent to the RCDPE AUDIT mail group for EFT Matched/EFTs that are matched to

an ERA >30 days but not yet posted.

From: POSTMASTER@XXXXX.MED.VA.GOV

Sent: Thursday, July 31, 2014 6:01 AM

To: "G.RCDPE AUDIT"@XXXXX.MED.VA.GOV

Subject: EDI LBOX-STA# 504-ACTION REQ-EFT:Matched/Not Posted ERA>30 days

Importance: High

The listed ERAs were received more than 30 days ago and have been matched but

have not been posted

Total # of ERAs - “MATCHED TO EFT” - 5

Total Dollar Amount - $2,041.91

ERA# PAYER NAME FILE DATE AMOUNT PAID

80933 OUTREACH HEALTH CARE SERVICES 5/31/12 $1,227.73

82352 ValueOptions, Inc. 7/11/12 $144.68

83339 ROYAL NEIGHBORS OF AMERICA 8/2/12 $33.70

83496 TLPEXTON 8/6/12 $8.99

83667 NALC HBP 8/10/12 $626.81

** END OF REPORT **

November 2018 ePayments User Guide (EDI Lockbox) 31

Unmatched EFTs > 14 days

A warning bulletin is sent to the RCDPE AUDIT Mail Group for unmatched EFTs greater than 14 days.

From: POSTMASTER@XXXXX.MED.VA.GOV

Sent: Thursday, July 31, 2014 6:01 AM

To: "G.RCDPE AUDIT"@XXXXX.MED.VA.GOV

Subject: EDI LBOX-STA# 623-ACTION REQ-EFTs > 14 days

Importance: High

The following EFTs were received more than 14 days ago and have not yet been matched –

or have been matched but not posted.

Total # of EFTs - 4

Total Dollar Amount - $87.99

DEPOSIT# PAYER NAME/TRACE# EFT DATE DEPOSIT AMT

5694XX617 BCBS OKFEPDENTAL/F14098E000X186X 4/11/14 $32.00

5694XX621 BCBS OKFEPDENTAL/F14104E000X244X 5/17/14 $8.00

5694XX675 BCBS OKFEPDENTAL/F14181E000X986X 6/3/14 $32.00

5694XX680 COMMUNITYCARE LI/5200088 7/11/14 $15.99

** END OF REPORT **

Suspense Entry Bulletin

A warning bulletin is sent to the RCDPE AUDIT Mail Group for Suspense Entries overdue for

processing. The suspense parameter determines when an entry is overdue and captured on the Suspense

Entry Bulletin.

From: POSTMASTER@xxxxxx [mailto:POSTMASTER@xxxxxxxxx]

Sent: Thursday, July 31, 2014 6:01 AM

To: "G.RCDPE AUDIT"@xxxxxxxxx

Subject: EDI LBOX-STA# 623-SUSPENSE ENTRIES OVERDUE FOR PROCESSING

Importance: High

The following entries have been in Suspense past the #days allowed by the

site parameter – which is currently set at 45 days.

Total # of Overdue Entries in Suspense - 3

Total Dollar Amount Overdue in Suspense - $21446.47

SUSP DATE #DAYS USER RECEIPT# AMOUNT DISP REASON

03/11/14 145 AB 7080793I $5500.00 PENDING NO BILL # OR EOB

04/15/14 112 RT 7354664R $15788.25 PENDING NO BILL # OR EOB

05/12/14 75 PR L1407020 $158.22 PENDING NO BILL # OR EOB

** END OF REPORT **

32 ePayments User Guide (EDI Lockbox) November 2018

3. Payments Processing

Daily activities related to processing ePayments are included in this section of the User’s Guide. It is

organized by how the daily workflow should be processed – starting with checking e-mail and processing

exceptions before proceeding to the ERA Worklist activities.

3.1. Check Email

The 3rd Party EDI Lockbox software makes extensive use of e-mail bulletins to alert users about actions

taken during the nightly processing of EFTs and ERAs received from payers. Check e-mail for these

notifications first thing in the morning to help plan the workday. If you receive a bulletin that states an

ERA was rejected because no valid EEOBs were found for your site, you should contact your ePayments

POC for assistance to ensure that no data is lost.

Starting with the Clerk’s AR Menu, the user must navigate through two screens in order to access the

functionality that is contained in the ERA Worklist/Scratchpad:

Audit/Set up a New Accounts Receivable ...

New Bill Forms Print ...

Profile of Accounts Receivable

Update Accounts Receivable ...

Adjustment to Accounts Receivable ...

Report Menu for Accounts Receivable ...

Follow-up Letter Menu ...

Establish/Edit Old Bills ...

Transaction Profile

TPJI Third Party Joint Inquiry

Account Management ...

Agent Cashier Menu ...

EDI Lockbox ...

FMS Utilities Menu ...

Refund Review and Approve

Select Clerk's AR Menu Option:

Select Clerk's AR Menu Option: edi Lockbox (ePayments)

EXC EDI Lockbox 3rd Party Exceptions

WL ERA Worklist

APAR Auto-Post Awaiting Resolution

MA Automatic Match EFTs to ERAs

MCR EEOB Move/Copy/Remove

MM Manual Match EFT-ERA

OEFT Unposted EFT Override

REFT Remove Duplicate EFT Deposits

REM Remove ERA from Active Worklist

REP EDI Lockbox Reports Menu ...

UN Unmatch An ERA

UP Update ERA Posted Using Paper EOB

ZB Mark 0-Balance EFT Matched

Select EDI Lockbox (ePayments) Option:

November 2018 ePayments User Guide (EDI Lockbox) 33

3.2. Exception Processing

Before starting to process anything on your ERA Worklist, check for exceptions by using the option EXC

EDI Lockbox 3rd Party Exceptions located on the EDI Lockbox (ePayments) Menu. Any

ERA or EEOB that cannot be automatically and completely matched into both the VistA AR and IB

packages will end up on the Exception Report. This includes ERAs with recognized errors that prevent a

clean update to automatically occur. Records can be viewed and various options are provided to reconcile

the exceptions and move them to the ERA Worklist for processing. An ERA cannot be processed in the

ERA Worklist if an exception exists on the ERA. The ERA Worklist will display “x” in front of the ERA

number to indicate an exception exists.

ERA List - Worklist Dec 12, 2014@14:18:37 Page: 4 of 7

SELECTED MATCH STATUS: BOTH POST STATUS : BOTH

DATE RANGE: 11/22/14-12/12/14 AUTO-POSTING : BOTH

ALL PAYERS PHARMACY/MEDICAL: BOTH

# ERA # Trace#

+ PAYER NAME/MATCH STATUS & DATE ERA PAID DT TOT AMT PAID DT REC'D

11 x5545 6353169460

12/10/14 0.00 12/10/14

AETNA APPROX # EEOBs: 2

UNMATCHED N/A

Details for processing the exceptions are included below.

There are two types of exceptions, Transmission Exceptions and Data Exceptions, explained below.

Exceptions should be worked daily and before the scratchpad is created for the ERA.

Transmission Exceptions

Transmission Exceptions occur when there was a problem storing ERA EEOB data. Here are three

examples of when a transmission error may occur:

1. All sequences for an ERA that was sent in multiple messages were not received at the site.

For example, AR cannot process these until ALL of the messages in the batch are received. The

exception list contains only 4 of 5 messages. You should wait for the 5th message. If the

message is not received in 24 hours, contact EPS at 1-888-596-4357 to enter a remedy ticket and

request a re-transmission.

2. An ERA transmission did not fully complete the permanent update process on a previous date and

remains in the file, partially processed. How is this corrected? Enter a remedy ticket, as this is

probably the result of a system problem. Once the problem has been resolved, use File Message

to process the ERA. Or, if the problem is severe and cannot be resolved, you will be instructed to

use DELETE MESSAGE to permanently remove the message from the list.

3. An ERA cannot identify any claims on the transmission as valid at your station. In Version 1,

this information was sent to the sites via e-mail messages. The information

contained in the e-mail messages is now stored under the Transmission Exceptions until filed and

corrected/saved or deleted.

34 ePayments User Guide (EDI Lockbox) November 2018

EEOB TRANSMISSION EXCEPTIONS Jul 01, 2010@10:41:30 Page: 1 of 1

ERA/EEOB MESSAGES WITH EXCEPTION CONDITIONS

# Message ID Msg Typ Date Received Mail Msg #

_______________________________________________________________________________

1 XXXXXXX ERA MAR 05, 2007@18:41 XXXXXXX

EXCEPTION: NO VALID CLAIMS

Payer Name: IBinsurance Company One

Payer ID: 5555555555

Trace #: XXXXXXXXXXX

Date Paid: 03/02/2007 Total Amt Paid: 22.39

*XXXKXXXXXXX

Enter ?? for more actions

View/Print Message Delete Message Exit

File Message TPJI

Select Action: Quit//

Figure 3a - Sample Transmission Exception Report

3.2.1.1. Processing Actions for Transmission Exceptions

Enter ?? for more actions

View/Print Message Delete Message Exit

File Message TPJI

Select Action: Quit//

List Manager options are used to complete the transmission exceptions. Each option is explained in detail

below.

➢ View/Print Message – Used to print or view the formatted version of the message and

optionally includes the actual text (raw data) received in the message.

➢ File Message – Used to attempt to re-file a message. This could be used if the message was

not completely stored in the permanent ELECTRONIC REMITTANCE ADVICE file. When

the user selects a message to re-file, the system checks the content of the message and tries to

automatically file the data in VistA. If successful, the exception is removed. A bulletin is

sent to the RCDPE PAYMENTS mail group reporting the attempt to re-file the message.

If this action is used with a NO VALID CLAIMS transmission, the exception will be

moved to the data transmissions screen where the claim numbers can be edited and the

EEOBs filed in IB.

➢ Delete Message – Used to remove the message from the exception list if the message cannot

be re-filed into VistA automatically. This action removes the message permanently from the

exception list and sends a bulletin to the RCDPE PAYMENTS Mail Group containing the

text of the message received.

The Delete Message action cannot be used if the ERA has a payment method of Automatic

Clearing House (ACH). An error message will display.

Note: The Delete Message action is locked with the security key, RCDPE ERA EXCEPT.

➢ TPJI (Third Party Joint Inquiry) – This is a link to TPJI in case further analysis of the site’s

receivables is required.

November 2018 ePayments User Guide (EDI Lockbox) 35

Data Exceptions

Data Exceptions may be filtered to view Medical claims, Pharmacy claims or both and by all payers or a

range of payers.

DO YOU WANT TO SEE (T)RANSMISSION OR (D)ATA EXCEPTIONS?: T// DATA

INCLUDE EXCEPTIONS FOR (M)EDICAL, (P)HARMACY, OR (B)OTH?: B// OTH

(A)LL PAYERS, (R)ANGE OF PAYER NAMES: ALL//

A Data Exception occurs when AR cannot match the claim number on the EEOB with a claim number in

AR. Here is an example of a Data Exception:

➢ An EEOB has encountered an error such as a typo or transposed bill number, the action

called Edit Claim # can be used to correct this error.

LOCKBOX EEOB DATA EXCEPTIONS Oct 13, 2010@15:38:12 Page: 1 of 1

EEOB DETAIL DATA WITH EXCEPTION CONDITIONS

# Trace # EOB Date

Insurance Co Name/ID .

1 XXXXXXXX XX/XX/XX

IBinsurance Company One/555555555

Seq #: 49 Bill: *442-XXXXXXX Pt: IBpatient,One A Pd: 1.82

ECME #: XXXXXXXXXXXX Release Date:

Comment: Pharmacy comment about prescription

**Exception: VALID BILL NOT FOUND

Enter ?? for more actions

View/Print Message Edit Claim # Exit

File EEOB in IB TPJI

Remove Exception Pharmacy Claim Comment

Select Action: Quit//

Figure 3b - Sample Data Exception Report

36 ePayments User Guide (EDI Lockbox) November 2018

3.2.1.2. Processing Actions for Data Exceptions

Enter ?? for more actions

View/Print Message Edit Claim # Exit

File EEOB in IB TPJI

Remove Exception Pharmacy Claim Comment

Select Action: Quit//

List Manager options are used to complete the data exceptions. Each option is explained in detail below.

➢ View/Print Message - Used to print or view the exception message and any detail on file for

it.

➢ File EEOB in IB - Used to attempt to re-file the EEOB data detail in IB (Integrated Billing) if

an exception occurred during a previous update attempt.

➢ Remove Exception - Used if there is no electronic way to resolve the exception condition.

This action marks the ERA or EEOB detail record so it no longer appears as an exception. A

bulletin will be sent to report this action to the RCDPE PAYMENTS mail group. If an

exception is removed, the EEOB will appear in the worklist as ‘not found in AR’

➢ Edit Claim # - Used to update the claim number to reflect the correct claim number you want

to file in the EEOB. TPJI can be used to view the claim detail before changing the claim

number. The system will also accept an entry that is not a valid claim number, which will

cause money to go to suspense.

Select Action: Next Screen// ED Edit Claim #

Select EDI LBox EEOB Data Exception(s): (96-99): 97

Selection #: 97 4343434

Select A/R Bill this EEOB is actually paying on: SUSPENSE

THIS CLAIM WAS NOT FOUND IN YOUR AR. DO YOU WANT TO CONTINUE?: NO// YES

EEOB Filed.

PRESS RETURN TO CONTINUE

Note #1: The Edit Claim # function actually REMOVES the old claim number from the ERA

Worklist and REPLACES it with the new one. If this change is made in the Worklist, the

original number remains on the EEOB and the new number also references the EEOB. It is

cleaner to do it here than the Worklist if the error is simply that the wrong bill # was reported

paid.

Note #2: Once a data exception has been resolved, the system will re-evaluate the ERA to

determine if it can be marked for Auto-Post. A message will display if the ERA was

successfully Marked for Auto-Post, or the reason it was not successfully marked.

➢ TPJI (Third Party Joint Inquiry) – This is a link to TPJI in case further analysis of the site’s

receivables is required.

➢ Pharmacy Claim Comment – Used to enter a one line comment for a non-released

prescription. Only the most recent comment is stored and displayed.

November 2018 ePayments User Guide (EDI Lockbox) 37

Non-Released Prescriptions

An ERA for a non-released prescription automatically goes to the exception list because a bill is not

created for a prescription until the prescription is released. VistA runs a nightly job to evaluate the ERAs

that are on the exception list due to non-released prescriptions. If the prescription has been recently

released, a bill exists, and the ERA has no more exception conditions, the nightly job removes the ERA

from the exception list. Processing of the ERA continues as normal.

3.3. Working the EEOB Scratchpad

The EEOB Scratchpad is a list of electronic EOB (EEOB) detail records that were included on a selected

electronic remittance advice (ERA). It allows for the creation of a receipt that will post each payment

contained in each EEOB against the site's A/R and send to FMS. To accomplish this, some manipulation

of the payment data may be necessary. The EEOB Scratchpad contains the tools for performing these

manipulations (i.e. distribute adjustments, split/edit a payment, etc.).

Note: Negative Claim Balance rule is enforced. When making adjustments the claim balance cannot

be less than zero dollars (collected/closed status).

Once the WL ERA Worklist option above has been selected, the process begins with at least one question

that determines the ERA (ERAs) that is (are) available to be processed. If the user has not saved a

preferred view, the questions associated with the Change View action will be asked. See the section on

the Change View action for details.

There is one question that will always display, regardless of the preferred view. The prompt asks if one

wants to work with a date range selection:

Date Range Selection:

➢ ALL

➢ RANGE

The initial list of the ERAs selected will then be presented:

ERA List - Worklist Jul 22, 2010@17:37:06 Page: 1 of 3

SELECTED: MATCH STATUS: BOTH POST STATUS : UNPOSTED

DATE RANGE : NONE SELECTED AUTO-POSTED : BOTH

ALL PAYERS PHARMACY/MEDICAL: BOTH

# ERA # TRACE#

PAYER NAME/MATCH STATUS & DATE ERA PAID DT TOT AMT PAID DT REC'D

1 1 12345

10/29/02 20.00 10/29/02

IBinsurance Company One APPROX # EEOBs: 1

CHK MATCHED 7/21/2010 EFT RECEIPT STATUS: NOT ENTERED

2 1234567891 TEST123

6/8/10 3456.78 6/8/10

IBinsurance Company Two APPROX # EEOBs: 1

CHK MATCHED 7/21/2010 (CHECK PAYMENT CHOSEN)

3 9876543210 01234567890123456789012345678901234567890123456789

7/21/10 123.45 7/21/10

IBinsurance Company Three APPROX # EEOBs: 1

CHK MATCHED 7/21/2010 (CHECK PAYMENT CHOSEN)

+ |'-' No scratchpad|'x' EXC |'A' autopost complete

Select ERA View/Print ERA Admin Cost Adj

Sort List Change View

Mark for Auto Post Manual Match Exit

Select Action: Next Screen//

38 ePayments User Guide (EDI Lockbox) November 2018

Figure 4 - Sample ERA List – Worklist (list manager worklist)

ERA List - Worklist Actions

There are a number of list manager options available on the ERA Worklist screen that provides greater

capability to manage records at the ERA level.

Select ERA

Used to select a specific ERA.

Sort List

Allows the user to sort the ERA worklist by multiple criteria; amount paid, payer

name, ERA paid date, or date ERA received. Sorting the worklist by these criteria does

not change the list of the individual EEOB’s within each ERA.

View/Print ERA

Used to display/print the summary ERA information.

Change View

Used to customize the information displayed on the ERA worklist.

Admin Cost Adj

Used to make Administrative Cost Adjustments to a claim.

3.3.1.1. Sort List

In order to work more efficiently with ERAs, the user can choose selections from two different sort levels

in order to identify the ERAs to be worked on first:

➢ First Level Sort: Amount Paid, Payer Name, ERA Paid Date, Date ERA Received

➢ Second Level Sort: None, or any of the data elements listed in the First Level Sort (cannot

use the same sort twice)

3.3.1.2. View/Print ERA

The View/Print ERA action is used to display and print the summary ERA information. If a data

exception exists for the selected ERA, a warning message will display. The user must press enter to

continue.

Select #: (6-9): 9

WARNING: Fix Transmission Exceptions first and then Data Exceptions

with the EXE EDI Lockbox 3rd Party Exceptions option which is located

on the EDI Lockbox (ePayments) Main Menu.

PRESS ENTER TO CONTINUE

The View/Print ERA action displays an AUTO-POST STATUS of UNPOSTED, PARTIAL or

COMPLETE, at the ERA summary level and EEOB detail level.

November 2018 ePayments User Guide (EDI Lockbox) 39

3.3.1.3. Change View

The Change View action is used to customize the information displayed on the ERA worklist. After

answering the questions, the system gives the user the option to “SAVE” the selections as a “preferred

view”. If the user saves a preferred view they will be prompted if they want to use that view in the future.

The answers are used to filter the worklist display to limit the entries that are included.

The following options are available as filters.

Select Action: Next Screen// C Change View

SELECT PARAMETERS FOR DISPLAYING THE LIST OF ERAs

(Z)ERO, (P)AYMENT, or (B)OTH: B//

ERA posting status: (U)NPOSTED, (P)OSTED, or (B)OTH: U//

DISPLAY (A)UTO-POSTING, (N)ON AUTO-POSTING, OR (B)OTH: B// OTH

(M)ARKED, (P)ARTIAL, (C)OMPLETE OR (A)LL: A// LL

ERA-EFT MATCH STATUS: (N)OT MATCHED, (M)ATCHED, or (B)OTH: B//

(M)EDICAL, (P)HARMACY, (T)RICARE or (A)LL: A//

(A)LL PAYERS, (R)ANGE OF PAYER NAMES: A// LL

DO YOU WANT TO SAVE THIS AS YOUR PREFERRED VIEW (Y/N)? NO//

Select Parameters for Displaying the List of ERAs:

➢ Zero – Show only zero dollar ERAs

➢ Payment – Show only ERAs with payments

➢ Both – Show both zero dollar and ERAs with payments

ERA Posting Status:

➢ UNPOSTED – ERA/Receipt has not been posted to FMS

➢ POSTED - ERA/Receipt has been posted to FMS

Auto-Posting Qualification

➢ AUTO-POSTING – ERA meets criteria for auto-posting

➢ NON AUTO-POSTING – ERA does not meet criteria for auto-posting

➢ BOTH – All ERAs, regardless of criteria for auto-posting

Partial Posted and Marked for Auto-Post Status:

➢ Select MARKED to only see ERAs currently marked for auto-post

➢ Select PARTIAL to only see ERAs with a partial auto-post status

➢ Select COMPLETE to only see ERAs with a complete auto-post status

➢ Select ALL to see ERAs with any auto-post status

ERA-EFT Match Status:

40 ePayments User Guide (EDI Lockbox) November 2018

➢ NOT MATCHED – ERA has not been matched with an EFT (automatically by nightly job) –

or – ERA has not been matched with a paper check by user - or - ERA has not been matched

with a Ø -payment by the user

➢ MATCHED - ERA was matched with an EFT (automatically by nightly job) – or – ERA was

matched with a paper check by user) – or – ERA was matched with a Ø-payment by user

➢ BOTH – list both Not Matched and Matched ERAs

Claim Type:

➢ MEDICAL – ERAs for Third Party Medical Claims

➢ PHARMACY – ERAs for Pharmacy Claims

➢ TRICARE – ERAs for Tricare Claims

➢ All – ERAS for Third Party Medical Claims, Pharmacy Claims and Tricare Claims

Payer Range Selection:

➢ ALL

➢ RANGE

3.3.1.4. Select ERA

The Select ERA action allows the user to select a specific ERA by number

If a user selects an ERA with one or more exceptions, the software will alert the user by displaying a

warning that access is denied until all exceptions for that particular ERA are resolved. Users now have the

option to go to exceptions from the worklist.

ACCESS DENIED: Scratchpad creation is not allowed when Exceptions

exist. Fix Transmission Exceptions first and then Data Exceptions

via the EXC EDI Lockbox 3rd Party Exceptions option which is

located on the EDI Lockbox Main Menu.

Do you want to begin clearing Exceptions for this ERA (Y/N)? Y//

If the user selects Y, the user “jumps” to the exceptions list to begin clearing exceptions following the

existing process. The user is returned to the Worklist if the user selects to exit the exceptions process or if

the user enters "N" to the original prompt and does NOT want to begin clearing Exceptions.

If the user selects an ERA that does not have a scratch pad, three options display.

Option

Description

Create Scratchpad

Used to create a scratchpad.

View ERA Details

Used to View/Print ERA; a scratchpad is not created.

Exit

Used to return to the worklist; a scratchpad is not created.

November 2018 ePayments User Guide (EDI Lockbox) 41

The user will be automatically prompted to select the display order for payment information before

continuing to the scratchpad screen.

Once the ERA is selected, if the payer has indicated a PAYMENT METHOD CODE on the ERA, it will

be displayed here. This can be used as a guide as to how the payer has decided to send the payment for

this ERA to the site. Some examples are: CHK indicates a paper check should be expected; NON-

indicates an Ø-payment; ACH indicates an EFT should be expected; FWT indicates a federal wire

transfer.

If the PAYMENT METHOD CODE indicates NON or CHK and is a zero-payment ERA, respond YES to

the next prompt to mark the ERA as MATCH-Ø-PAYMENT.

42 ePayments User Guide (EDI Lockbox) November 2018

If matching a paper check with an ERA, enter the check # and date of the check.

ERA Worklist/Scratch Pad Jul 21, 2010@12:17:58 Page: 1 of 1

ERA Entry #: 9876543210 Total Amt Pd: 123.45 Current View:

Payer Name/ID: IBinsurance Company One/55555555 NO SORT ORDER

PAPER CHECK #: 1003 ALL EEOBs

1 EEOB Seq # On ERA: 1 Net Payment Amt: 123.45

1.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One A/5555

Claim Bal: 0.00 Billed Amt: 0.00 Amt To Post: 123.45

Svc Dt: 6/1/00 COB: NO Rx Copay: UNKNOWN Means Tst: ??

Payment Amt: 123.45 Total Adjustments: 0.00 Net: 123.45

ECME #: XXXXXXXXXXXX

Rx/Fill/Release Status: XXXXXXX/1/Released

DOS: 1/4/13

..............................................................................

Enter ?? for more action

Split/Edit A Line Look At Receipt Mark for Auto Post

Distribute Adj Amts Review Line ERA View/Print ERA

Refresh Scratch Pad Verify RP Receipt Processing

Research Menu Change View EXIT

Select Action: Next Screen//

Figure 5 - Sample ERA Worklist/Scratch Pad

The header of the ERA Worklist/Scratch Pad screen contains the ERA Entry #; the Name and ID number

of the Payer; the Total Amount being Paid on the ERA (this will equal the dollar amount of the Electronic

Funds Transfer or Paper Check received from the Payer; and the EFT Trace # or the number from the

Paper.

Each EEOB line item equates to a line item on a paper EOB form. The advantage is that the information

on the ERA Worklist/Scratch Pad will always be in the same location, regardless of Payer. HIPAA

mandates standardization of the electronic transmissions.

Field

Description

EEOB Seq # on

ERA:

This shows the line item order as the payer sent it. Remember, the Worklist can be

sorted with Zero Payments First or Zero Payments Last, so the sequence number may

not match the line item list on the far left of the screen.

Net Payment

Amt:

The payment amount plus or minus the adjustment amount will equal the net payment

amount for this claim number.

Claim #:

The claims number associated with this payment. This may or may not be the correct

claim number. Research each claim carefully to see the amount being paid is

appropriate for the claim in AR. Test sites have identified Payer errors (typos) that

could result in a payment being applied to the wrong claim if not corrected by using the

Split/Edit A Line action. If the line item is marked (V), the system has already done a

verification match between bill number and the patient name, last four of the social,

date of service and original billed amount.

November 2018 ePayments User Guide (EDI Lockbox) 43

Field

Description

Patient/Last 4:

The patient’s name and last four digits from their SSN. Used to help identify this

payment is for the correct Claim.

Claim Balance:

Current balance from AR.

Billed Amt:

Original billed amount from AR.

Amount to Post:

The payment amount plus or minus the adjustment amount will equal the amount to

post for this claim number.

Service Date:

Beginning Service Date for this Claim

COB:

Coordination of Benefits information that indicates whether a secondary payer has been

identified for this claim.

Rx Copay:

Current Rx Copay status of the patient

Means Test:

Indicates if this patient may be responsible for Means Test co-payments

Payment Amt:

Amount of money paid for this claim on this ERA.

Total

Adjustments:

Net total of all adjustments for this line item.

Net:

The payment amount plus or minus the adjustment amount.

ECME #:

ECME number generated when the NCPDP claim is submitted for a pharmacy

prescription. This field only displays for a pharmacy claim.

Rx/Fill/Release

Status:

The prescription number, fill number and release status (released, non-released). This

field only displays for a pharmacy claim.

DOS:

The date of service submitted on the NCPDP claim. This field only displays for a

pharmacy claim.

If there are unposted payments (EFTs), the system may block access to the scratchpad. Based on the age

of the oldest EFT, the system may generate a warning message, an error message, or no message.

Type of

Claim

Age of oldest EFT

Result

Medical

Less than or equal to 14 calendar days

No warning message or error message displays.

Medical

More than 14 calendar days

A warning message displays. The user must press

enter to continue.

Medical

More than the number of calendar days

specified in site parameters

An error message displays. The user is not allowed

to continue.

Pharmacy

Less than or equal to 21 calendar days

No warning message or error message displays.

Pharmacy

More than 21 calendar days

A warning message displays. The user must press

enter to continue.

Pharmacy

More than the number of calendar days

specified in site parameters

An error message displays. The user is not allowed

to continue.

44 ePayments User Guide (EDI Lockbox) November 2018

The warning messages and error messages display the trace numbers of the older EFTs to allow the users

to research and resolve the problem. If a posting override exists, the warning messages and error

messages are suppressed. See the section on posting overrides for more information.

Worklist Actions

There are a number of actions available on the ERA Worklist/Scratchpad that can assist a user to ensure

that the correct payment is being applied to the correct claim.

Action

Description

Split/Edit a Line

Used to split a payment or adjustment between two or more bills (if the payer has

combined payments) or to correct the claim # associated with a payment (if the payer

has reported the payment for the wrong bill).

The automatic update of EEOB information to reflect the split/edit of claims will

occur at receipt creation in the PRCA nightly autopost job (for APAR) or at receipt

creation in the ERA Worklist.

Note: This action is not available for an auto-posted ERA.

Distribute Adj Amt

Used to balance the receipt total to be posted with the total amount deposited if the

payer sends a takeback within the ERA.

Note: This action now allows adjustments to lines marked as ‘Claim not found in

AR’.

Note: This action is not available for an auto-posted ERA.

Refresh Scratch

Pad

Restores the scratch pad record to the original lines extracted from the ERA. All

previous actions (splits/ edits/ comments) that were performed will be deleted and

must be re-entered.

Note: This action is not available for an auto-posted ERA.

This is locked with the security key “RCDPEPP”.

Research Menu

Link to all the necessary AR functions/ processes such as TPJI, needed to process

ERAs. These can each still be accessed through regular AR menu options.

Look at Receipt

Compiles the payments in the ERA Worklist/Scratch Pad and displays the lines that

will be entered on a receipt.

Note: This action is not available for unposted EEOBs that are part of an auto-

posted ERA. For auto-posted ERAs, only one receipt displays at once.

This is locked with the security key “RCDPEPP”.

Review Line

Allows addition of comments or used as a bookmark on a specific line within an

ERA in case processing was interrupted, thereby allowing the user to more easily

resume where he/she left off. This option must be turned ‘on’ each time the user

enters the ERA to enter or view comments.

Verify

Provides the functionality to identify and manually mark EEOBs as verified.

Note: This action is not available for an auto-posted ERA.

This is locked with the security key “RCDPEPP”.

Change View

Used to customize the information displayed on the ERA worklist.

November 2018 ePayments User Guide (EDI Lockbox) 45

Mark for Auto Post

Option used to indicate the ERA is ready for the software to auto post the ERA

during the next nightly process.

This is locked with the security key “RCDPEPP”.

View/Print ERA

Used to view/print the entire formatted ERA, with or without the EEOB detail.

Receipt Processing

Option that allows the user to process a receipt.

This is locked with the security key “RCDPEPP”.

EXIT

NOTE: The system is modified to remove case sensitivity when comparing Trace #s while manually

matching an ERA/EFT.

3.3.1.5. Split/Edit a Line

Sometimes Payers combine payments for two or more claims onto one claim. This action is used to split

the payment to the appropriate claim. It can also be used to correct an incorrect claim number.

ERA Worklist/Scratch Pad Oct 07, 2003@16:55:39 Page: 2 of 3

ERA Entry #: 21 Total Amt Pd: 1165.99 Current View:

Payer Name/ID: Aetna/US Healthcare/1953402799 NO SORT ORDER

PAPER CHECK #: 05507-93746289 ALL EEOBs

3 EEOB Seq # On ERA: 3 Net Payment Amt: 812.00

3.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One/1234

Claim Bal: 14850.54 Billed Amt: 14850.54 Amt To Post: 812.00

Svc Dt: 12/12/02 COB: NO Rx Copay: NON-EXEMPT Means Tst: YES

Payment Amt: 812.00 Total Adjustments: 0.00 Net: 812.00

............................................................................

4 EEOB Seq # On ERA: 4 Net Payment Amt: 343.99

4.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One/1234

Claim Bal: 100.00 Billed Amt: 100.00 Amt To Post: 343.99

Svc Dt: 1/22/03 COB: NO Rx Copay: NON-EXEMPT Means Tst: YES

Payment Amt: 343.99 Total Adjustments: 0.00 Net: 343.99

...........................................................................

Enter ?? for more actions

Split/Edit A Line Look At Receipt Mark for Auto Post

View/Print EEOB Review Line ERA View/Print ERA

Refresh Scratch Pad Verify RP Receipt Processing

Research Menu Change View EXIT

Select Action: Next Screen//

This example shows how to Split/Edit Line item #4 to post the payment correctly. This action takes place

after reviewing the EEOB detailed data to confirm how the payment should be applied.

Select Action: Next Screen// Split/Edit A Line

SELECT THE ENTRY THAT HAS A LINE YOU NEED TO SPLIT/EDIT

Select EEOB Line: (3-4): 4

4.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One/1234

Claim Bal: 100.00 Billed Amt: 1719.92 Amt To Post: 343.99

Svc Dt: 1/22/03 COB: NO Rx Copay: NON-EXEMPT Means Tst: YES

Payment Amt: 343.99 Total Adjustments: 0.00 Net: 343.99

46 ePayments User Guide (EDI Lockbox) November 2018

.............................................................................

CLAIM #: KXXXXXX// >>Current claim balance is: 100.00

PAYMENT AMOUNT TO APPLY TO THIS CLAIM: 343.99// 100.00

RECEIPT LINE COMMENT: SPLIT PAYMENT REMAINDER APPLIED TO KXXXXXX

CLAIM #: KXXXXXX >>Current claim balance is: 2341.39

PAYMENT AMOUNT TO APPLY TO THIS CLAIM: 243.99// <RET>

RECEIPT LINE COMMENT: SPLIT PAYMENT - ORIG APPLIED TO KXXXXXX

Apply the correct payment amount to the correct claim number(s) until all the funds are applied.

Claim # Payment Amount Adjustment Amt Net Amount

1 KXXXXXX 100.00 0.00 100.00

SPLIT PAYMENT REMAINDER APPLIED TO KXXXXXX

2 KXXXXXX 243.99 0.00 243.99

SPLIT PAYMENT - ORIG APPLIED TO KXXXXXX

============== ============== ===========

TOTALS: 343.99 0.00 343.99

Enter ?? for more actions………………………………………………………………………………………………………….

File New Lines Edit Lines Split Exit

Select Action:Quit// File New Lines

Edit Line Split if the information is not correct. File the new lines to save this information. Exiting

without filing will mean all changes are discarded.

4 EEOB Seq # On ERA: 4 Net Payment Amt: 343.99

4.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One/1234

Claim Bal: 100.00 Billed Amt: 1719.92 Amt To Post: 100.00

Svc Dt: 1/22/03 COB: NO Rx Copay: NON-EXEMPT Means Tst: YES

Payment Amt: 100.00 Total Adjustments: 0.00 Net: 100.00

Receipt Comment: SPLIT PAYMENT REMAINDER APPLIED TO KXXXXXX

..............................................................................

4.002 Claim #: KXXXXXX Patient/Last 4: IBpatient,One/1234

Claim Bal: 2341.39 Billed Amt: 2341.39 Amt To Post: 243.99

Svc Dt: 1/22/03 COB: NO Rx Copay: NON-EXEMPT Means Tst: YES

Payment Amt: 243.99 Total Adjustments: 0.00 Net: 243.99

Receipt Comment: SPLIT PAYMENT - ORIG APPLIED TO KXXXXXX

Sub lines are created for each EEOB line item to allow the payment amounts to be split and distributed as

necessary. The sub lines are numbered in increments of .001. In this example, the sub-lines are

numbered 4.001 and 4.002.

Reason text (i.e. Comment) is mandatory when leaving a portion of the payment in suspense.

COMMENT: ??

Enter a code from the list.

Select one of the following:

1 Collected/Closed

2 Cancelled

3 Returned refund

4 Overpayment

5 Inactive bill

6 Duplicate payment

November 2018 ePayments User Guide (EDI Lockbox) 47

7 Policy termed

8 Service connected

9 Other

The scratchpad screen displays the following if a receipt line comment has been added

2.002 Claim #: SUPENSE Patient/Last 4: ??

***CLAIM NOT FOUND IN YOUR AR ***

Payment Amt: 160.00 Total Adjustments: 0.00 Net: 160.00

Receipt: E1702150EB

Receipt Comment: OVERPAYMENT

Added By: EMPLOYEE,ONE

Date/Time Added: July 20 2017@10:00:00

3.3.1.6. Distribute Adj Amt

There are circumstances where payers determine they have ‘overpaid’ a VA facility on a claim. There are

two possible ways Payers process transactions to recoup overpayments:

• Process a retraction of funds on a subsequent payment (take back)

• Issue a negative payment adjustment (clipped payment)

Here are two examples showing how a ‘clipped payment’ and a ‘take back’ will appear on an ERA.

Example One: Take back

VA billed Payer $200.00 for care. Payer issued a payment for $160.00 (80% of the billed amount). A

Payer review shows policy should have paid at 60% so the actual payment should have been $120.00.

3 EEOB Seq # On ERA: 3 Net Payment Amt: -40.00

3.001 Claim #: KXXXXXX Patient/Last 4: VA Patient One/1234

Claim Bal: 0.00 Billed Amt: 200.00 Amt To Post: -40.00

Svc Dt: 12/12/02 COB: NO Rx Copay: NON-EXEMPT Means Tst: YES

Payment Amt: 120.00 Total Adjustments: -160.00 Net: -40.00

In this example, the Payer sent an EEOB with both the new payment amount ($120.00) and the retraction

of the incorrect payment (-$160.00). This resulted in the Net Payment amount of a negative number (-

$40.00) being recorded on this EEOB. Use the action called Distribute Adj Amts on the ERA

Worklist to decrease the payments received on one or more of the other claims within the ERA. See the

Distributed Adjustments section of this guide for instructions on how to perform this action.

Example Two: Clipped Payment

48 ePayments User Guide (EDI Lockbox) November 2018

Payer determines an overpayment of $14.00 was made to VA. Rather than process a negative transaction

adjustment on as specific VA claim, they process a non-specific retraction.

1 EEOB Seq # On ERA: ADJ1 Net Payment Amt: -14.00

1.001***ADJUSTMENT AT ERA LEVEL

Payment Amt: 0.00 Total Adjustments: -14.00 Net: -14.00

ADJUSTMENTS:

1. Non-specific retraction (ref# S1234): -14.00

The EEOB line shows an adjustment at an ERA level. This is because the Payer did not provide a VA

claim number. The Payment Amount will show as $0.00 and the adjustment amount -$14.00. The net

payment amount is -$14.00. The Ref # is provided by the Payer as a way for both you and the payer to

identify and track this transaction. The Adjustment comments show this is a non-specific retraction with

no reference to a claim number. Again, use the action called Distribute Adj Amts on the ERA

Worklist to decrease the payments received on one or more of the other claims within the ERA. .

Sometimes Payers will process non-specific payments to VA.

2 EEOB Seq # On ERA: ADJ2 Net Payment Amt: 24.00

2.001***ADJUSTMENT AT ERA LEVEL

Payment Amt: 0.00 Total Adjustments: 24.00 Net: 24.00

ADJUSTMENTS:

1. Non-specific payment (ref# A1234): 24.00

ERA level adjustments do not reference individual claims. The payment amount = Ø, the total

adjustments is a positive number ($24.00) and with a net payment for the amount adjusted (negative for a

retraction/positive for an additional payment). The Ref # is provided by the Payer as a way for both you

and the payer to identify and track this transaction. This non-specific payment will be placed in your

facility’s suspense account when the receipt is processed for this ERA.

Use the Distribute Adj Amt action to resolve take-backs and clipped payments.

Select Action: Next Screen// Distribute Adj Amts

SELECT A LINE THAT NEEDS AN ADJUSTMENT AMOUNT DISTRIBUTED: 1.001// <RET>

LINE #: 1.001 AMOUNTS NEEDED TO DISTRIBUTE: -14.00

SELECT A LINE TO DISTRIBUTE THE ADJUSTMENT AMOUNT TO: ?

THE FOLLOWING LINE(S) HAVE A NET PAYMENT THAT CAN BE USED TO OFFSET THE

NEGATIVE NET PAYMENT FOR LINE 1.001 (-14.00):

3.001 812.00 On hold exists

4.001 243.99

2.001 24.00

SELECT A LINE TO DISTRIBUTE THE ADJUSTMENT AMOUNT TO:

In this example, line item 1.001 has a negative amount that needs to be distributed to a payment. Entering

a question mark displays the lines on the ERA that have a positive payment that can be used to offset the

negative net payment.

SELECT A LINE TO DISTRIBUTE THE ADJUSTMENT AMOUNT TO: 4.001

LINE #: 4.001 LINE BALANCE: 243.99

November 2018 ePayments User Guide (EDI Lockbox) 49

ADJUSTMENT AMOUNT TO DISTRIBUTE: 14.00// <RET>

DECREASE ADJ COMMENT (1-60 CHARACTERS):

> RETRACTED FOR ERA ADJ #1 Ref: S1234

Replace <RET>

An adjustment amount can be distributed against several lines if necessary. The user does not have to

perform an adjustment for the take back amount. A DECREASE ADJUSTMENT will be automatically

performed for the decreased amount when the user processes the receipt for posting if the Worklist is used

to create the receipt. A standard comment will be used will be used when the DECREASE

ADJUSTMENT is sent unless a new comment is entered. (It is up to each station to determine if the

default comment is used or a more detailed comment needs to be entered by the user.)

Distribute Adj Amts – Warning Message

SELECT A LINE THAT NEEDS AN ADJUSTMENT AMOUNT DISTRIBUTED: 4.001//

LINE #: 4.001 AMOUNT NEEDED TO DISTRIBUTE: -6.55

SELECT A LINE TO DISTRIBUTE THE ADJUSTMENT AMOUNT TO: 7

THIS IS NOT AN ACTIVE BILL !

CANNOT PERFORM DISTRIBUTION TO THIS CLAIM

An adjustment cannot be made against a line within the ERA that represents a closed claim (claim

balance equals zero dollars). A warning message will be generated if these types of lines are selected and

the user will be forced to select another line.

1 EEOB Seq # On ERA: ADJ1 Net Payment Amt: 0.00

1.001***ADJUSTMENT AT ERA LEVEL

Payment Amt: 0.00 Total Adjustments: 0.00 Net: 0.00

ADJUSTMENTS:

1. Non-specific retraction (ref# S1234): -14.00

2. Adjustment distribution to balance receipt: 14.00

RETRACTED FUNDS DEDUCTED FROM OTHER PAYMENT ON THIS ERA

...........................................................................

4.001 Claim #: KXXXXXX Patient/Last 4: VA Patient One/1234

Claim Bal: 2341.39 Billed Amt: 2341.39 Amt To Post: 229.99

Svc Dt: 1/22/03 COB: NO Rx Copay: NON-EXEMPT Means Tst: YES

Payment Amt: 243.99 Total Adjustments: -14.00 Net: 229.99

ADJUSTMENTS:

1. Distributed adj dec for retraction S1234: -14

RETRACTED FOR ERA ADJ #1 Ref: S1234

50 ePayments User Guide (EDI Lockbox) November 2018

An adjustment record is then displayed attached to BOTH lines selected, indicating the action that was

taken. The negative net payment line will have its net amount automatically increased by the amount

selected and show a Net Payment Amount of zero. The line with the positive net payment data will be

automatically decreased by this same amount to balance the amount of the deposit/check with the amount

being posted. The Total Adjustments field shows the amount adjusted, while the Amount to Post and Net

show the new payment amount.

November 2018 ePayments User Guide (EDI Lockbox) 51

3.3.1.7. View/Print EEOB and View/Print ERA

These Worklist actions are used to display/print the detail received from a Payer. Where the View/Print

EEOB will only show the information for one line on the ERA, the View/Print ERA will show detailed

information on each and every EEOB line for the entire ERA. Here is a sample of the EEOB information

sent by Payers.

EDI LOCKBOX EEOB DETAIL FROM WORKLIST 10/13/10 Page: 1

ERA NUMBER: XXXXXXXXXX ERA DATE: Feb 07, 2010

INS COMPANY: IBinsurance Company One/555555555

ERA TRACE #: XXXXXXXXXXX

===============================================================================

CLAIM #: XXX-KXXXXXX

EOB GENERAL INFORMATION:

Type : NORMAL EOB EOB Paid DT : 02/07/07

Entry Dt/Tm :02/09/07 4:32 pm Claim Status : PROCESSED

Entry Dt/Tm :02/09/07 4:32 pm Review Status: ACCEPTED-COMPLETE EOB

Entered By : Insurance Seq: PRIMARY

Last Edited : 02/09/07 6:50 pm Last Edit By : POSTMASTER

Patient Name: IBpatient,One A Pt. Relation : PATIENT

Insured Name: IBpatient,One A Insured ID : XXXXXXXXX

Claim Rec'd Date :

Other Subscriber Name:

Enter RETURN to continue or '^' to exit:

EDI LOCKBOX EEOB DETAIL FROM WORKLIST 10/13/10 Page: 2

ERA NUMBER: XXXXXXXXXX ERA DATE: Feb 07, 2010

INS COMPANY: IBinsurance Company One/555555555

ERA TRACE #: XXXXXXXXXXX

===============================================================================

PAYER INFORMATION:

Payer Name : IBinsurance Company One

Payer Id : 555555555

ICN : XXXXXXXXX

Contact Phone : 555-555-5555

Contact e-Mail : XXXXXX@XXXX.COM

Payer Web Site : http://www.WebSite.com

Policy Reference: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Cross Ovr ID : XXXXXXXXXX

Cross Ovr Nm: XXXXXXXXXX XXXXXX

Enter RETURN to continue or '^' to exit:

EDI LOCKBOX EEOB DETAIL FROM WORKLIST 7/22/10 Page: 3

ERA NUMBER: XXXXXXXXXX ERA DATE: Feb 07, 2010

INS COMPANY: IBinsurance Company One/555555555

ERA TRACE #: 1234567890123456789012345678901234567890123456789

==============================================================================

CLAIM LEVEL PAY STATUS:

Tot Submitted Chrg: 102.95 Covered Amt : 0.00

Payer Paid Amt : 20.59 Patient Resp. Amt : 0.00

CLAIM LEVEL ADJUSTMENTS:

52 ePayments User Guide (EDI Lockbox) November 2018

NONE

MEDICARE INFORMATION:

NONE

LINE LEVEL ADJUSTMENTS:

# SV DT REVCD PROC MOD UNITS BILLED DEDUCT COINS ALLOW PYMT

1 06/01/10 510 99213 1 102.95 0.00 0.00 102.95 20.59

ADJ: CO 23 Payment adjusted because charges have been paid by another payer.

ADJ AMT: 82.36

Enter RETURN to continue or '^' to exit:

The example below shows the EEOB move/copy history

EDI LOCKBOX EEOB DETAIL FROM WORKLIST 2/6/17 Page: 2

ERA NUMBER: 147 ERA DATE: Feb 06, 2017

INS COMPANY: TJB INSURANCE CO./xxxxxxxxx

ERA TRACE #: xxxxxxxxxxxxxxx

Payer Name : EPHARM INSURANCE

Payer Id : xxxxxxxxxxx

ICN : xxxxxxxxxxx

MOVE/COPY HISTORY

Date/Time of EEOB Copy: FEB 03, 2017@10:27:18

Copy of EEOB performed by: EMPLOYEE,ONE

Copy Justification Comments:

JUSTIFICATION

Other Claims: K50000E

**A/R CORRECTED PAYMENT DATA:

TOTAL AMT PD: 1200.00

[suspense]NO BILL 1000.00

xxx-K500009 200.00

3.3.1.8. Review Line

This worklist action is used to enter comments for an EEOB or as a bookmark when an EEOB was last

worked on, so that the process be more easily resumed after an interruption. This option now remains

active for the user, even if he/she leaves the worklist. Additionally, each user comment that has been

entered is identified by the user and the date/time that it was entered or edited. This will allow the user to

edit his/her own comments. Individual user preference determines whether this option is consistently on

or off.

Select Action: Next Screen// re

1 Refresh Scratch Pad

2 Research Menu

3 Review Line

CHOOSE 1-3: 3 Review Line

REVIEW DATA DISPLAY IS CURRENTLY TURNED ON

DO YOU WANT TO TURN IT OFF?: NO//

Select EEOB Line: (1-2): 1

November 2018 ePayments User Guide (EDI Lockbox) 53

REVIEW DATE/TIME: 8/12/04@13:13:18

COMMENT:

1>this is a test

EDIT Option:

REVIEWED?: y YES

3.3.1.9. Verify

The system has been enhanced to automatically mark EEOBs as verified based on the first five digits of

the patient’s last name, the patient’s last four of their social security number, the claim number, the

original bill amount, and the date of service. If all the criteria matches in the EEOB and in the AR

package, the system will place a (V) next to the EEOB to indicate that all the criteria was automatically

verified. For non auto-post ERAs, where the system indicator has not been automatically updated, this

worklist action is manually used to mark EEOBs as verified. In addition, for both auto-post and non auto-

post ERAs, the user can display/print the list of bills that were not automatically verified or contain

discrepancies between the EEOB and the bill record in VistA. The report will include data from the

original bill (i.e. patient full name, date of service, last 4 digits of patient’s SSN, billed amount, and bill

number) as well as data from the EEOB (i.e. patient full name, date of service, billed amount and bill

number). Note that all the data shown on the worklist for the EEOB is taken from the claim in VistA.

You must use the report below to identify the discrepancies for unverified EEOBs. This action requires

the RCDPEPP security key.

Autopost ERA Lines Discrepancy Report

EDI LBOX WORKLIST - AUTOPOST ERA LINES DISCREPANCIES REPORT 3/30/18 Page: 1

ERA #: 92599 TRACE #: ABC6467843571

PAYER: AETNA ERA DT: 2/1/18

PATIENT NAME SUBMITTED AMT SVC DATE(S)

* preceding data = data has discrepancy

================================================================================

EEOB Sequence #(s) on the ERA:1 K1000000 Unverified

VistA:*Last, First Middle 186.66 7/10/00 – 7/10/00

ERA:*Last, First Middle 186.66 7/10/00 – 7/10/00

Figure 8 - Sample of Autopost ERA Lines Discrepancies Report Output

54 ePayments User Guide (EDI Lockbox) November 2018

Change View

The Change View action is used to customize the information displayed on the ERA worklist scratchpad.

After answering the questions, the system gives the user the option to “SAVE” the selections as a

“preferred view”. If the user saves a preferred view they will be prompted if they want to use that view in

the future.

The answers are used to filter the scratchpad display to limit the entries that are included.

The following options are available as filters.

Select Action: Quit// c Change View

ORDER OF PAYMENT: N// O ORDER

DISPLAY FOR AUTO-POSTED ERAS: (U)NPOSTED EEOBs, (P)OSTED EEOBs, OR (A)LL: U// NP

OSTED

DO YOU WANT TO SAVE THIS AS YOUR PREFERRED VIEW (Y/N)? NO/

Order of Payment:

➢ N NO ORDER – Does not list payments with respect to zero-payments

➢ F ZERO-PAYMENTS FIRST – Display all zero-payments first

➢ L ZERO-PAYMENTS LAST – Display all zero-payments last

Auto-Posting Qualification

➢ U UNPOSTED – Only display unposted EEOBs

➢ P POSTED – Only display posted EEOBs

➢ A ALL – Display all EEOBS, both posted and unposted

Research Menu Actions

The Research Menu provides access to functionality necessary to process ERAs. It can be accessed from

the ERA Worklist/Scratch Pad to facilitate business process. Links to the following existing AR

functions are available.

Action

Description

Full Account

Profile

This option will display a full account profile of all bills for a debtor regardless

of the status of the bill.

TPJI

Comment History will display contact information if provided

Bill Comment

Log

Allows user to document any necessary and pertinent information on a 3rd party

bill.

Re-establish

Bill

Provides the capability to re-establish a bill for the specific site.

This is locked with the security key “RCDPEAR”.

View/Print

EEOB

Used to display/print the detail received on the ERA for a selected line.

Review Line

Bookmarks a specific line within an ERA in case processing was interrupted,

thereby allowing the user to more easily resume where he/she left off.

November 2018 ePayments User Guide (EDI Lockbox) 55

Comment History Screen of TPJI

The Comments History screen of the Third Party Joint Inquiry option displays contact data which will

include payer name and can include phone number, fax number, email address, and website address.

Contact data that comes in from an ERA or MRA transaction will be distinguishable from manually

entered comments by use of the program generated text, “ERA Payer Contact Information”. Refer to

example below:

Comment History Jul 07, 2011@18:27:38 Page: 1 of 1

K700CM9 CAGGIANO,GARTH JR C1547 DOB: 04/29/39 Subsc ID: 520372456

AR Status: COLLECTED/CLOSED Orig Amt: 4.49 Balance Due: 0.00

3551940 01/17/07 2A FOLLOW-UP DT:

3649412 07/07/11 ERA Payer Contact Information FOLLOW-UP DT:

Payer Name: UNITEDHEALTHCARE

Contact Name: TEST PAYER 1

Phone Number: 800-909-1212

Payer Name: MEDICARE (WNR)

Contact Name: MEDICARE TEST PAYER

Phone Number: 888-998-1212

Email Address: EMAIL1@YAHOO.COM

Enter ?? for more actions

BC Bill Charges AR Account Profile VI Insurance Company

DX Bill Diagnosis AD Add Comment VP Policy

PR Bill Procedures IR Insurance Reviews AB Annual Benefits

CI Go to Claim Screen HS Health Summary EL Patient Eligibility

AL Go to Active List EX Exit

Select Action: Quit//

The Trace number and ERA number will display on the Bill Charges screen of TPJI for non-MRA ERAs.

Refer to example below:

Bill Charges Nov 27, 2011@20:47:24 Page: 1 of 2

%K4004JU ZELE,ELI R Z9854 DOB: 12/08/44 Subsc ID: SUBSC ID 587893

03/11/02 - 03/11/02 ADMIT THRU DISCHARGE Orig Amt: 177.72

G2 830148494

03 11 02 03 11 02 22 99213 123 17772 1 1790708568

>> EOB/MRA Information (1 OF 1)

EOB Type: NORMAL EOB

ICN: EP253MC4S0000 Patient Resp Amount: 128.92

Payer Name: AETNA US HEALTHCARE Total Allowed Amount: 0.00

EOB Date: Jan 07, 2004 Total Submitted Charges: 177.72

Svc From Dt: Svc To Dt:

Reported Payment Amt: 48.80

ERA #: 12 Auto-Post Status: Partial

Trace #: 804001620000025

+ |% EEOB | Enter ?? for more actions|

PR Bill Procedures CM Comment History AB Annual Benefits

CI Go to Claim Screen IR Insurance Reviews EL Patient Eligibility

HS Health Summary EX Exit

ED EDI Status AL Go to Active List

VI Insurance Company

Select Action: Next Screen//

56 ePayments User Guide (EDI Lockbox) November 2018

Example of processing a Paper Check and ERA

VAMC received a paper check from IBinsurance Company One, a payer who sends Electronic

Remittance Advices (ERAs). Begin by selecting the ERA Worklist option.

Select EDI Lockbox (ePayments) Option: WL ERA Worklist

SELECT PARAMETERS FOR SELECTING AN ERA

ERA POSTING STATUS: UNPOSTED//

ERA-EFT MATCH STATUS: BOTH// NOT MATCHED

LIMIT THE SELECTION TO A DATE RANGE WHEN THE ERA WAS RECEIVED?: NO//

Select ELECTRONIC REMITTANCE ADVICE ENTRY: 55555-55555555 6 55555-55555555 03-06-03

509.61 IBinsurance Company One UNMATCHED

The paper check (55555-55555555) matches the ERA Trace # and the check amount received from the

Payer.

No Worklist currently exists for this ERA. Create one now.

NO WORKLIST SCRATCH PAD ENTRY EXISTS FOR THIS ERA

DO YOU WANT TO CREATE ONE NOW?: NO// YES

NO PAYMENT METHOD CODE REPORTED

THIS ERA DOES NOT HAVE A MATCHING EFT

ENTER THE NUMBER OF THE PAPER CHECK YOU RECEIVED FOR THIS ERA: 55555-55555555// <RET>

DATE OF CHECK: 3/6/03// <RET> (MAR 06, 2003)

CHECK BANK/ROUTING #: 123456 IBinsurance Company One

ERA #6 (TRACE #:55555-55555555) MATCHED TO PAPER CHECK 55555-55555555

IS THIS CORRECT?: YES// <RET>

ORDER OF PAYMENTS: NO ORDER// L ZERO-PAYMENTS LAST

November 2018 ePayments User Guide (EDI Lockbox) 57

Verify the paper check number is correct. The date on the check should match the date listed in VistA. If

it does not match, correct the VistA date to match the paper check. Enter the Check Bank/ Routing

number as station policy dictates. Again, verify the information is correct. Select the order of the

Payments. In this case, select L to sort the zero payment EEOBs to the bottom of the Worklist.

ERA Worklist/Scratch Pad Sep 11, 2010@13:24:20 Page: 1 of 2

ERA Entry #: 5 Total Amt Pd: 509.61 Current View:

Payer Name/ID: IBinsurance Company One/5555555555 NO SORT ORDER

PAPER CHECK #: 55555-55555555 ALL EEOBs

1 EEOB Seq # On ERA: 3 Net Payment Amt: 509.61

1.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One/1234

Claim Bal: 559.61 Billed Amt: 559.61 Amt To Post: 509.61

Svc Dt: 2/4/03 COB: NO Rx Copay: NON-EXEMPT Means Tst: NO

Payment Amt: 509.61 Total Adjustments: 0.00 Net: 509.61

...........................................................................

2 EEOB Seq # On ERA: 1 Net Payment Amt: 0.00

2.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One/1234

Claim Bal: 0.00 Billed Amt: 19.47 Amt To Post: 0.00

Svc Dt: 1/27/03 COB: NO Rx Copay: NON-EXEMPT Means Tst: ??

Payment Amt: 0.00 Total Adjustments: 0.00 Net: 0.00

...........................................................................

+ Enter ?? for more actions

Split/Edit A Line Look At Receipt Mark for Auto Post

View/Print EEOB Review Line ERA View/Print ERA

Refresh Scratch Pad Verify RP Receipt Processing

Research Menu Change View EXIT

Select Action: Next Screen// EOB View/Print EEOB

3.3.1.10. Process EEOB Line Items

• In order to process line item #1, select the Research Menu action to access Third Party Joint

Inquiry (TPJI) to confirm this payment is correct for this claim.

• The IB application is enhanced to display the Trace Number and ERA Number on the TPJI screen

when viewing the EEOB.

Select Action: Next Screen// BC Bill Charges

DO YOU WANT ALL EEOB DETAILS?: NO// YES

>> EOB/MRA Information (1 OF 1)

EOB Type: NORMAL EOB

ICN: XXXXXXXXXXXX Patient Resp Amount: 50.00

Payer Name: IBinsurance Company One Total Allowed Amount: 0.00

EOB Date: Mar 06, 2003 Total Submitted Charges: 559.61

Reported Payment Amt: 509.61

Bill #: XXX-KXXXXXX

Adjustment Group Code: PR

Adjustment Reason Code: 3

Adjustment Amount: 50.00

Quantity: 0

Reason Code Text: Co-payment Amount

58 ePayments User Guide (EDI Lockbox) November 2018

The user can view the EEOB details without going back to the worklist by selecting Bill Charges (BC)

from within TPJI to view the EEOB Details for this claim. Scrolling down to the bottom of the EEOB

information shows the Payer adjusted this payment by $50.00 for the patient’s insurance co-payment

amount.

3.3.1.11. Create Receipt

After all of the EEOB lines have been reviewed, verified as correct and adjusted appropriately, it is time

to create the receipt for these payments. Select Look at Receipt from the ERA Worklist/Scratch Pad

screen.

ERA WORKLIST PREVIEW RECEIPT Oct 07, 2003@15:09:36 Page: 1 of 1

ERA Entry #: 6 Total Amt Pd: 509.61

Payer Name/ID: IBinsurance Company One/5555555555

PAPER CHECK #: 55555-55555555

LINE # ACCOUNT AMOUNT .

PAYMENTS (LINES FOR RECEIPT):

2.001 XXX-KXXXXXX 509.61

ZERO DOLLAR PAYMENTS:

1.001 XXX-KXXXXXX 0.00

3.001 XXX-KXXXXXX 0.00

Enter ?? for more actions………………………………………………………………………………………………………….

Print Receipt Preview Create Receipt Exit

Select Action: Quit//

The preview screen is divided into two sections. The top contains the line items and payment

information. The bottom section lists all of the zero-dollar payments. Zero-dollar payments can be

worked using AR options in the research menu from within the Worklist.

The Create Receipt action will create the receipt for lines on the ERA that contain payments and those

lines used to offset any negative payments on this ERA. The ERA Worklist can no longer be used to

adjust any of the line items once the receipt is created.

THIS ACTION WILL CREATE THE RECEIPT FOR THIS ERA. ONCE THE RECEIPT IS

CREATED HERE, NO MORE AUTOMATIC ADJUSTMENTS MAY BE MADE FOR THIS ERA.

ARE YOU SURE YOU ARE READY TO CREATE THIS RECEIPT?: NO// YES

Select AR DEPOSIT TICKET #: 123456 03-10-03 IBpatient,One A

$0.00 OPEN

ARE YOU SURE YOU WANT TO USE THIS DEPOSIT?: NO// YES

RECEIPT EXXXXXXXX HAS BEEN CREATED FOR THIS ERA

DO YOU WANT TO GO TO RECEIPT PROCESSING NOW? YES// <RET>

November 2018 ePayments User Guide (EDI Lockbox) 59

Processing receipts for paper checks require the entry of an AR Deposit Ticket #. Contact the Agent

Cashier for this number. The system will automatically generate a receipt number for this payment. All

3rd Party EDI Lockbox receipts will begin with the letter ‘E’. It is important to note that every ERA is

assigned its own receipt number. If four ERAs are processed on a given day, then there will be four ‘E’

receipts – one for each ERA. The system assigns the electronic receipt number based on the date and the

last two digits are a combination of numbers or letters. In the example below, the receipt was created on

October 7, 2003 and was the first batch created for that day (00).

Receipt Profile Oct 07, 2003@15:14:52 Page: 1 of 1

Receipt #: EXXXXXXXX Type of Payment: CHECK/MO PAYMENT

Deposit #: XXXXXX ERA #: 6 Receipt Status: OPEN

ERA #: xxxxxxxxxx ERA TTL: xxxxxx.xx FMS Document: NOT SENT

EFT #: xxxxxxxxxx EFT TTL: xxxxxx.xx FMS Doc Status: NOT ENTERED

# Account Pay Date By Pay Amt Proc Amt

1 XXX-KXXXXXX 10/07/03 EG 509.61 0.00

-------- --------

TOTAL DOLLARS FOR RECEIPT 509.61 0.00

Receipt History

Opened By: IBclerk,One Date/Time Opened: Oct 7, 2003

Last Edit By: Date/Time Last Edit:

Processed By: Date/Time Processed:

Enter ?? for more actions………………………………………………………………………………………………………….

NP New Payment AP Account Profile PR Process Receipt

EP Edit Payment RR Reprint Receipt 21 (215 Report)

CP Cancel Payment WL Worklist (ERA) EA Exit Action

MP Move Payment CU Customize CR Entered Online

ER Edit Receipt

Select Action: Quit//

The Receipt Profile screen is the same screen used when the option Receipt Processing is selected. All of

the payment line items automatically transfer to this screen. No additional data entry is required to input

these claim numbers and payment amounts. Process this receipt as normal to complete processing a

Paper Check and ERA. The following condition must be met before the receipt can be fully processed to

FMS:

The total on the receipt must be equal to the total reported on the ERA.

When the above condition is met, select the PROCESS RECEIPT action. The system will:

a) Generate the decrease adjustment for any distributed adjustments made to the payments

on the Worklist AND add any related bill comments to the Bill record in AR.

b) If the receipt passes the normal edits for posting, the system will post payments to your

AR and then generate and transmit the appropriate CR document to FMS for these

payments.

60 ePayments User Guide (EDI Lockbox) November 2018

Example of processing a matched ERA and EFT

VAMC received an Electronic Funds Transfer (EFT) from IBinsurance Company One, a payer who sends

both EFTS and ERAs. Begin by selecting the ERA Worklist option.

Select EDI Lockbox (ePayments) Option: WL ERA Worklist

DO YOU WANT A (L)IST OF ERAs OR A (S)PECIFIC ONE?: LIST//

LIMIT THE SELECTION TO A DATE RANGE WHEN THE ERA WAS RECEIVED?: NO//

The EFT payment was automatically matched with the ERA during the AR nightly job. The user can

select a specific payer by selecting Range or can view all payers by selecting All. All is the default

selection.

Select ELECTRONIC REMITTANCE ADVICE ENTRY: 25 55555-55555555 03-10-03 79.55

IBinsurance Company One MATCHED

NO WORKLIST SCRATCH PAD ENTRY EXISTS FOR THIS ERA

(C)reate scratchpad, (V)iew ERA details or (E)xit:

NO PAYMENT METHOD CODE REPORTED

ORDER OF PAYMENTS: NO ORDER//

In this example the user selected ERA #25 after viewing the worklist. The EFT Trace # 55555-55555555

was received from the Payer. Note that no check information is required. The EFT payment was already

deposited into US Treasury, account MCCR RSC 528704/8NZZ for the VA.

If no scratchpad entry currently exists for this ERA, create one now.

November 2018 ePayments User Guide (EDI Lockbox) 61

ERA Worklist/Scratch Pad Oct 07, 2003@15:52:17 Page: 1 of 2

ERA Entry #: 25 Total Amt Pd: 79.55 Current View:

Payer Name/ID: IBinsurance Company One/5555555555 NO SORT ORDER

EFT #/TRACE #: 3/55555-55555555 ALL EEOBs

1 EEOB Seq # On ERA: 1 Net Payment Amt: 47.26

1.001 Claim #: KXXXXXX Patient/Last 4:IBpatient,One/0000

Claim Bal: 236.31 Billed Amt: 236.31 Amt To Post: 47.26

Svc Dt: 1/15/03 COB: NO Rx Copay: NON-EXEMPT Means Tst: NO

Payment Amt: 47.26 Total Adjustments: 0.00 Net: 47.26

...........................................................................

2 EEOB Seq # On ERA: 2 Net Payment Amt: 32.29

2.001 Claim #: KXXXXXX Patient/Last 4: IBpatient,One/0000

Claim Bal: 161.46 Billed Amt: 161.46 Amt To Post: 32.29

Svc Dt: 7/26/02 COB: NO Rx Copay: NON-EXEMPT Means Tst: NO

Payment Amt: 32.29 Total Adjustments: 0.00 Net: 32.29

...........................................................................

Enter ?? for more actions

Split/Edit A Line Look At Receipt Mark for Auto Post

View/Print EEOB Review Line ERA View/Print ERA

Refresh Scratch Pad Verify RP Receipt Processing

Research Menu Change View EXIT

Select Action: Quit//

The header of the ERA Worklist/Scratch Pad screen shows the EFT #/Trace # instead of the number from

the paper check.

Processing of an EFT/ERA is no different than processing an ERA and Paper Check. Perform the

necessary reviews and processing for each claim.

3.3.1.12. Create Receipt

After all of the EEOB lines have been reviewed and processed, it is time to create the receipt for these

payments. Select Look AT Receipt from the ERA Worklist/Scratch Pad screen.

ERA WORKLIST PREVIEW RECEIPT Oct 07, 2003@16:20:17 Page: 1 of 1

ERA Entry #: 25 Total Amt Pd: 79.55

EFT #/TRACE #: 3/55555-55555555

Payer Name/ID: IBinsurance Company One/5555555555

LINE # ACCOUNT AMOUNT .

PAYMENTS (LINES FOR RECEIPT):

1.001 XXX-KXXXXXX 47.26

2.001 XXX-KXXXXXX 32.29

ZERO DOLLAR PAYMENTS:

3.001 XXX-KXXXXXX 0.00

Enter ?? for more actions

Print Receipt Preview Create Receipt Exit

Select Action: Quit//

62 ePayments User Guide (EDI Lockbox) November 2018

The ‘look at’ screen is divided into two sections. The top contains the line items and payment

information. The bottom section lists all of the zero-dollar payments. Zero-dollar payments can be

“worked” using AR options or from within the Worklist.

The Create Receipt action will create the receipt for the lines on the ERA that contain payments and those

lines used to distribute negative payments on this ERA. The ERA Worklist can no longer be used to

adjust any of the line items once the receipt is created.

THIS ACTION WILL CREATE THE RECEIPT FOR THIS ERA. ONCE THE RECEIPT IS

CREATED HERE, NO MORE AUTOMATIC ADJUSTMENTS MAY BE MADE FOR THIS ERA.

ARE YOU SURE YOU ARE READY TO CREATE THIS RECEIPT?: NO// YES

RECEIPT E03100701 HAS BEEN CREATED FOR THIS ERA

DO YOU WANT TO GO TO RECEIPT PROCESSING NOW? YES//

Processing receipts for EFTs does not require or allow the entry of an AR Deposit Ticket #. Remember,

The EFT payment was already deposited into US Treasury for the VA. As with the receipt for a paper

check, the system will automatically generate a receipt number for this payment. All 3rd Party EDI

Lockbox receipts will begin with the letter ‘E’. It is important to note that every ERA is assigned its own

receipt number. If four ERAs are processed on a given day, then there will be four ‘E’ receipts – one for

each ERA.

ER Edit Receipt

Receipt Profile Oct 07, 2003@16:24:41 Page: 1 of 1

Receipt #: E03100701 Type of Payment: EDI LOCKBOX

EFT Detail #: 3 VETERAN ERA #: 25 Receipt Status: OPEN

ERA #: xxxxxxxxxx ERA TTL: xxxxxx.xx FMS Document: NOT SENT

EFT #: xxxxxxxxxx EFT TTL: xxxxxx.xx FMS Doc Status: NOT ENTERED

# Account Pay Date By Pay Amt Proc Amt

1 XXX-KXXXXXX 10/07/03 EG 47.26 0.00

2 XXX-KXXXXXX 10/07/03 EG 32.29 0.00

-------- --------

TOTAL DOLLARS FOR RECEIPT 79.55 0.00

Receipt History

Opened By: IBclerk,One Date/Time Opened: MAR 10, 2003

Last Edit By: Date/Time Last Edit:

Processed By: Date/Time Processed:

Enter ?? for more actions………………………………………………………………………………………………………….

NP New Payment AP Account Profile PR Process Receipt

EP Edit Payment RR Reprint Receipt 21 (215 Report)

CP Cancel Payment WL Worklist (ERA) EA Exit Action

MP Move Payment CU Customize CR Entered Online

ER Edit Receipt

Select Action: Quit// QUIT

November 2018 ePayments User Guide (EDI Lockbox) 63

The Receipt Profile screen is the same screen as you would see for Receipt Processing. Instead of a

Deposit Ticket #, the EFT Detail and ERA # will display. The Type of Payment indicates EDI

LOCKBOX. All of the payment line items automatically transfer to this screen. No additional data entry

is required to input these claim numbers and payment amounts. Process the receipt as normal. The

following conditions must be met before the receipt can be fully processed to FMS:

a. An ERA receipt cannot be processed if the EFT receipt for the EFT related to this ERA has

not yet been recorded in FMS and confirmed as ACCEPTED in VistA. Wait until the FMS

document for the EFT deposit has reached this status in VistA before processing the ERA

related to the EFT.

b. If there is an error on the EFT where the checksum was determined to be invalid, the receipt

cannot be processed until the EDI Lockbox checksum exception is cleared on the EFT

transmission

c. If the total of the receipt is not the same as the total reported on the EFT, the receipt cannot

be processed.

d. A receipt for an ERA related to an EFT cannot have a deposit associated with it.

When the above conditions have been met, and you select PROCESS RECEIPT, the system will:

a. Generate the decrease adjustments for any distributed adjustments made to the payments in

the Worklist and add any related bill comments to the bills.

b. If the receipt passes the normal edits for posting, it will post the payments to your A/R and

will generate and transmit the appropriate TR document to FMS for EFT payments. The TR

documents will transfer the payment amounts from the Fund 528704, Revenue Source Code

8NZZ account (where it was placed by the CR generated when the EFT was recorded) into

the correct General Ledger accounts for the claims on the ERA. A CR document is created

and recorded in FMS for receipts that are processed using a paper check.

3.3.1.13. How to Process an EFT using a Paper EOB (when the ERA is not

received)

It is important to process an EFT even if the ERA is unavailable. By processing the EFT, the funds are

appropriately transferred to the appropriate revenue source codes and the third party payments are applied

to the proper outstanding accounts receivables.

Create a receipt using the receipt number of the EFT. A letter or number will need to be added to the end

of the receipt. This process will create a good audit trail of the EFT. The EFT receipt number can be

located by accessing the EFT Daily Activity Report (see Reports section).

Enter EDI LOCKBOX for the receipt payment type.

Select the corresponding EFT. (To see a complete listing of EFTs, enter ‘??’)

Do not enter a deposit ticket. The Funds have already been deposited in to the appropriate fund.

64 ePayments User Guide (EDI Lockbox) November 2018

Manually enter each payment.

Complete the receipt processing function according to local policy.

*NOTE – The EFT will be removed from the EFT Unmatched Aging Report with this process; however,

the Unapplied EFT Deposits Report will still display this EFT. (A future enhancement will correct this

issue)

3.4. Auto-Posting Claims

VistA runs a nightly job to automatically post third party medical claims by creating and processing

receipts. The system attempts to create and process receipts for claims that are candidates for auto-

posting based on auto posting parameters.

Medical Auto-Posting Candidates

A third party medical claim is a candidate for auto-posting if the following conditions are met:

• Auto-posting is enabled in the EDI LOCKBOX PARAMETERS [RCDPE EDI

LOCKBOX PARAMETERS]

• The EEOB payer is not excluded from auto-posting in the EDI LOCKBOX

PARAMETERS [RCDPE EDI LOCKBOX PARAMETERS]

• The ERA does not have an exception

• The ERA does not contain interest

• The ERA does not contain an adjustment

• The EFT and ERA are matched

• The ERA total amount equals the sum of all EEOBs listed on the ERA

• The EFT and ERA total amounts must balance

• The EFT has been accepted by FMS

• The ERA negative payments all have a matching positive payment (+/- pairs)

Medical Auto-Posting Create and Process Receipt

When the nightly job runs, a receipt is created and processed if the following conditions are met:

• The EEOB detail has been verified against the bill detail

• The claim balance covers the payment to be posted for all EEOBs

• The claim status is open for all EEOBs

• The claim has not been referred to regional council or general council

If all auto-posting conditions to create and process a receipt are not met for an EEOB, the system sends that

EEOB to the Auto-Posting Awaiting Resolution list. Once a user corrects the condition that prevented

receipt processing, the EEOB can be reprocessed by the next nightly job. For more details, refer to the

section on Auto-Posting Awaiting Resolution.

November 2018 ePayments User Guide (EDI Lockbox) 65

Medical Auto-Posting Receipts

The system creates a receipt for all EEOBs that can be auto-posted, even if all EEOBs in an ERA cannot

be posted at the same time.

The following examples illustrate possible auto-posting situations.

1. Example of a Partially Posted ERA

Scenario:

The ERA contains a hundred EEOBs and the ERA is an auto-posting candidate.

Seventy of the EEOBs meet the conditions to create and process a receipt.

The nightly auto-posting job runs.

Auto-Posting Day #1:

A receipt is created and processed for seventy EEOBs. The receipt number is

E14101306A.

Thirty EEOBs do not have a receipt and the EEOBs are on the Auto-Posting Awaiting

Resolution list.

The ERA is partially posted.

Note: The receipt number contains an alphabetic character at the end.

Auto-Posting Day #2:

A user resolved the issues on twenty of the EEOBs.

The nightly auto-posting job runs.

A receipt is created and processed for twenty EEOBs. The receipt number is

E14101306B.

Ten EEOBs do not have a receipt and the EEOBs are on the Auto-Posting Awaiting

Resolution list.

The ERA is partially posted.

Note: The receipt number contains an alphabetic character at the end, incrementing to

the next letter of the alphabet.

Auto-Posting Day #3:

A user resolved the issues on the remaining ten EEOBs.

The nightly auto-posting job runs.

A receipt is created and processed for ten EEOBs. The receipt number is E1410306C.

The ERA is completely posted.

None of the EEOBs for this ERA are on the Auto-Posting Awaiting Resolution list.

Note: The receipt number contains an alphabetic character at the end, incrementing to

the next letter of the alphabet.

2. Example of a Completely posted ERA

Scenario:

The ERA contains a hundred EEOBs and the ERA is an auto-posting candidate.

66 ePayments User Guide (EDI Lockbox) November 2018

All of the EEOBs meet the conditions to create and process a receipt.

The nightly auto-posting job runs.

Auto-Posting Day #1:

A receipt is created and processed for all EEOBs. The receipt number is E14101305.

The ERA is completely posted.

None of the EEOBs for this ERA are on the Auto-Posting Awaiting Resolution list.

Note: The receipt number does not contain an alphabetic character at the end.

Pharmacy Auto Posting Candidates:

The system auto-posts for pharmacy claims when the following conditions are met:

• Auto-posting for pharmacy claims is enabled in the EDI LOCKBOX PARAMETERS

• The EEOB payer is not excluded from pharmacy auto-posting in the EDI LOCKBOX

PARAMETERS

• The Electronic Remittance Advice (ERA) does not have an exception

• The ERA does not contain interest

• The ERA does not contain an ERA level adjustment

• The EFT and ERA are matched

• The EFT has been accepted by Financial Management System (FMS)

• The ERA negative payments all have a matching positive payment (+/- pairs)

When the nightly job runs, a receipt is created and processed if the following conditions are met:

• The EEOB detail has been verified against the bill detail

• The claim balance covers the payment to be posted for all EEOBs

• The claim status is open for all EEOBs

• The claim has not been referred to regional council or general council

If all auto-posting conditions to create and process a receipt are not met for an EEOB, the system sends that

EEOB to the Auto-Posting Awaiting Resolution list. Once a user corrects the condition that prevented

receipt processing, the EEOB can be reprocessed by the next nightly job. For more details, refer to the

section on Auto-Posting Awaiting Resolution.

Pharmacy Auto Posting Receipts

The system creates a receipt for all EEOBs that can be auto-posted, even if all EEOBs in an ERA cannot

be posted at the same time.

If all EEOBs in an ERA can be posted, the receipt number will contain “E” followed by numeric

characters.

If only some of the EEOBs in an ERA can be posted, the receipt number will have an alphabetic character

on the end, starting with “A” and proceeding in order until all EEOBs have been posted. The base

number stays the same.

November 2018 ePayments User Guide (EDI Lockbox) 67

1. Example of Completed Posted Pharmacy ERA Scenario:

The ERA contains ten EEOBs and the ERA is an auto posting candidate. All of the EEOBs meet

the conditions to create and process a receipt.

The nightly auto-posting job runs.

Auto-Posting Day #1:

A receipt is created and processed for all EEOBs. The receipt number is E14101308.

The ERA is completely posted.

None of the EEOBs for this ERA are on the Auto-Posting Awaiting Resolution list.

Note: The receipt number does not contain an alphabetic character at the end.

1. Example of a Partially Posted ERA

Scenario:

The ERA contains a ten EEOBs and the ERA is an auto-posting candidate.

Seven of the EEOBs meet the conditions to create and process a receipt.

The nightly auto-posting job runs.

Auto-Posting Day #1:

A receipt is created and processed for seventy EEOBs. The receipt number is

E14101309A.

Three EEOBs do not have a receipt and the EEOBs are on the Auto-Posting Awaiting

Resolution list.

The ERA is partially posted.

Note: The receipt number contains an alphabetic character at the end.

Auto-Posting Day #2:

A user resolved the issues on two of the EEOBs.

The nightly auto-posting job runs.

A receipt is created and processed for twenty EEOBs. The receipt number is

E14101309B.

One EEOB does not have a receipt and the EEOBs are on the Auto-Posting Awaiting

Resolution list.

The ERA is partially posted.

Note: The receipt number contains an alphabetic character at the end, incrementing to

the next letter of the alphabet.

Auto-Posting Day #3:

A user resolved the issues on the remaining one EEOB.

The nightly auto-posting job runs.

A receipt is created and processed for one EEOB. The receipt number is E1410309C.

The ERA is completely posted.

68 ePayments User Guide (EDI Lockbox) November 2018

None of the EEOBs for this ERA are on the Auto-Posting Awaiting Resolution list.

Note: The receipt number contains an alphabetic character at the end, incrementing to

the next letter of the alphabet.

EEOB Worklist

The EEOB WORKLIST option displays an "A" indicator before the ERA number if auto-posting is

complete for that ERA. The indicator is displayed for both medical and pharmacy auto posted ERAs.

# ERA # TRACE#

PAYER NAME/MATCH STATUS ERA PAID DT TOT AMT PAID DT REC'D

1 A4667 000032974

3/31/05 7.46 3/31/05

THE COMMUNITY HOSPITAL APPROX # EEOBs: 1

Ignore Payment Retraction Pairs

The system ignores payment retraction pairs for medical and pharmacy claims when the following

conditions are met, without regard to case sensitivity:

• Payment/Retraction pair is in the same ERA

• The first 5 characters of the patient's last names match

• The dates of service match

• The bill numbers or claim numbers match

• The social security numbers or patient IDs match

• The amounts billed sum to zero, such as +5 and -5

Status Change

The system makes the following status changes when a medical or pharmacy claim is successfully auto-

posted:

• Claim Status – Collected/Closed or Open (with residual balance)

• Receipt Status – Closed

• Detail Post Status – Posted, Not Posted or Partial

NOTE: Detail Post Status becomes Posted when all lines have been posted. Detail Post Status becomes

Partial if some lines have been posted but not all.

AR Display

The system displays the auto-posted transactions within Accounts Receivable in the same manner as a

manually posted transaction. Specifically, Auto-Posted payments display on the TPJI – AR Account

Profile and VT Transaction Profile screens.

3.5. Working the APAR List

The Auto-Posting Awaiting Resolution list displays EEOB detail records that require user intervention

before the nightly auto-posting job can post. The APAR screen contains the actions that enable research,

resolution and the ability to mark the EEOB for auto-posting. Once an entry is marked for auto-post, the

entry is removed from the APAR display.

Once the APAR option has been selected, the initial list of EEOBs are presented.

November 2018 ePayments User Guide (EDI Lockbox) 69

Field

Description

ERA #:

The number that the VistA system has assigned to designate an ERA. It is shown

on the ERA List – Worklist), after accessing the WL Worklist menu option. Each

ERA is in numerical order as it is accepted into Vista.

Claim #:

Claim used to bill the insurance company

Posted

The total amount posted to the claim

Post Dt

The date the amount was posted

Unposted

The balance remaining

Use preferred view N// O

(A)LL PAYERS, (R)ANGE OF PAYER NAMES: A// LL

(M)EDICAL, (P)HARMACY, or (B)OTH: BOTH//

Sort By PAYER (N)AME, APAR (R)EASON, (P)OSTED, (U)NPOSTED,: UNPOSTED// ??

Enter ‘PAYER NAME’ to sort by payer name.

Enter ‘APAR REASON’ to sort by the reason code.

Enter ‘POSTED’ to sort by the posted amount.

Enter ‘UNPOSTED’ to sort by the unposted amount.

Select one of the following:

N PAYER

R REASON

P POSTED

U UNPOSTED

Sort By PAYER (N)AME, APAR (R)EASON, (P)OSTED, (U)POSTED, APAR (R)EASON: UNPOSTED//

Sort By (H)IGHEST TO LOWEST or (L)OWEST TO HIGHEST: HIGHEST TO LOWEST// ??

Enter ‘HIGHEST TO LOWEST’ to sort amounts in decreasing order.

Enter ‘LOWEST TO HIGHEST’ to sort amounts in increasing order.

Select one of the following:

1 HIGHEST TO LOWEST

2 LOWEST TO HIGHEST

Sort By (H)IGHEST TO LOWEST or (L)OWEST TO HIGHEST: HIGHEST TO LOWEST//

AUTOPOST - AWAIT RESOLUTION Feb 14, 2017@02:43:35 Page: 1 of 1

Current View: MEDICAL CLAIMS for ALL PAYERS

Sorted By: Posted – Highest to Lowest

ERA #.Seq Claim # Posted Post Dt Unposted

Payer Name/ID

APAR Reason

1 43416.1 K100000 0.00 1/23/17 2169.44

AETNA/10XXXXXXXX

CLAIM ALREADY COMPLETED/CLOSED

2 43417.1 K100001 0.00 1/23/17 594.33

70 ePayments User Guide (EDI Lockbox) November 2018

AETNA/10XXXXXXXX

3 43419.1 K100002 0.00 1/23/17 487.76

CIGNA BEHAVIORAL HEALTH, INC./10XXXXXXXX

APAR - Actions

There are a number of list manager options available on the APAR screen that provides greater capability

to manage EEOB records.

Select EEOB

Used to select a specific EEOB.

View/Print ERA

Used to display/print the summary ERA information.

Change View

Used to customize the information displayed on the APAR list.

3.5.1.1. View/Print ERA

The View/Print ERA action is used to display and print the summary ERA information.

3.5.1.2. Change View

The Change View action is used to customize the information displayed on the APAR list. After

answering the question, the system gives the user the option to “SAVE” the selection as a “preferred

view”. The answer is used to filter the display to limit the entries that are included.

If the user saves a preferred view they will be prompted if they want to use that view in the future.

The following option is available as a filter.

Select Action: Next Screen// C Change View

(M)EDICAL, (P)HARMACY, OR (B)OTH: BOTH//

(A)LL PAYERS, (R)ANGE OF PAYER NAMES: A//

DO YOU WANT TO SAVE THIS AS YOUR PREFERRED VIEW (Y/N)? NO//

Payer Range Selection:

ALL

RANGE

The screen header will indicate the Current View selected as follows:

AUTO-POST - AWAIT RESOLUTION Nov 19, 2013@21:37:21 Page: 1 of 2

Current View: MEDICAL + PHARMACY CLAIMS for ALL PAYERS

ERA#.Seq Claim# Posted Amt Post Date Un-posted Bal

____ _Payer Name/ID_________________________________________________________________

1 87705.1 K307YUC 3000.41 11/1/13 127.44

ANTHEM BCBS OF WISCONSIN/139XX38065

2 87705.2 K307740 3000.41 11/1/13 127.44

ANTHEM BCBS OF WISCONSIN/139XX38065

Enter ?? for more actions

Select EEOB View/Print ERA

Change View Exit

November 2018 ePayments User Guide (EDI Lockbox) 71

Select Action: Next Screen//

3.5.1.3. Select EEOB

The Select EEOB action allows the user to select a specific EEOB by number. After selection, the APAR

scratchpad is displayed.

APAR - EEOB ITEM - SCRATCHPAD Jul 21, 2014@15:34:59 Page: 1 of 1

ERA Entry #: 5177 Total Amt Pd: 50.00

Posted Amt: 0.00 Unposted balance: 50.00

Payer Name/ID: ONE INSURANCE COMPANY/11111111

EFT #/TRACE #: 177/1234123456

Posted Receipt #(s):

EEOB: ERA Seq # 1 Net Payment Amt: 50.00

1.001 Claim #: K4000FM Patient/Last 4: PATIENT,ONE/1234

Claim Bal: 51051.58 Billed Amt: 51051.58 Amt To Post: 50.00

Svc Dt: 4/23/14 COB: NO Rx Copay: UNKNOWN Means Tst: ??

Payment Amt: 50.00 Total Adjustments: 0.00 Net: 50.00

APAR Reason: FIELD VERIFICATION FAILED

..............................................................................

Enter ?? for more actions

Split/Edit a Line EOB View/Print EEOB Review Line

Mark for Auto Post ERA View/Print ERA Verify

Claim Comment Research Menu EXIT

Select Action: Quit//

The header of the APAR Scratchpad screen contains the ERA Entry #; the Total Amount being Paid on

the ERA (this will equal the dollar amount of the Electronic Funds Transfer ); the Posted Amount; the

Unposted balance; the Name and ID number of the Payer; the EFT Trace #; and the base number for the

Posted Receipt(s) numbers.

Each EEOB line item equates to a line item on a paper EOB form. HIPAA mandates standardization of

the electronic transmissions.

Field

Description

EEOB Seq # on

ERA:

This shows the line item order as the payer sent it. Remember, the Worklist can be

sorted with Zero Payments First or Zero Payments Last, so the sequence number may

not match the line item list on the far left of the screen.

Net Payment Amt:

The payment amount plus or minus the adjustment amount will equal the net payment

amount for this claim number.

Claim #:

The claim number associated with this payment. This may or may not be the correct

claim number. Research each claim carefully verify if the amount being paid is

appropriate for the claim in AR. If the line item is marked (V), the system has already

done a verification match between bill number and the patient name, last four of the

social, date of service and original billed amount.

Patient/Last 4:

The patient’s name and last four digits from their SSN. Used to help identify this

payment is for the correct Claim.

Claim Balance:

Current balance from AR.

72 ePayments User Guide (EDI Lockbox) November 2018

Field

Description

Billed Amt:

Original billed amount from AR.

Amount to Post:

The payment amount plus or minus the adjustment amount will equal the amount to

post for this claim number.

Service Date:

Beginning Service Date for this Claim

COB:

Coordination of Benefits information that indicates whether a secondary payer has

been identified for this claim.

Rx Copay:

Current Rx Copay status of the patient

Means Test:

Indicates if this patient may be responsible for Means Test co-payments

Payment Amt:

Amount of money paid for this claim on this ERA.

Total

Adjustments:

Net total of all adjustments for this line item.

Net:

The payment amount plus or minus the adjustment amount.

ECME #:

ECME number generated when the NCPDP claim is submitted for a pharmacy

prescription. This field only displays for a pharmacy claim.

Rx/Fill/Release

Status:

The prescription number, fill number and release status (released, non-released). This

field only displays for a pharmacy claim.

DOS:

The date of service submitted on the NCPDP claim. This field only displays for a

pharmacy claim.

APAR Reason:

The reason the EEOB is on the APAR list

APAR Scratchpad - Actions

There are a number of actions available on the APAR Scratchpad that can assist a user to ensure that the

correct payment is being applied to the correct claim. With the exception of the Mark for Auto-Post

action, the actions behave the same as the actions on the ERA Worklist Scratchpad. Refer to the ERA

Worklist Scratchpad section for more details on functionality.

Action

Description

Split/Edit a Line

Used to split a payment or adjustment between two or more bills (if the payer has

combined payments) or to correct the claim # associated with a payment (if the payer

has reported the payment for the wrong bill). Option can also be used to put payment

into suspense.

This is locked with the security key “RCDPEPP”.

Mark for Auto-

Post

This action checks the EEOB for auto-posting criteria. If all criteria are met, the

EEOB is successfully marked for auto-post which means the EEOB will be removed

from the APAR display and reprocessed by the nightly auto-post job. Verification

(V) is not required before marking an EEOB for auto-posting.

This is locked with the security key “RCDPEPP”.

November 2018 ePayments User Guide (EDI Lockbox) 73

Claim Comment

Used to enter a one line comment for ANY exception on the APAR List.

View/Print EEOB

Used to display/print the detail received on the ERA for a selected line (EEOB).

View/Print ERA

Used to view/print posting for claims with the entire formatted ERA, with or without

the EEOB detail.

Research Menu

Link to all the necessary AR functions/ processes such as TPJI, needed to process

ERAs. These can each still be accessed through regular AR menu options.

Review Line

Allows addition of comments or used as a bookmark on a specific line within an ERA

in case processing was interrupted, thereby allowing the user to more easily resume

where he/she left off. This option must be turned ‘on’ each time the user enters the

ERA to enter or view comments.

Verify

Provides the functionality to identify and manually mark EEOBs as verified.

This is locked with the security key “RCDPEPP”.

74 ePayments User Guide (EDI Lockbox) November 2018

3.5.1.4. Action Option: Split/Edit a Line

Sometimes Payers combine payments for two or more claims onto one claim. This action is used to split

the payment to the appropriate claim and to put a payment into suspense. It can also be used to correct an

incorrect claim number. This action requires the RCDPEPP security key.

APAR - EEOB ITEM - SCRATCHPAD Jun 29, 2016@11:49:03 Page: 1 of 1

ERA Entry #: 43622 Total Amt Pd: 2555.25

Posted Amt: 0.00 Un-posted balance: 2555.25

Payer Name/ID: AETNA/1066033492

Posted Receipt #(s):

EEOB: ERA Seq # 1 Net Payment Amt: 2555.25

1.001 Claim #: K602VMV Patient/Last 4: TW-WOMACK,JOHNNY/2222

Claim Bal: 0.00 Billed Amt: 2555.25 Amt To Post: 2555.25

Svc Dt: 11/3/15 COB: NO Rx Copay: NON-EXEMPT Means Tst: REQ

Payment Amt: 2555.25 Total Adjustments: 0.00 Net: 2555.25

APAR Reason: FIELD VERIFICATION FAILED

..............................................................................

Enter ?? for more actions

Split/Edit a Line EOB View/Print EEOB Review Line

Mark for Auto Post ERA View/Print ERA Verify

Claim Comment Research Menu EXIT

Select Action: Quit//SPLIT

This example shows how to Split/Edit Line item #4 to post the payment correctly. This action takes place

after reviewing the EEOB detailed data to confirm how the payment should be applied.

1.001 Claim #: K602VMV Patient/Last 4: TW-WOMACK,JOHNNY/2222

Claim Bal: 0.00 Billed Amt: 2555.25 Amt To Post: 2555.25

Svc Dt: 11/3/15 COB: NO Rx Copay: NON-EXEMPT Means Tst:

REQ

Payment Amt: 2555.25 Total Adjustments: 0.00 Net: 2555.25

APAR Reason: FIELD VERIFICATION FAILED

.......................................................................

.......

CLAIM #: K602VMV// >>Current claim balance is: 0.00

PAYMENT AMOUNT TO APPLY TO THIS CLAIM: 2555.25// 2000

RECEIPT LINE COMMENT: comment for claim K602vmv

CLAIM #: k602vmu >>Current claim balance is: 3444.75

PAYMENT AMOUNT TO APPLY TO THIS CLAIM: 555.25// 500

RECEIPT LINE COMMENT: comment for claim K602vmu

CLAIM #: k602vmy >>Current claim balance is: 0.00

PAYMENT AMOUNT TO APPLY TO THIS CLAIM: 55.25//

RECEIPT LINE COMMENT: comment for claim K602vmy

November 2018 ePayments User Guide (EDI Lockbox) 75

Apply the correct payment amount to the correct claim number(s) until all the funds are applied.

EEOB WORKLIST SPLIT LINE Jun 29, 2016@12:04:13 Page: 1 of 1

1.001 Claim #: K602VMV Patient/Last 4: TW-WOMACK,JOHNNY/2222

Claim Bal: 0.00 Billed Amt: 2555.25 Amt To Post: 2555.25

Svc Dt: 11/3/15 COB: NO Rx Copay: NON-EXEMPT Means Tst: REQ

Payment Amt: 2555.25 Total Adjustments: 0.00 Net: 2555.25

APAR Reason: FIELD VERIFICATION FAILED

..............................................................................

Claim # Payment Amount Adjustment Amt Net Amount

1 K602VMV 2000.00 0.00 2000.0

comment for claim K602vmv

2 k602vmu 500.00 0.00 500.0

comment for claim K602vmu

3 k602vmy 55.25 0.00 55.2

comment for claim K602vmy

============== ============== =============

TOTALS: 2555.25 0.00 2555.2

Enter ?? for more actions

File New Lines Edit Lines Split Exit

Select Action:Quit//

At this point the user should FILE NEW LINES to process the split.

Edit Line Split if the information is not correct. File the new lines to save this information. Exiting

without filing will mean all changes are discarded.

Reason text (i.e. Comment) is mandatory when leaving a portion of the payment in suspense.

COMMENT: ??

Enter a code from the list.

Select one of the following:

1 Collected/Closed

2 Cancelled

3 Returned refund

4 Overpayment

5 Inactive bill

6 Duplicate payment

7 Policy termed

8 Service connected

9 Other

The scratchpad screen displays the following if a receipt line comment has been added

2.002 Claim #: SUPENSE Patient/Last 4: ??

***CLAIM NOT FOUND IN YOUR AR ***

76 ePayments User Guide (EDI Lockbox) November 2018

Payment Amt: 160.00 Total Adjustments: 0.00 Net: 160.00

Receipt: E1702150EB

Receipt Comment: OVERPAYMENT

Added By: EMPLOYEE,ONE

Date/Time Added: July 20 2017@10:00:00

3.5.1.5. Action Option: Mark for Auto-Post

The ListManager screen contains the action of Mark for Auto-Post that will check the EEOB for auto-

posting criteria and mark the EEOB for auto-posting if all criteria are met. This action requires the

RCDPEPP security key.

3.5.1.6. Action Option: Claim Comment

The ListManager screen includes a “Claim Comment” option to allow you to enter a one line comment

for ANY exception on the APAR List.

+ Enter ?? for more actions

Split/Edit a Line EOB View/Print EEOB t Review Line

Mark for Auto Post ERA View/Print ERA Verify

Claim Comment Research EXIT

Select Action: Quit//Claim

Select EDI LBox EEOB Data Exception(s): (1-4): 2

Selection #: 2 K777777

Comment: This is where the Claim Comment will appear and may wrap to the next line.

A comment can be entered for ANY claim and is tied to an ERA Seq line#.

NOTE: Once successfully entered, the Claim Comment displays as indicated in the APAR screen display

and on the ERA Worklist/Scratch Pad as well as on the View/Print ERA display – on the individual

EEOB. If the EEOB has no comment, nothing will display.

3.5.1.7.Action Option: MARK FOR AUTO-POST

When you select the new “Mark for Auto Post” Action Option, the system re-evaluates the selected ERA

to determine if the ERA can be marked as an Auto-Post CANDIDATE. The system displays a message to

the user indicating whether the ERA was successfully Marked as an Auto-Post CANDIDATE – or – the

reason why the check failed. This action requires the RCDPEPP security key.

• If the system determines that the ERA IS an Auto-Post CANDIDATE, the following success

message is displayed:

ERA List - Worklist Nov 30, 2015@12:31:17 Page: 1 of 22

SELECTED MATCH STATUS: BOTH POST STATUS : BOTH

DATE RANGE: 2/12/15-2/12/15 AUTO-POSTING : BOTH

ALL PAYERS PHARMACY/MEDICAL: BOTH

# ERA # Trace#

PAYER NAME/MATCH STATUS & DATE ERA PAID DT TOT AMT PAID DT REC’D

1 4 63595X56923

2/12/15 485.27 2/12/15

November 2018 ePayments User Guide (EDI Lockbox) 77

EPHARM INSURANCE APPROX # EEOBs: 1

EFT MATCHED 2/12/15 EFT RECEIPT STATUS: NOT ENTERED

|’-‘ No scratchpad|’x’ EXC |’A’ autopost complete

Select ERA View/Print ERA Admin Cost Adj

Sort List Change View Exit

Mark for Auto Post Manual Match

Select Action: Quit// MAR Mark for Auto Post

ERA has been successfully Marked as an Auto-Post CANDIDATE

Enter RETURN to continue or ‘^’ to exit:

NOTE: If the ERA is deemed an Auto-Post CANDIDATE, the ERA enters the Auto-Post pipeline to

be processed with other CANDIDATES during the next nightly process.

• If the system determines that the ERA IS NOT an Auto-Post CANDIDATE, ONE of the error

message reasons is displayed:

ERA was NOT Marked as an Auto-Post CANDIDATE – Already marked for Auto-Posting

ERA was NOT Marked as an Auto-Post CANDIDATE – Already partially Auto-Posted

ERA was NOT Marked as an Auto-Post CANDIDATE – Already completely Auto-Posted

ERA was NOT Marked as an Auto-Post CANDIDATE – ERA not matched

ERA was NOT Marked as an Auto-Post CANDIDATE – Zero value ERA

ERA was NOT Marked as an Auto-Post CANDIDATE – Medical auto-posting off

ERA was NOT Marked as an Auto-Post CANDIDATE – Pharmacy auto-posting off

ERA was NOT Marked as an Auto-Post CANDIDATE – Medical payer excluded

ERA was NOT Marked as an Auto-Post CANDIDATE – Pharmacy payer excluded

ERA was NOT Marked as an Auto-Post CANDIDATE – Invalid Bill Number Exception(s)

ERA was NOT Marked as an Auto-Post CANDIDATE – ERA level Adjustment(s)

ERA was NOT Marked as an Auto-Post CANDIDATE – ERA has a receipt

ERA was NOT Marked as an Auto-Post CANDIDATE – Unable to create scratchpad

ERA was NOT Marked as an Auto-Post CANDIDATE – Claim Level Adjustments w/o payment

ERA was NOT Marked as an Auto-Post CANDIDATE – +/- pairs do not balance

3.6. Auto-Decrease of Medical Claims

VistA runs a nightly job to automatically perform a decrease adjustment to a third party medical claim

under certain conditions. The automatic decrease is made with a contractual decrease adjustment amount

that brings the claim balance to zero.

An automatic decrease will only occur if the EEOB has been auto-posted. Refer to the section on

Parameters for details on the settings that affect auto-decrease of medical claims.

The following conditions must be met:

• Auto-posting of third party medical claims is enabled in the EDI LOCKBOX

PARAMETERS [RCDPE EDI LOCKBOX PARAMETERS].

• The payer is not excluded from auto-posting of third party medical claims in the

EDI LOCKBOX PARAMETERS [RCDPE EDI LOCKBOX PARAMETERS]

and the EEOB is auto-posted.

• Auto-decrease of third party medical claims is enabled in the EDI LOCKBOX

PARAMETERS [RCDPE EDI LOCKBOX PARAMETERS].

• The payer is not excluded from auto-decrease of third party medical claims in the

EDI LOCKBOX PARAMETERS [RCDPE EDI LOCKBOX PARAMETERS].

78 ePayments User Guide (EDI Lockbox) November 2018

• The number of days since the EEOB was posted is equal to or greater than the

number of days specified in the EDI LOCKBOX PARAMETERS [RCDPE EDI

LOCKBOX PARAMETERS].

• The residual balance on the EEOB is equal to or less than the dollar amount

maximum specified in the EDI LOCKBOX PARAMETERS [RCDPE EDI

LOCKBOX PARAMETERS].

• The claim has not been referred to regional council or general council.

Decrease Adjustment Warning Messages

The option DECREASE ADJUSTMENT [PRCAC TR DECREASE] displays a warning message if there

are pending payments for the selected claim. Additionally, the user can receive a “Marked for Auto-Post

warning if they try to make a decrease adjustment on a bill that has at least one associated EEOB marked

for auto-post.

Select Adjustment to an AR record <TEST ACCOUNT> Option: Decrease Adjustment

Select (B)ILL or (E)CME#: B// ILL NUMBER

Select BILL: Kxxxxxx

1 Kxxxxxx 552-Kxxxxxx RX CO-PAYMENT/N 10/01/03 xxxx,xxxx COLLECTED

2 Kxxxxxx 405-Kxxxxxx REIMBURS.HEALTH 05/15/14 EXPRESS SC ACTIVE

CHOOSE 1-2: 2 405-Kxxxxxx REIMBURS.HEALTH 05/15/14 EXPRESS SC ACTIVE

Principal Balance: 51051.58 FY: 14 Principal Balance: 51051.58

Interest Balance: 0.00

Admin Balance: 0.00

-----------

TOTAL Balance: 51051.58

Checking the bill's balance ... IN Balance!

Marked for Auto-Post. Are you sure? (Y/N) NO// NO

Exiting bill adjustment.

Select (B)ILL or (E)CME#: B// ILL NUMBER

1 Kxxxxxx 552-Kxxxxxx RX CO-

PAYMENT/N 10/01/03 xxxxx,xxxx COLLECTED

2 Kxxxxxx 405-Kxxxxxx REIMBURS.HEALTH 05/15/14 EXPRESS SC ACTIVE

CHOOSE 1-2: 2 405-Kxxxxxx REIMBURS.HEALTH 05/15/14 EXPRESS SC ACTIVE

Principal Balance: 51051.58 FY: 14 Principal Balance: 51051.58

Interest Balance: 0.00

Admin Balance: 0.00

-----------

TOTAL Balance: 51051.58

Checking the bill's balance ... IN Balance!

Warning – Pending Payments of $XXXX.XX exist

Rcpt: XXXXXXXXX $XX.XX No Trace Number

Rcpt: XXXXXXXXX $XXX.XX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

ERA: XXXXX $XX.XX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Marked for Auto-Post. Are you sure? (Y/N) NO// YES

Enter the DECREASE Adjustment AMOUNT, from .01 to 51051.58.

DECREASE PRINCIPAL BALANCE BY: 1.00

Is this a CONTRACT adjustment ? YES//

November 2018 ePayments User Guide (EDI Lockbox) 79

If you process the transaction, the bill will look like:

Current Principal Balance: 51051.58

NEW DECREASE Adjustment: -1.00

-----------

NEW Principal Balance: 51050.58

Are you sure you want to enter this DECREASE adjustment ? YES//

Adjustment Transaction: 8770898 has been added.

Enter a comment for the DECREASE Adjustment:

COMMENTS:

No existing text

Edit? NO//

80 ePayments User Guide (EDI Lockbox) November 2018

4. The EFT has been accepted by FMS

4.1. FMS

Financial Management System (FMS) is an interactive system to manage central payment services to

federal government agencies including the VHA financial data. Deposits to FMS are transmitted during

the nightly process as individual deposits and are relayed through the DMI/mailman system. The EFT

information is transferred into VistA from Financial Services Center (FSC). Although paper checks are

also deposited through FMS by a daily deposit ticket at each medical center, EFT’s are also deposited via

a deposit ticket. Deposit tickets are assigned for EFT’s by PNC bank (they assign the 6-digit number, and

the FSC makes it a 9-digit number by adding a “569” prefix).

4.2. Three Day EFT Cycle

The diagram below demonstrates a high level overview of the ePay/FMS process. Upon adjudication at

the payer level, the payer transmits 835 information to their respective banking partner. In turn, this

banking partner transmits the information to PNC Bank, the banking partner of the VA. PNC bank sends

the EFT information to US Treasury for deposit and to FSC to be translated into VistA language and for

processing to the sites. In addition to sending the data to each individual VistA system, FSC also sends

the information to EPHRA for storing and reference of the data as needed. Each VistA system interacts

with FMS through the nightly process, notifying the financial system of funds that have been processed

for each medical center. A complete cycle takes three business days to complete.

Payer

Bank A

PNC Bank

US Treasury

Austin

FSC/CFD

EPHRA

VAMC VISTA

FMS

Bank B

Bank C

November 2018 ePayments User Guide (EDI Lockbox) 81

The three day cycle detailed:

• Day 1 – EFT populates VistA with a system generated electronic (e) receipt and transmits to FMS

with a CR document during the nightly process. This shows in the VistA system as ‘NA’ when

viewing the worklist. Deposit can be viewed by looking at Receipt profile, List of receipts, or

deposit processing.

CBO …Putting ‘Business’to work for America’s Veterans 7

Processing EFTs –Day 1

Payer transmits

EFT to PNC Bank

EFT & CR info sent to

VistA by FSC

VistA

FSC

US Treasury

Payer

PNC Bank sends

record of deposit

to US Treasury

PNC

Bank EPHRA

PNC Bank

sends EFT &

Deposit

Ticket to

FSC

FMS

VistA’s nightly

job sends CR

doc to FMS

(no user action)

FSC sends

EFT info to

EPHRA

82 ePayments User Guide (EDI Lockbox) November 2018

• Day 2 – FMS accepts deposit and sends message back to VistA during nightly process. The

money is deposited into 528704/8NZZ. This shows in the VistA system as ‘transmitted’ when

viewing the worklist.

CBO …Putting ‘Business’to work for America’s Veterans 10

Processing EFTs –Day 2

Payer transmits

EFT to PNC Bank

VistA

FSC

US Treasury

Payer

PNC Bank sends

record of deposit

to US Treasury

PNC

Bank

EPHRA

FMS

AR Staff

FMS accepts &

processes EFT Deposit

to 528704/8NZZ account.

Sends message to VistA

(no user action)

PNC Bank

sends EFT &

Deposit

Ticket to

FSC

FSC sends

EFT info to

EPHRA

• Day 3 – EFT is ready to be processed with ERA or paper EOB and transmit back to FMS. This

shows in the VistA system as ‘accepted’ when viewing the worklist.

CBO …Putting ‘Business’to work for America’s Veterans 12

Processing EFTs –Day 3

Payer transmits

EFT to PNC Bank

VistA

FSC

US Treasury

Payer

PNC Bank sends

record of deposit

to US Treasury

PNC

Bank

EPHRA

FMS

AR Staff

User processes EFT

with ERA (or paper

EOB)

Receipt processing

transmits TR

Document.

Transfers EFT $

from 528704/8NZZ

account to correct

MCCF Account.

PNC Bank

sends EFT &

Deposit

Ticket to

FSC

FSC sends

EFT info to

EPHRA

November 2018 ePayments User Guide (EDI Lockbox) 83

The screen capture below demonstrates how the three day cycle shows on your worklist in your VistA

system. This information can also be viewed on the EFT Daily Activity Report and the EFT unmatched

aging report:

When an e-receipt is processed to FMS, a TR document (transfer document) is created. The TR

document transmits during the nightly process. The TR document does not transmit money to FMS, but

rather transfers funds from 528704/8NZZ to the appropriate MCCF appropriation of 528704. The TR

document number can be viewed in the VistA system under the Receipt Processing Option.

4.3. EFT Deposits

To view a copy of the CR code sheet on the CRLT table, enter the transaction code (CR) and the CR

number. This screen shows the Fund and RSC the money dropped into in FMS. For this example, the CR

number is 555K4A000C:

ACTION: N TABLEID: CRLT USERID: S555 SLK

*** CASH RECEIPTS LINE INQUIRY SCREEN ***

KEY IS TRANS CODE, CR NUMBER, LINE

TRANS CODE: CR CR NUMBER: 555K4A000C

01-

LINE: 001 BFYS: 04 FUND:

528704

STATION/SAT: 555 FCP/PRJ: JOB NO:

COST CTR/SUB: BOC/SUB: REPT CATG:

REV SRCE/SUB: 8NZZ CLSD BFYS: CLSD FUND:

GL ACCOUNT: TRANS TYPE: 23 TRAVEL TYPE:

VENDOR/PROVIDER: MCCFVALUE UNAPPLIED DEPOSIT NO:

AMOUNT: 1,480.00 CHECK NUMBER:

REF TC: REF DOC NO: REF LINE:

ADV: ADVANCE NO: ADV IND:

AGREEMENT NO: ACTION OUT:

Day 3

Day 2

Day 1

Day 3

Day 2

Day 1

84 ePayments User Guide (EDI Lockbox) November 2018

DESCRIPTION:

View the GLDB table to see all deposits into the GL ACCT and RSC for approximately 2 months. For

this table, select the FY, BFY, FUND, GL ACCT, AD/OF, STN, and RSC.

ACTION: R TABLEID: GLDB USERID: S570 SLK

*** GENERAL LEDGER DETAIL BALANCE INQUIRY SCREEN ***

FY BFY FUND GL ACCT AD/OF STN COST CTR FCP/PRJ BOC/REV

SRCE TYPE

-- ----- ------ ------- ---- ------- -------- --------- ----------

-- ----

04 04 528704 1029 10 570 8NZZ

TRANS ID DATE FM REF DOCUMENT VENDOR VENDOR INV #

AMT

---------- ------ -- ------------- ------- -----------------

----------

CR555K4A000C 031003 01 MCCFVALUE

1,480.00

CR555K4A000H 031004 01 MCCFVALUE

428.34

CR555K4A000Q 031007 01 MCCFVALUE

37.64

CR555K4A0001 031002 01 MCCFVALUE

1,084.95

All transfers in from CR Documents will show up under GL ACCT 1029. All transfers, from the TR

documents will show up on this table under the GL ACCT 1030.

Key:

Fiscal Year

BFY

Budget Fiscal Year

FUND

Fund

GL ACCT

General Ledger Acct

AD/OF

Administrative Office

STN

Station

BOC/REV SRCE

Revenue Source Code

November 2018 ePayments User Guide (EDI Lockbox) 85

(This page included for two-sided copying.)

86 ePayments User Guide (EDI Lockbox) November 2018

5. NPI

The facility and providers NPI can be found within the ERA by viewing the ERA details. This was an added

function by Patch.

EDI LOCKBOX WORKLIST - ERA DETAIL 10/10/03 Page: 2

==============================================================================

PATIENT: IBpatient,One A/5555 CLAIM #: XXX-KXXXXXX

**EOB PROVIDER(S)/NPI CLAIM PROVIDER(S)/NPI**

--------------------- -----------------------

BILLING: /XXXXXXXXXX XXXXXXXX VAMC/XXXXXXXXXX

RENDERING: Ibclerk,One/XXXXXXXXXX

EOB GENERAL INFORMATION:

Type : NORMAL EOB EOB Paid DT : 02/07/07

Entry Dt/Tm :02/09/07 4:32 pm Claim Status : PROCESSED

Entry Dt/Tm :02/09/07 4:32 pm Review Status: ACCEPTED-COMPLETE EOB

Entered By : Insurance Seq: PRIMARY

Last Edited : 02/09/07 6:50 pm Last Edit By : POSTMASTER

Patient Name: IBpatient,One A Pt. Relation : PATIENT

Insured Name: IBpatient,One A Insured ID : XXXXXXXXX

Claim Rec'd Date :

Other Subscriber Name: XXXXX,XXXX X

Enter RETURN to continue or '^' to exit:

November 2018 ePayments User Guide (EDI Lockbox) 87

(This page included for two-sided copying.)

88 ePayments User Guide (EDI Lockbox) November 2018

6. Additional Functionality

6.1. Auto–Audit

New functionality is included with the 3rd Party EDI Lockbox patch. It allows EDI claims to

automatically be audited and assigned an active status. Integrated Billing was modified to update AR

whenever an EDI electronic status message is received for a bill that corresponds to one of these statuses:

A3 CLAIM SENT FOR ALL PAYER ROUTING

AC CLAIM FORWARDED TO PRINT CENTER

A7 CLAIM SENT TO PAYER, NO FURTHER UPDATES TO FOLLOW

A8 CLAIM SENT TO PAYER

AA CLAIM RECEIVED, PRINTED AND MAILED BY PRINT CENTER

2P CLAIM ACCEPTED BY CLEARINGHOUSE- NO FURTHER UPDATES TO

10 Claim sent to Payer

11 Claim sent to Payer

The auto-audit function must be made active by using the Update Rate Types For Auto-audit option

located in the Supervisor’s AR Menu. Once the rate type is selected, answer YES to the prompt AUTO-

AUDIT? Then enter the appropriate Bill Resulting From reason must be selected. This reason will be

assigned to every EDI claim for this rate type that is auto-audited by the system. To turn off auto-audit

for a rate type, select the option, enter the rate type and answer NO to the prompt AUTO-AUDIT?. This

deletes the Bill Resulting From field from for the rate type selected and from that point on, no more bills

having that rate type will be auto-audited. NOTE: Any claims that have claim rejects on the Claims

Status Awaiting Resolution (CSA) worklist will not be auto-audited.

Update Rate Types for Auto-audit

To activate auto-audit for EDI claims within a particular rate type proceed with the following selections:

Select Supervisor's AR Menu Option: Update Rate Types For Auto-audit

Select RATE TYPE NAME: ??

Choose from:

1 CRIME VICTIM Who's Responsible: INSURER

2 DENTAL Who's Responsible: PATIENT

3 HUMANITARIAN Who's Responsible: PATIENT

4 INTERAGENCY Who's Responsible: INSURER

5 MEANS TEST Who's Responsible: PATIENT

6 MEDICARE ESRD Who's Responsible: OTHER (INSTITUTION)

7 NO FAULT INS. Who's Responsible: INSURER

8 REIMBURSABLE INS. Who's Responsible: INSURER

9 SHARING AGREEMENT Who's Responsible: OTHER (INSTITUTION)

10 TORT FEASOR Who's Responsible: INSURER

11 WORKERS' COMP. Who's Responsible: INSURER

12 CHAMPVA REIMB.INS. Who's Responsible: INSURER

Select RATE TYPE NAME: REIMBURSABLE INS. Who's Responsible: INSURER

AUTO-AUDIT?: NO// YES

BILL RESULTING FROM: HI HEALTH INSURANCE 3RD PARTY BILLING

...OK? Yes// <RET>

November 2018 ePayments User Guide (EDI Lockbox) 89

Process Open Bills/Paper Claims

The system, as part of the current nightly processing, automatically runs through open bills/paper claims

with a status of NEW BILL in AR File #430.

NOTES: A “Paper Claim” is identified by looking at the “Force To Print?” Parameter:

• MEDICAL Paper Claim = “FORCE LOCAL PRINT”

• PHARMACY Paper Claim = “NOT APPLICABLE – NOT TRANSMITTABLE”

Validate Bill Data and Status

The system identifies which bills have bill type = “Reimbursable”, “NEW BILL” status, and have been

created/completed in the billing package and signed off by a biller (i.e. which bills have all of the

necessary information within patient info, insurance company, subscriber info, codes). Specifically, the

data elements that must be present include Patient IEN, Debtor, Subscriber IEN, Group Name and Group

Number.

Process AR entry

If all of the necessary information is in the AR file #430, the process updates the AR entry to contain the

Category of REIMBURSABLE INSURANCE, HI (HEALTH INSURANCE 3RD PARTY BILLING) in

the ‘Bill Resulting From’ field.

• For records updated during this process, the system updates the status to ACTIVE in AR File

#430.

Required Security Key

The system utilizes the security key RCDPE AUTO DEC which is NOT automatically assigned to any

user.

6.2. Automatic Match EFTs to ERAs Acronym: MA

This option manually starts the routine that runs as part of the normal nightly processing. Only select this

option if you need to initiate the process of matching the 3rd Party Lockbox EFT records that have not yet

been matched to the electronic ERAs currently on file. The process must be queued and only one of these

processes can be running at any given time.

6.3. Manual Match EFT-ERA Acronym: MM

This option allows the user to manually match an EFT detail record and an ERA record and will mark the

2 records as matched. Use this option only if the automatic matching function is not able to make the

match. The EFT and ERA selected must both be unmatched and the ERA must not be associated with a

receipt. This action may be necessary if the Trace Numbers or Insurance Company IDs do not match on

the 2 records, but the payer has confirmed they are indeed supposed to be matched. To make matching

easier, the system allows a partial match on trace number and leading zeroes are ignored. A date range

filter can narrow the options for selection.

This option allows you to manually have the ERA re-evaluated for Auto-Posting to determine if the ERA

can be marked for auto-post.

Select EDI Lockbox (ePayments) <TEST ACCOUNT> Option: Manual Match EFT-ERA

THIS OPTION WILL ALLOW YOU TO MANUALLY MATCH AN EFT DETAIL RECORD

WITH AN ERA RECORD.

Select by date Range? (Y/N) NO//

90 ePayments User Guide (EDI Lockbox) November 2018

SELECT THE UNMATCHED EFT TO MATCH TO AN ERA: 1176 TT8104351 09-15-2015

EFT TRANSACTION: 1176 PAYER NAME: AETNA

PAYER ID: 1066033492 TRACE #: ABC6381043449

TAX ID CORRECTION: NO CHANGE AMOUNT OF PAYMENT: 2202.50

MATCH STATUS: UNMATCHED RECEIPT #: E15091502

EFT RECORDED AT SITE: YES DATE CLAIMS PAID: SEP 15, 2015

DATE RECEIVED: SEP 15, 2015 TRANSACTION #: 1

ARE YOU SURE THIS IS THE EFT YOU WANT TO MATCH?: YES//

SELECT THE UNMATCHED ERA TO MATCH TO EFT #3055: 43563 ABC6381045098 09-15-15

2202.50 AETNA UNMATCHED

ENTRY: 43563 TRACE NUMBER: ABC6381043449

INSURANCE CO ID: 1066014321 ERA DATE: SEP 15, 2015

TOTAL AMOUNT PAID: 2202.50 PAYMENT FROM: AETNA

FILE DATE/TIME: SEP 15, 2015@12:31:42

EFT MATCH STATUS: UNMATCHED ERA TYPE: ERA

INDIVIDUAL EOB COUNT: 1 MAIL MESSAGE: 218296

ERA DETAIL POST STATUS: NOT POSTED EXPECTED PAYMENT METHOD CODE: ACH

ARE YOU SURE THIS IS THE CORRECT ERA TO MATCH TO?: YES//

EFT #3055 WAS SUCCESSFULLY MATCHED TO ERA #43563

Do you wish to mark this entry for Auto Posting (Y/N)?

If the system determines that the ERA is NOT an auto-post candidate, one of the following error

messages is displayed:

ERA was NOT Marked as an Auto-Post CANDIDATE – Already marked for Auto-Posting

ERA was NOT Marked as an Auto-Post CANDIDATE – Already partially Auto-

Posted

ERA was NOT Marked as an Auto-Post CANDIDATE – Already completely Auto-

Posted

ERA was NOT Marked as an Auto-Post CANDIDATE – ERA not matched

ERA was NOT Marked as an Auto-Post CANDIDATE – Zero value ERA

ERA was NOT Marked as an Auto-Post CANDIDATE – Medical auto-posting off

ERA was NOT Marked as an Auto-Post CANDIDATE – Pharmacy auto-posting off

ERA was NOT Marked as an Auto-Post CANDIDATE – Medical payer excluded

ERA was NOT Marked as an Auto-Post CANDIDATE – Pharmacy payer excluded

ERA was NOT Marked as an Auto-Post CANDIDATE – Invalid Bill Number

Exception(s)

ERA was NOT Marked as an Auto-Post CANDIDATE – ERA level Adjustment(s)

ERA was NOT Marked as an Auto-Post CANDIDATE – ERA has a receipt

ERA was NOT Marked as an Auto-Post CANDIDATE – Unable to create

scratchpad

ERA was NOT Marked as an Auto-Post CANDIDATE – Claim Level Adjustments w/o

payment

ERA was NOT Marked as an Auto-Post CANDIDATE – +/- pairs do not balance

November 2018 ePayments User Guide (EDI Lockbox) 91

6.4. Mark Ø-Balance EFT Matched Acronym: ZB

There may be times when an EFT is received with a zero payment and has a paper EEOB associated with

it. This option allows the user to select an EFT detail record and mark it as matched to a paper EEOB.

This removes it from the EFT UNMATCHED AGING REPORT.

6.5. Unmatch an ERA Acronym: UN

If an ERA has been marked with a match status in error, this option allows it to be marked as unmatched

again. Only select an ERA that was previously marked as matched and that has had no receipt created for

it yet. If the Scratchpad entry has been created, it will need to be deleted before the unmatch can occur.

If the ERA was matched to an EFT, the EFT will be remarked as unmatched, and returned to the EFT

Unmatched Aging Report.

6.6. Update ERA Posted using Paper EOB Acronym: UP

When Payers first come on-line with the 3rd Party EDI Lockbox functions it is possible for a facility to

receive both EEOB data and paper EOBs at the same time. As a result, there may be times when the EOB

data gets posted from the paper EOB to AR and FMS without referencing the ERA. In this situation, the

ERA will indicate it is unposted. Use this option to mark the ERA as POSTED. It requires entering the

receipt # used to post the paper EOB information.

• The existing functionality of the Update ERA Posted Using Paper EOB option is extended to

include an automatic system search of an existing receipt when associating payments to the ERA.

The automatic search for receipts to post requires the user to enter an ERA number to be updated

to initiate automatic system search for associated receipt. The AR application will collect only

those receipts that have an FMS DOC STATUS of “ACCEPTED BY FMS” as indicated in the

following options:

o Receipt Processing [RCDP RECEIPT PROCESSING]

o List Of Receipts Report [RCDP LIST OF RECEIPTS REPORT]

1. System will display specific payment details associated with the ERA for validation by the user

prior to updating the ERA

o Patient Name/Last 4 of SSN

o Bill Number

o Check number

o Trace number

o Date of Service

o AR Transaction Amount

o Receipt Number

o Date of Receipt

2. A new audit report will display or print data to identify usage of the Update ERA Posted to EOB

option.

ERAs Posted with Paper EOB - Audit Report Page: 1

Run Date: 11/27/11@21:05:06

DIVISIONS: ALL

Date Range: 8/19/11 - 11/27/11 (DATE ERA UPDATED)

Date/Time User Who EFT Match Status

ERA # Receipt # ERA Updated Updated Detail Post Status

92 ePayments User Guide (EDI Lockbox) November 2018

===============================================================================

14201 2362006 9/12/11@14:03:33 User, One MATCHED TO PAPER CHECK

MANUALLY POSTED

13877 13398756 10/10/11@16:31:09 User, Two MATCHED TO PAPER CHECK

MANUALLY POSTED

14150 E06111505 10/14/11@13:23:52 User, One MATCHED TO PAPER CHECK

MANUALLY POSTED

14151 13805055 10/14/11@14:29:30 User, One MATCHED TO PAPER CHECK

MANUALLY POSTED

14232 13805672 10/14/11@14:40:26 User, One MATCHED TO PAPER CHECK

The option now includes the capability of an automatic system search of an existing receipt when

associating payments to the ERA.

Select EDI Lockbox Option: up Update ERA Posted Using Paper EOB

Select one of the following:

M Manually select receipt to post

A Automatic search for receipt to post

Select type of receipt to ERA link: M// a Automatic search for receipt to post

Select ELECTRONIC REMITTANCE ADVICE ENTRY: 14124 0039693212 02-20-07 398.07

GREAT-WEST LIFE UNMATCHED

PATIENT: Patient,Test A/3738

Bill number: K700UHD

Check #: 2398902

Trace #: 120199719GH0428

DOS: Nov 21, 2006

AR Transaction amount: 8

RECEIPT#: 13804836

Date of Receipt: Mar 06, 2006@08:06

Total Receipt AMOUNT: 398.07

Link to update Remittance entry # 14124 with receipt 13804836? NO//

ERA HAS BEEN MARKED AS POSTED USING PAPER EOB

PRESS RETURN TO CONTINUE

November 2018 ePayments User Guide (EDI Lockbox) 93

6.7. Remove ERA from Active Worklist Acronym: REM

This option allows the user to remove an unmatched ERA from the active Worklist. Use this option only

if the deposit has not been made. The Remove ERA from Active Worklist option should always be used

cautiously. Here are some common scenarios: you have received a duplicate ERA; the ERA doesn’t

belong to your station, the Update an ERA Posted using a paper EOB is not feasible or there is no other

way to process the ERA (i.e. Receipts are purged from system). This marks the POSTED status of the

ERA as NOT POSTED-REMOVED; and the EFT MATCH STATUS of the ERA is updated to

REMOVED FROM WORKLIST.

This option has been enhanced to require the user to have the security key RCDPE MARK ERA and

requires that a comment is entered that will represent the reason the ERA was removed from the Worklist.

• If user tries to use the Remove ERA from Active Worklist option without having the

RCDPE MARK ERA security key assign to them will get the following error message

(refer to sample screen shot below):

EXC EDI Lockbox 3rd Party Exceptions

WL ERA Worklist

APAR Auto-Post Awaiting Resolution

MA Automatic Match EFTs to ERAs

MCR EEOB Move/Copy/Remove

MM Manual Match EFT-ERA

OEFT Unposted EFT Override

REFT Remove Duplicate EFT Deposits

REM Remove ERA from Active Worklist

REP EDI Lockbox (ePayments) Reports Menu ...

UN Unmatch An ERA

UP Update ERA Posted Using Paper EOB

ZB Mark 0-Balance EFT Matched

Select EDI Lockbox Option: REM Remove ERA from Active Worklist

SORRY, YOU ARE NOT AUTHORIZED TO USE THIS OPTION

This option is locked with RCDPE MARK ERA key.

Enter RETURN to continue or '^' to exit:

94 ePayments User Guide (EDI Lockbox) November 2018

November 2018 ePayments User Guide (EDI Lockbox) 95

6.8. EEOB Move/Copy/Remove Acronym: MCR

The EEOB Move/Copy/Remove option was added to the EDI Lockbox Menu which provides the

capability to move or copy an EEOB to the correct patient account to ensure PHI is not compromised.

This option has the following features:

• Ability to select an EEOB and move or copy it to the appropriate claim(s) or remove it from the

claim

• The move, copy, or removal of an EEOB is captured and can be viewed with a new audit report

The remove option is locked with security key RCDPE REMOVE EEOB to restrict usage of removing

EEOBs from claims.

Example of MOVE function

Select EDI Lockbox Option: mcr EEOB Move/Copy/Remove

Select one of the following:

M Move EEOB to different claim

C Copy EEOB to multiple claims

R Remove EEOB from claim

Select action: M// ove EEOB to different claim

Select EXPLANATION OF BENEFIT (EEOB) to MOVE: K400M44 ARPatient,One

12-01-03 Inpatient REIMBURSABLE INS. PRNT/TX

AETNA US HEALTHCARE (PRIMARY)

Select A/R Bill to MOVE to: K400M42 442-K400M42 REIMBURS.HEALTH INS. 01

-12-04 AETNA US HEALTHCARE COLLECTED/CLOSED $0.00

Move EEOB from claim K400M44 to claim K400M42 ? YES//

Enter JUSTIFICATION COMMENT: Moving EEOB to correct claim number

EEOB Update Complete

Note: For audit purposes, a justification is required to move an EEOB

Example of COPY function

Select EDI Lockbox Option: mcr EEOB Move/Copy/Remove

Select one of the following:

M Move EEOB to different claim

C Copy EEOB to multiple claims

R Remove EEOB from claim

Select action: M// c Copy EEOB to multiple claims

Select EXPLANATION OF BENEFIT (EEOB) to COPY: K301XF4 User,Test

07-24-03 Outpatient REIMBURSABLE INS. PRNT/TX

AETNA US HEALTHCARE (PRIMARY)

Select A/R Bill to COPY to: K301SHC 442-K301SHC REIMBURS.HEALTH INS. 07

-18-03 AETNA US HEALTHCARE COLLECTED/CLOSED $0.00

Select another A/R Bill to COPY to: K301SI9 442-K301SI9 REIMBURS.HEALTH INS

. 07-18-03 AETNA US HEALTHCARE COLLECTED/CLOSED $0.00

Select another A/R Bill to COPY to:

Copy EEOB from claim K301XF4 to claim(s) K301SHC, K301SI9 ? YES//

Enter JUSTIFICATION COMMENT: Copying EEOB information to additional claim K123456.

EEOB Update Complete

Note: A justification comment is required to copy an EEOB to another claim.

96 ePayments User Guide (EDI Lockbox) November 2018

Example of REMOVE function

Select EDI Lockbox Option: mcr EEOB Move/Copy/Remove

Select one of the following:

M Move EEOB to different claim

C Copy EEOB to multiple claims

R Remove EEOB from claim

Select action: M// R Remove EEOB from claim

Select EXPLANATION OF BENEFIT (EEOB) to REMOVE: K301XF4 User,Test

07-24-03 Outpatient REIMBURSABLE INS. PRNT/TX

AETNA US HEALTHCARE (PRIMARY)

Are you sure you want to remove EEOB from claim K301XF4 (Y/N)?? YES//

Enter JUSTIFICATION COMMENT: Removing EEOB information for test.

EEOB Update Complete

Note: A justification comment is required to remove an EEOB. Also, the remove action is locked with

security key RCDPE REMOVE EEOB.

6.9. Remove Duplicate EFT Deposits Acronym: REFT

The Remove Duplicate EFT Deposits option was added to the EDI Lockbox Menu which provides the

capability to remove a duplicate EFT from the EFT Unmatched Aging report.

Select EDI Lockbox Option: reft Remove Duplicate EFT Deposits

WARNING: REMOVING AN EFT IS **NOT** REVERSIBLE

USE THIS OPTION ONLY IF YOU ARE SURE YOU WANT TO REMOVE THIS EFT.

PLEASE BE AWARE THAT ONCE AN EFT IS REMOVED --- IT CANNOT BE RESTORED.

Are you sure you want to continue? NO// y YES

Select EDI THIRD PARTY EFT DETAIL EFT TRANSACTION: 232 469655 05-02-20

06 SF MUTUAL 120199768GH0428 23.06

THIS WILL MARK THE EFT # 232 AS REMOVED

ARE YOU SURE YOU WANT TO CONTINUE?: NO// y YES

EFT REMOVAL REASON: Duplicate deposit for number 469655

EFT # 232 HAS BEEN MARKED AS REMOVED

PRESS RETURN TO CONTINUE

Any EFTs marked as duplicates are displayed on the EFT Daily Activity report with a new display field

that indicates the justification for the removal and the user that removed the EFT.

November 2018 ePayments User Guide (EDI Lockbox) 97

EDI LOCKBOX EFT DAILY ACTIVITY DETAIL REPORT Page: 1

RUN DATE: 11/30/16@11:12:12

DIVISIONS: ALL

PAYERS: ALL

DATE RANGE: 1/1/00 - 11/30/16 (Date Deposit Added)

DEP # DEPOSIT DT DATE PD DEP AMOUNT FMS DEPOSIT STAT

EFT # MATCHED DT PAYMENT AMOUNT ERA MATCH STATUS

EFT PAYER TRACE # CR #

PAYMENT FROM

TR #

DEP RECEIPT # DEP RECEIPT STATUS

===============================================================================

DATE EFT DEPOSIT RECEIVED: 1/14/04

469082 1/7/04 1/7/04 136.49 NO FMS DOC

1 1/7/04 10.80 MATCHED/ERA #10

803365450000024 1234567890

AETNA LIFE INS/1066033492

1234567890, 1234567890, 1234567890, 1234567890, 1234567890, 1234567890,

1234567890, 1234567890, 1234567890, 1234567890, 1234567890, 1234567890, 1234567890,

1234567890, 1234567890, 1234567890, 1234567890

E16xxxxxB QUEUED

1 1/7/04 125.69 MATCHED/ERA #12

The Duplicate EFT Audit Report was created to list all the EFT deposits that were removed from the EFT

Unmatched Aging Report also referred to as the EFT Worklist. This report is found in the EDI Lockbox

(ePayments) Reports Menu.

The new option is locked with a new security key RCDPE REMOVE DUPLICATES to restrict usage of

removing EFTs from the EFT Unmatched Aging Report. Appropriate personnel, such as: managers,

supervisors and leads should be assigned this security key.

EXC EDI Lockbox 3rd Party Exceptions

WL ERA Worklist

APAR Auto-Post Awaiting Resolution

MA Automatic Match EFTs to ERAs

MCR EEOB Move/Copy/Remove

MM Manual Match EFT-ERA

OEFT Unposted EFT Override

REFT Remove Duplicate EFT Deposits

REM Remove ERA from Active Worklist

REP EDI Lockbox (ePayments) Reports Menu ...

UN Unmatch An ERA

UP Update ERA Posted Using Paper EOB

ZB Mark 0-Balance EFT Matched

Select EDI Lockbox Option: reft Remove Duplicate EFT Deposits

SORRY, YOU ARE NOT AUTHORIZED TO USE THIS OPTION

The removed EFT will no longer display on the EFT Unmatched Aging Report

EFT UNMATCHED AGING REPORT Page: 1

RUN DATE: 11/27/11@15:27:12

PAYERS: ALL

DATE RANGE: 11/27/11 - 11/27/11 (DATE EFT FILED)

98 ePayments User Guide (EDI Lockbox) November 2018

AGED

DAYS TRACE #

DEPOSIT FROM/ID DEP DATE

FILE DATE DEPOSIT AMOUNT DEP#/EFT# DEPOSIT POST STATUS

=============================================================================

TOTALS:

NUMBER AGED ELECTRONIC EFT MESSAGES FOUND: 0

AMOUNT AGED ELECTRONIC EFT MESSAGES FOUND: $0.00

=============================================================================

*** END OF REPORT ***

6.10. EEOB Indicator

The following reports and screens display an EEOB indicator, the “%” character, next to the third party

accounts claim number when an EEOB has been received in the system for the claim.

o Brief Account Profile [PRCAY ACCOUNT PROFILE]

o Full Account Profile [PRCAY FULL ACCOUNT PROFILE]

o List All Bills [PRCA LIST ALL BILLS]

o Bill Profile [RCDP BILL PROFILE]

o Bill Transactions [RCDP BILL TRANSACTIONS]

o Claims Matching Report [RCDP CLAIMS MATCH]

o List all Bills for a Patient [IB LIST ALL BILLS FOR PAT]

o Insurance Payment Trend Report [IB OUTPUT TREND REPORT]

o BILL CHARGES screen of Third Party Joint Inquiry [IBJ THIRD PARTY JOINT

INQUIRY]

o Third Party Active Bills screen of Third Party Joint Inquiry [IBJ THIRD PARTY

JOINT INQUIRY]

o Third Party Inactive Bills screen of Third Party Joint Inquiry [IBJ THIRD PARTY

JOINT INQUIRY]

o Third party Follow-Up Report [IBJD FOLLOW-UP THIRD PARTY]

The following reports and screens display the EEOB indicator next to the first party claim number when a

match can be made to an associated third party claim that has received an EEOB.

• Brief Account Profile [PRCAY ACCOUNT PROFILE]

• Full Account Profile [PRCAY FULL ACCOUNT PROFILE]

• First Party Follow-Up Report [IBJD FOLLOW-UP FIRST PARTY]

• List all Bills for a Patient [IB LIST ALL BILLS FOR PAT]

• List All Bills [PRCA LIST ALL BILLS]

• Bill Profile [RCDP BILL PROFILE]

• Bill Transactions[RCDP BILL TRANSACTIONS]

Example of the EEOB indicator, the “%” character, appearing before a claim number

500-92004A 03/01/11 XRAY CORP ACTIVE 127 62.00

%500-92005A 03/01/11 PRUDENTIAL ACTIVE 127 55.00

%500-92055A 01/06/11 AETNA NEW BILL -31 -31.00

November 2018 ePayments User Guide (EDI Lockbox) 99

6.11. Receipt Processing

The RECEIPT PROCESSING option generates a new warning message that will alert the user that the

receipt cannot be processed when a claim on the ERA Worklist would result in a negative balance if the

decrease adjustment is allowed against the claim.

Receipt Processing – Warning Message

Receipt Profile May 15, 2017@15:57:59 Page: 1 of 1

Receipt #: E17051500 Type of Payment: CHECK/MO PAYMENT

Deposit #: Receipt Status: OPEN

ERA #: xxxxxxxxxx ERA TTL: xxxxxx.xx FMS Document: NOTSENT

EFT #: xxxxxxxxxx EFT TTL: xxxxxx.xx FMS Doc Status: NOT ENTERED

# Account Pay Date Open By Edit By Pay Amt Proc Amt

1 442-K405IET 05/15/17 CM 4.38 0.00

-------- --------

TOTAL DOLLARS FOR RECEIPT 4.38 0.00

+ Enter ?? for more actions

NP New Payment AP Account Profile PR Process Receipt

EP Edit Payment RR Reprint Receipt 21 (215 Report)

CP Cancel Payment WL Worklist (ERA) EA Exit Action

MP Move Payment CU Customize CR Entered Online

ER Edit Receipt

Select Action: Next Screen// PR Process Receipt

This option will process the payments for the receipt updating the AR

Package and generate the transfer receipt document to FMS. Any decrease

adjustments entered via the EDI Lockbox Worklist will also be generated.

Once a receipt has been processed, the receipt status will change to closed

and no further processing of the receipt can occur. If the FMS transfer

receipt document rejects, you can use this same option to reprocess the

receipt.

Generating automatic decrease adjustments from EDI Lbox Worklist ...

ARE YOU SURE YOU WANT TO CONTINUE?: YES// YES

Could not perform automatic decrease adj from ERA Worklist for

bill # 442-K700WEI for amount of -6.55

WARNING: Receipt cannot be processed.

Processing this receipt will cause this bill to have a negative balance

which is outside the scope of VA Accounting regulations.

Correct the error and reprocess this receipt.

6.12. Unposted EFT Override Acronym: OEFT

The Unposted EFT Override option displays current warning messages or error messages for third party

medical claims and pharmacy claims. A user can select either Medical or Pharmacy claims to file an

This new message is generated only when the decrease adjustment would have caused a

negative claim balance.

100 ePayments User Guide (EDI Lockbox) November 2018

override. A comment must be entered to explain why the override is occurring. An override allows

unrestricted scratchpad creation for the day the override is filed.

Note: The Unposted EFT Override option is locked with the security key, RCDPE AGED

PMT.

The menu option to override unposted EFT posting prevention requires the user to hold security key

RCDPE AUTO DEC.

6.13. Identify Payers Acronym: IDP

The Identify Payers option allows all users to see a list of all payer names and if they have been identified

as Tricare and/or Pharmacy only payers.

If the user has the RCDPE PAYER IDENTIFY security key they are allowed to set the Tricare and

Pharmacy indicators for payers.

Prompts

Select EDI Lockbox (ePayments) <TEST ACCOUNT> Option: IDP Identify Payers

Filter by Date Added? NO//

Select payers to show. (A)ll, (P)harmacy, (T)ricare, (M)edical: A// ll

Payer List

Payer Pharmacy/Tricare Oct 10, 2017@13:04:57 Page: 1 of 16

Current Filter: ALL Payers

# PAYER TIN Rx TR

1 AETNA 10XXXXXX92 Y

2 AETNA -CONTINENTAL LIFE INSURANCE COMPANY OF BRENTWOOD 16XXXXXX09

3 AETNA AMERICAN CONTINENTAL INSURANCE COMPANY 12XXXXXX54

4 AETNA GENWORTH LIFE AND ANNUITY INSURANCE 12XXXXXX54

5 ALLEGIANCE BENEFIT PLAN MANAGEMENT 18XXXXXX50 Y

6 ALTIUS HEALTH PLANS A COVENTRY HEALTH CARE PLAN 18XXXXXX31

7 AMERICAN FAMILY LIFE ASSURANCE COMPANY 15XXXXXX85

8 AMERICAN FAMILY MUTUAL INSURANCE 13XXXXXX10 Y Y

9 AMERICAN NAT'L INS CO OF TEXAS 17XXXXXX94

+ Enter ?? for more actions >>>

ED Edit Flags PH Flag Pharmacy Q Quit

FI Filter TR Flag Tricare

Select Action:Next Screen//

The Edit Flags, Flag Pharmacy and Flag Tricare actions will only be accessible to those with the RCDPE

PAYER IDENTIFY security key.

November 2018 ePayments User Guide (EDI Lockbox) 101

7. EDI Lockbox (ePayments) Reports Menu

Acronym: REP

The EDI Lockbox (ePayments) Reports Menu lists the available EDI Lockbox Reports.

EXC EDI Lockbox 3rd Party Exceptions

WL ERA Worklist

APAR Auto-Post Awaiting Resolution

MA Automatic Match EFTs to ERAs

MCR EEOB Move/Copy/Remove

MM Manual Match EFT-ERA

OEFT Unposted EFT Override

REFT Remove Duplicate EFT Deposits

REM Remove ERA from Active Worklist

REP EDI Lockbox (ePayments) Reports Menu ...

UN Unmatch An ERA

UP Update ERA Posted Using Paper EOB

ZB Mark 0-Balance EFT Matched

Select EDI Lockbox (ePayments) Option:

All of the EDI Lockbox Reports are listed here and display after you type REP above.

DA EFT Daily Activity Report

EFT EFT Unmatached Aging Report

ERA ERA Unmatched Aging Report

ETR EFT/ERA TRENDING Report

UN Unapplied EFT Deposits Report

AB Active Bills with EEOB Report

AD Auto-Decrease Adjustment Report

AP Auto-Post Report

APR Auto-Posted Receipt Report

CR 835 CARC Data Report

DUPR Duplicate EFT Deposits Audit Report

ESC ERA Status Change Audit Report

ETA EFT Transaction Audit Report

MCR EEOB Move/Copy/Remove Audit Report

PLB Provider level Adjustments (PLB) Report

POSR ERAs Posted with Paper EOB Audit Report

PX Payer Implementation Report

QS CARC/RARC Quick Search

REMR Remove ERA from Active Worklist Audit Report

TB CARC/RARC Table Data Report

VP View/Print ERA

Select EDI Lockbox (ePayments) Reports Menu Option:

7.1. EFT Daily Activity Report Acronym: DA

The Summary EFT Daily Activity Report provides total data on all EFT deposits. The report can be run

on-demand with detail by date or just the summary data for the date range. Detail format provides a

detailed list of all EFT deposits received within the selected date range and the corresponding EFT

payments from the payers comprising each deposit. The following information appears on the EFT Daily

Activity Statement.

102 ePayments User Guide (EDI Lockbox) November 2018

• Deposit Ticket Information – including deposit number, date received, trace #, which payment

was from, CR document number, and TR document number(s)

• EFT’s that have been matched to an ERA

• Accepted EFT’s represent total dollars posted to FUND 52870404/Revenue Source Code 8NZZ.

• A flag to indicate if an EFT is a debit received by the payer, resulting in a debit voucher

When to run this report

Review the EFT Daily Activity Report on an as-needed basis to monitor electronic funds deposited to the

US Treasury that are associated with your site.

Reviewing at least monthly you can ensure all deposits are in an ‘accepted’ status or in an appropriate

‘transmitted’ status. ALL deposits in a ‘rejected’ status must be corrected, in order to process the

payments OR get collection credit for the funds.

How to run this report

To run the EFT Daily Activity Report in detail proceed through the following steps:

Select EDI Lockbox (ePayments) Reports Menu Option - DA EFT Daily Activity Report

Select division: ALL//

(S)UMMARY OR (D)ETAIL?: D// DETAIL AND TOTALS

START DATE: 3/1/2017 (MAR 01, 2017)

END DATE: MAR 01, 2017// T (APR 14, 2017)

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

RUN REPORT FOR (A)LL, (S)PECIFIC, OR (R)ANGE OF INSURANCE COMPANIES?: ALL//

Show EFTs with debits only? NO// YES

DISPLAY IN LISTMANAGER FORMAT (Y/N): NO//

DEVICE: HOME// TELNET TERMINAL

EDI LOCKBOX EFT DAILY ACTIVITY DETAIL REPORT Page: 1

RUN DATE: 04/30/17@16:56:14

DIVISIONS: ALL

PAYERS: SELECTED MEDICAL/PHARMACY/TRICARE:TRICARE

DATE RANGE: 03/01/17 - 03/01/17 (DATE DEPOSIT ADDED) DEBIT ONLY EFTs: NO

DEP # DEPOSIT DT DATE PD DEP AMOUNT FMS DEPOSIT STAT

EFT # MATCHED DT PAYMENT AMOUNT ERA MATCH STATUS

EFT PAYER TRACE # CR #

PAYMENT FROM

TR #

DEBIT DEP RECEIPT # DEP RECEIPT STATUS

===============================================================================

DATE EFT DEPOSIT RECEIVED: 03/01/17

T331543 03/01/17 03/01/17 737.58 ACCEPTED

2100.01 03/01/17 737.58 MATCHED/ERA #92594

ABC6434331449 CR-442K5A0A64

FEDERAL EMPLOYEES HEALTH BENEFIT A COVENTRY HEALTH CARE PLAN/1066033492

TR-442K5A0A65

E17030100 ACCEPTED

To run the EFT Daily Activity Report in summary, proceed through the following steps:

November 2018 ePayments User Guide (EDI Lockbox) 103

Select division: ALL//

(S)UMMARY OR (D)ETAIL?: D// SUMMARY TOTALS ONLY

START DATE: 3/1/2017 (MAR 01, 2017)

END DATE: MAR 1,2017// (MAR 01, 2017)

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

RUN REPORT FOR (A)LL, (S)PECIFIC, OR (R)ANGE OF INSURANCE COMPANIES?: ALL//

Display in List Manager format? (Y/N): NO//

DEVICE: HOME// HOME (CRT) Right Margin: 80//

EDI LOCKBOX EFT DAILY ACTIVITY SUMMARY REPORT Page: 1

RUN DATE: 04/30/17@17:10:48

DIVISIONS: ALL

PAYERS: SELECTED MEDICAL/PHARMACY/TRICARE:TRICARE

DATE RANGE: 03/01/17 - 03/01/17 (Date Deposit Added) DEBIT ONLY EFTs: NO

===============================================================================

**TOTALS FOR DATE: 03/01/17 # OF DEPOSIT TICKETS RECEIVED: 1

TOTAL AMOUNT OF DEPOSITS RECEIVED: $737.58

DEPOSIT AMOUNTS SENT TO FMS:

ACCEPTED: $737.58

QUEUED: $0.00

ERROR/REJECT: $0.00

NOT IN FMS: $0.00

DEBIT VOUCHERS: $0

# EFT DEBIT VOUCHERS: 0

# EFT PAYMENT RECORDS: 1

# EFT PAYMENTS MATCHED: 1

**** TOTALS FOR DATE RANGE: # OF DEPOSIT TICKETS RECEIVED: 1

TOTAL AMOUNT OF DEPOSITS RECEIVED: $737.58

DEPOSIT AMOUNTS SENT TO FMS:

ACCEPTED: $737.58

QUEUED: $0.00

ERROR/REJECT: $0.00

NOT IN FMS: $0.00

DEBIT VOUCHERS: $0

# EFT DEBIT VOUCHERS: 0

# EFT PAYMENT RECORDS: 1

# EFT PAYMENTS MATCHED: 1

***** END OF REPORT *****

Enter RETURN to continue or '^' to exit:

104 ePayments User Guide (EDI Lockbox) November 2018

7.2. EFT Unmatched Aging Report Acronym: EFT

The EFT Unmatched Aging Report contains a list of all Electronic Funds Transfer (EFT) records that

have not been successfully matched to ERAs or to paper EOBs within the user-specified number of days.

Within EDI Lockbox Site Parameters, each site can set the number of days an EFT should wait before

appearing on this report. The default parameter is set at 5 days.

When to run this report

Review the EFT Unmatched Aging Report on a regular basis, as determined by your site, to monitor

outstanding electronic funds requiring a match to an ERA or even a paper EEOB.

How to run this report

To run the summary EFT Unmatched Aging Report, proceed with the following selections.

Select EDI Lockbox Reports Menu Option: EFT EFT Unmatched Aging Report

Start date: T-1000 (AUG 07, 2014)

End date: AUG 7,2014// T (MAY 03, 2017)

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

RUN REPORT FOR (A)LL, (S)PECIFIC, OR (R)ANGE OF INSURANCE COMPANIES?: ALL//SPECIFIC

Select Insurance Company Name: TRICARE WEST 1860813402

Export the report to Microsoft Excel? (Y/N): NO//

Display in List Manager format? (Y/N): NO//

DEVICE: HOME// TELNET TERMINAL

EFT UNMATCHED AGING REPORT Page: 1

RUN DATE: 5/3/17@15:21:37

PAYERS: SELECTED MEDICAL/PHARMACY/TRICARE:TRICARE

DATE RANGE: 8/7/14 - 5/3/17 (DATE EFT FILED)

AGED

DAYS TRACE # DEP DATE

DEPOSIT FROM/ID

FILE DATE DEPOSIT AMOUNT DEP#/EFT# DEPOSIT POST STATUS

================================================================================

Totals:

Number Aged Electronic EFT Messages Found: 1

Amount Aged Electronic EFT Messages Found: $66.76

================================================================================

637 68127436 3/18/15

FEDERAL EMPLOYEES HEALTH BENEFIT A COVENTRY HEALTH CARE PLAN/1470246511

8/5/15 66.76 569469949/2101.2 Posted to 8NZZ 8/6/15

***** END OF REPORT *****

November 2018 ePayments User Guide (EDI Lockbox) 105

7.3. ERA Unmatched Aging Report Acronym: ERA

This option produces the ERA aging report containing a list of all Electronic Remittance Advice (ERA)

records that have not been successfully matched to electronic EFTs within the user-specified number of

days. Within EDI Lockbox Site Parameters, each site can set the number of days an ERA should wait

before appearing on this report. An indicator of “x” displays before the Aged Days if an exception exists

for the ERA.

When to run this report

Review the ERA Unmatched Aging Report on a regular basis, as determined by your site, to monitor

outstanding electronic remittance advices requiring a match to an EFT or paper check.

How to run this report

To run the summary ERA Unmatched Aging Report proceed with the following selections:

Select EDI Lockbox Reports Menu Option: ERA ERA Unmatched Aging Report

Select division: ALL//

START DATE: 1/1/2005 (JAN 01, 2005)

END DATE: JAN 1,2005// T (SEP 20, 2011)

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

RUN REPORT FOR (A)LL, (S)PECIFIC, OR (R)ANGE OF INSURANCE COMPANIES?: ALL//

Include Zero payment amounts? (Y/N): YES//

Export the report to Microsoft Excel? (Y/N): NO// EXPORT THE REPORT TO Microsoft

Excel (Y/N): ? NO//

Display in List Manager format? (Y/N): NO//

DEVICE: HOME// TELNET TERMINAL

ERA UNMATCHED AGING REPORT Page: 1

RUN DATE/TIME: 9/20/11@14:44:15

DIVISIONS: ALL

PAYERS: SELECTED MEDICAL/PHARMACY/TRICARE:TRICAREDATE

RANGE: 1/1/05 - 9/20/11 (ERA FILE DATE)

AGED

DAYS TRACE #

PAYMENT FROM/ID ERA DATE

FILE DATE AMOUNT PAID EEOB CNT ERA #

===============================================================================

TOTALS:

NUMBER AGED ELECTRONIC ERA MESSAGES FOUND: 155

AMOUNT AGED ELECTRONIC ERA MESSAGES FOUND: $55,599.63

===============================================================================

1672 0003214829

FIRST HEALTH/1364072377 2/17/07

2/21/07 10.56 1 14102

EEOB Seq #: 1 EEOB on file for K700XL8 10.56

x1672 2013140051

MAIL HANDLERS BENEFIT PLAN/1382242132 2/17/07

2/21/07 18.53 1 14106

Enter RETURN to continue or '^' to exit:

106 ePayments User Guide (EDI Lockbox) November 2018

7.4. EFT/ERA Trending Report Acronym: ETR

The ERA/EFT TRENDING Report is used to display metrics on #ERAs, #EEOBs, #EFTs with #days

between ERA and EFT transactions. The report can be run for ALL payers or selected payer(s).

This report can also be found under the EDI Diagnostics Measures Reports menu.

7.5. Unapplied EFT Deposits Report Acronym: UN

This option produces a list of EFT deposits that have EFT detail records whose funds have not been

applied to bills in A/R. These funds remain in FUND 5287.4, RSC 8NZZ. Only those EFTs that have

either not been matched to an ERA or have been matched to an ERA , but the payment receipt has not

been posted to FMS, will appear on this report

EFT’s posted using a paper EOB will continue to show on this report. This will be updated with a future

enhancement.

When to run this report

You will run the Unapplied EFT Deposits Report on a regular basis, as determined by your facility, to

monitor funds outstanding in FUND 5287.4, REVENUE SOURCE CODE 8NZZ.

How to run this report

To run the Unapplied EFT Deposits Report proceed with the following selections:

Unapplied EFT Deposits Report Page: 2

Run Date: 12/12/16@16:42:39 MEDICAL/PHARMACY/TRICARE:TRICARE

Date Range: 7/28/89 - 12/12/16 (Deposit Date)

TOTAL NUMBER OF UNAPPLIED DEPOSITS: 13

TOTAL AMOUNT OF UNAPPLIED DEPOSITS: $8,274.78

DEPOSIT#/EFT# DEPOSIT DATE TOT AMT OF DEPOSIT TOT AMT UNPOSTED

PAYER/ID

TRACE # PAYMENT AMT RECEIPT #

ERA MATCHED FMS DOC #/STATUS

=============================================================================

569836 3/4/11 1345.68 1345.68

FEDERAL EMPLOYEES HEALTH BENEFIT A COVENTRY HEALTH CARE PLAN/1362739571

1044620067/2119.1 880.98 E11030800

MATCHED TO ERA #: 43349 TR-442K1A03DK - TRANSMITTED

Press enter to continue, '^' to exit:

7.6. Active Bills with EEOB Report Acronym: AB

This report was created in order to enable one to manage ACTIVE third party insurance claims that have

an EDI Lockbox EEOB, but have a balance remaining. All active bills that have EEOBs associated with

them and also have a balance >0 will be displayed, sorted by insurance company.

When to run this report

Run this report on a routine basis, as determined by your site, in order to identify any payments that have

been posted to accounts without any contractual adjustments and analysis having been performed. This

report is a very useful tool for keeping Account Receivables from becoming aged.

November 2018 ePayments User Guide (EDI Lockbox) 107

The ERA Unmatched Aging report should be current before working this report.

NOTE

: It is recommended that the report is queued, since it will take a while to print.

How to run this report

To run the Active Bills with an EEOB > 0 report, proceed with the following steps:

Select EDI Lockbox Reports Menu Option: AB Active Bills With EEOB Report

Select division: ALL//

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/ <=new prompt/Default=ALL

RUN REPORT FOR (A)LL, (S)PECIFIC, OR (R)ANGE OF INSURANCE COMPANIES?: ALL//

RUN REPORT FOR (A)LL EEOBs or (Z)ERO PAYMENT EEOBs only: ALL// <=new

prompt/Default=ALL

WITHIN INS CO, SORT BY (P)ATIENT NAME OR (L)AST 4 OF SSN?: PATIENT NAME//

SORT PATIENT NAME (F)IRST TO LAST OR (L)AST TO FIRST?: FIRST TO LAST//

START DATE (RECEIVED): t-30 (DEC 03, 2014) <= no need to default to T

END DATE (RECEIVED): DEC 3,2014// t (JAN 02, 2015) <= no need to default to T

Export the report to Microsoft Excel? (Y/N): NO//

Display in List Manager format? (Y/N): NO//

DEVICE: HOME// VIRTUAL TELNET Right Margin: 80//

EDI LOCKBOX ACTIVE BILLS W/EEOB REPORT Page: 1

RUN DATE: 1/2/15@08:39:45

DIVISIONS: ALL

PAYERS: SELECTED MEDICAL/PHARMACY/TRICARE:TRICARE

DATE RANGE: 12/03/14 - 01/02/15 PAYMENT TYPE:TRICARE

PATIENT NAME SSN BILL#

INS CO NAME BALANCE AMT BILLED AMT PAID

TRACE# DT REC'D DT POST

================================================================================

XXXXXXXXXXXXXXXXXX 2335 626KXXXXXX

AETNA* 14.53 14.53 0.00

8132X65800XX230 9/16/13 9/25/13

XXXXXXXXXXXXXXXXXXX 9633 626KXXXXXX

AETNA* 53.66 53.66 0.00

8141X55200XX932 7/9/14 7/14/14

XXXXXXXXXXXXXXXXXXX 9633 626KXXXXXX

AETNA* 46.31 46.31 0.00

8141X95800XX893 7/21/14 8/5/14

7.7. Auto Decrease Adjustment Report Acronym: AD

This report was created to monitor EEOBs that have been automatically decreased to a zero balance by

the system.

When to run this report

Run this report on a routine basis, as determined by your site, in order to identify any EEOB with a

contractual decrease adjustment performed automatically by the system.

7.8. Auto-Post Report Acronym: AP

This report was created to monitor EEOBs that have been automatically processed by the nightly job to

create and process a receipt. This report has filter questions for Medical, Pharmacy, TRICARE or ALL

claim types and allows the user to filter and sort by Insurance Company Name or TIN.

108 ePayments User Guide (EDI Lockbox) November 2018

When to run this report

Run this report on a routine basis, as determined by your site, in order to identify any EEOB that has a

processed receipt resulting from the nightly auto-posting job.

7.9. Auto-Posted Receipt Report Acronym: APR

When to run this report

Review this report on a regular basis, as determined by your site, to display all auto-posted receipts to

ensure payments are posted to patient’s 3rd party claims. If payments are 'hung up' and not processed

timely, veterans’ copayments are not credited in a timely fashion.

How to run this report

To run the Auto-Posted Receipt Report proceed through the following steps:

Select EDI Lockbox Reports Menu Option - APR AUTO-POSTED RECEIPT REPORT

Select division: ALL//

(A)uto-Post Date or (E)RA Date Received? (A/E): A//

START DATE: 3/1/2017 (MAR 01, 2017)

END DATE: MAR 01, 2017// T (MAY 01, 2017)

Select ERAs to be Displayed: Both// ??

Enter 1 to only display Posted Receipts.

Enter 2 to only display ERAs with missing receipts.

Enter 3 to display all receipts.

Select one of the following:

1 Posted/Completed Receipts

2 Missing Receipts

3 Both

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

Run Report for (A)LL, (S)PECIFIC, or (R)ANGE of Insurance Companies?: ALL//

Sort by (D)ate or (M)issing Receipts: D//

Display in List Manager format? (Y/N): NO//

Export the report to Microsoft Excel? NO//

DEVICE: HOME//

AUTO-POSTED RECEIPT REPORT May 01, 2017@13:08:17 Page: 1

FILTERS: All Divs; Selected Payers;TRICARE Auto-Post Date 03/01/17-05/01/17

ERA: All Receipts SORT: Auto-Post Date

DATE DATE

RECEIVED POSTED RECEIPT USER AMOUNT FMS DOC

--------------------------------------------------------------------------------

Payer: AETNA

ERA: 92594 ERA Total: 737.58

Receipt Total: 737.58

Trace #: ABC6434331449

03/01/17 03/01/17 E17030101 737.58 TR-442K5A0A65

ERA: 92595 ERA Total: 371.72 * Missing Receipts *

Receipt Total: 177.72

Trace #: ABC6435956395

03/17/17 * Missing * POST 194.00

03/17/17 03/17/17 E17031701A POST 177.72 TR-442K5A0A67

***** END OF REPORT *****

November 2018 ePayments User Guide (EDI Lockbox) 109

7.10. 835 CARC Data Report Acronym: CR

When to run this report

Run this report on a routine basis, as determined by your site, in order to determine any CARC codes

returned on 835 forms by payers.

How to run this report

To run the 8335 CARC Data report, proceed with the following steps:

Select EDI Lockbox Reports Menu Option: CR 835 CARC Data Report

Select Division: ALL//

(S)UMMARY or (D)ETAIL FORMAT: SUMMARY//

<=Defaults to SUMMARY

SELECT (C)ARC, (R)ANGE of CARCs or (A)LL: ALL//

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

Run Report for (A)LL,(S)PECIFIC,or (R)ANGE of Insurance Companies?: ALL//SPECIFIC

Select Insurance Company NAME: TRICARE WEST 1860813402

SORT BY (C)ARC or (P)AYER?: CARC//

<=Defaults to CARC

START DATE: T//090115

END DATE: T//091615

DEVICE: HOME// UCX/TELNET Right Margin: 80//

7.11. Duplicate EFT Audit report Acronym: DUPR

When to run this report

Review the Duplicate EFT Audit Report on a regular basis, as determined by your site, to monitor usage

of the Remove Duplicate EFT Deposits option.

How to run this report

To run the Duplicate EFT Audit report, proceed with the following selections:

Select EDI Lockbox Reports Menu Option: dupr Duplicate EFT Deposits Audit Repor

START DATE: t-100 (AUG 19, 2011)

END DATE: AUG 19,2011// t (NOV 27, 2011)

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

EXPORT THE REPORT TO Microsoft Excel (Y/N): ? NO//

Display in List Manager format? (Y/N): NO//

DEVICE: HOME// TELNET TERMINAL

Duplicate EFT Deposits - Audit Report Page 1

Run Date: 11/27/11@22:15:30 MEDICAL/PHARMACY/TRICARE:TRICARE

Date Range: 8/19/11 - 11/27/11 (DATE EFT REMOVAL)

Deposit#/EFT# Trace #

Payer Name Date/Time User Who

Amount Removed Removed

===============================================================================

469573/2119.1 120174234GH1230

SF MUTUAL

11.27 8/31/11@20:31:17 User,One

469579/2101.1 1000512901

CHEYENNE VAMC

407.76 8/24/11@10:51:07 User,Two

Justification Comments: this is a test on 08/24

110 ePayments User Guide (EDI Lockbox) November 2018

7.12. ERA Status Change Audit Report Acronym: ESC

When to run this report

Run this report on a routine basis, as determined by your site, in order to display a detailed audit trail

listing of ERA AUTO POST STATUS changes.

The report allows you to run an audit for a single ERA or ALL ERAs for a date range. Report will be

sorted by ERA then by date/time. Specific data elements shall include: Date/Time, User, ERA#, STATUS

(old/new) and Reason text.

The Reason text will be a summary of the “process” that caused the ERA Status to be changed along with

the “outcome” of the change. Example Reason text messages are listed below with some of these

messaged displayed in the report mockup.

Auto Matching: Marked as Auto-Post Candidate

Auto Posting: Removed from Auto Posting-Unable to create scratchpad

Auto Posting: Removed from Auto Posting-ERA level Adjustment(s)

Auto Posting: Removed from Auto Posting-+/- pairs do not balance

Auto Posting: Removed from Auto Posting-Unable to create receipt

Auto Posting: Removed from Auto Posting-Error in receipt processing

Auto Posting: ERA posted successfully

Auto Posting: Some of the ERA lines went to APAR

Auto Posting: Previously processed ERA posting attempt

Exceptions: Marked as Auto-Post Candidate

Exceptions: Not Marked as Auto-Post Candidate-<Reasons listed in section 2.9.1.2>

Worklist: Marked as Auto-Post Candidate

Worklist: Not Marked as Auto-Post Candidate-<Reasons listed in section 2.9.1.2>

Select EDI Lockbox Reports Menu Option: dupr Duplicate EFT Deposits Audit Repor

START DATE: t-100 (AUG 19, 2011)

END DATE: AUG 19,2011// t (NOV 27, 2011)

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

EXPORT THE REPORT TO Microsoft Excel (Y/N): ? NO//

Display in List Manager format? (Y/N): NO//

DEVICE: HOME// TELNET TERMINAL

Duplicate EFT Deposits - Audit Report Page 1

Run Date: 11/27/11@22:15:30 MEDICAL/PHARMACY/TRICARE:TRICARE

Date Range: 8/19/11 - 11/27/11 (DATE EFT REMOVAL)

Deposit#/EFT# Trace #

Payer Name Date/Time User Who

Amount Removed Removed

===============================================================================

469573/1234.1 120174234GH1230

SF MUTUAL

11.27 8/31/11@20:31:17 User,One

469579/5678.1 1000512901

CHEYENNE VAMC

407.76 8/24/11@10:51:07 User,Two

Justification Comments: this is a test on 08/24

November 2018 ePayments User Guide (EDI Lockbox) 111

Manual Match: Marked as Auto-Post Candidate

Manual Match: Not Marked as Auto-Post Candidate-<Reasons listed in section 2.9.1.2>

Unmatch: Removed as Auto-Post Candidate

How to run this report

To run the ERA Status Change Audit report, proceed with the following steps:

Select EDI Lockbox (ePayments) Reports Menu <TEST ACCOUNT> Option: ERA Status C

hange Audit Report

SELECT (S)ingle ERA or (A)LL: ALL//

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

START DATE: T// (DEC 03, 2015)

END DATE: T// (DEC 03, 2015)

DEVICE: HOME// HOME (CRT) Right Margin: 80//

The ERA Status Change Audit report will display as follows:

EDI Lockbox ERA Status Change Audit Report Page: 1

RUN DATE: DEC 03, 2015@14:39:45 MEDICAL/PHARMACY/TRICARE:TRICARE

DATE RANGE: 12/03/2015 - 12/03/2015

ERA# Date/Time Edited Status (Old/New) User

Reason Text

--------------------------------------------------------------------------------

43522 12/03/15@01:54:13 NULL UNPOSTED POSTMASTER

Auto Matching: Marked as Auto-Post Candidate

43566 12/03/15@01:55:18 NULL NULL POSTMASTER

Auto Posting: Removed from Auto Posting-ERA level Adjustment(s)

44448 12/03/15@01:56:22 UNPOSTED PARTIAL POSTMASTER

Auto Posting: Some of the ERA lines went to APAR

44467 12/03/15@01:58:16 UNPOSTED COMPLETE POSTMASTER

Auto Posting: ERA posted successfully

44699 12/03/15@01:59:44 PARTIAL COMPLETE POSTMASTER

Auto Posting: ERA posted successfully

46777 12/03/15@12:10:12 NULL NULL SMITH,JOE

Exceptions: Not Marked as Auto-Post Candidate-ERA not matched

46784 12/03/15@12:22:47 NULL NULL SMITH,JOE

Exceptions: Not Marked as Auto-Post Candidate-Invalid Bill Number Exception(s)

46799 12/03/15@12:31:22 NULL UNPOSTED SMITH,JOE

Exceptions: Marked as Auto-Post Candidate

47786 12/03/15@12:40:47 NULL UNPOSTED SMITH,JOE

Worklist: Marked as Auto-Post Candidate

48422 12/03/15@13:11:33 COMPLETE COMPLETE SMITH,JOE

Worklist: Not Marked as Auto-Post Candidate-Already completely Auto-Posted

48687 12/03/15@13:44:44 NULL UNPOSTED SMITH,JOE

Manual Match: Marked as Auto-Post Candidate

112 ePayments User Guide (EDI Lockbox) November 2018

48696 12/03/15@13:55:55 NULL NULL SMITH,JOE

Manual Match: Not Marked as Auto-Post Candidate-+/- pairs do not balance

48777 12/03/15@14:12:22 UNPOSTED NULL SMITH,JOE

Unmatch: Removed as Auto-Post Candidate

November 2018 ePayments User Guide (EDI Lockbox) 113

7.13. EFT Transaction Audit Report Acronym: ETA

When to run this report

Run this report on a routine basis, as determined by your site, in order to list all actions taken place for a

single EFT.

For example: If a user matched the EFT to a paper EOB, the report would list the date, user and deposit

ticket number. If another user unmatched/matched the EFT to an ERA, this data would also be displayed

on the report. This report also identifies which EFTs are ready to lock up the system.

How to run this report

To run the EFT Transaction Audit report, proceed with the following steps:

The EFT Transaction Audit Report allows the user to generate SUMMARY or DETAIL EFT Data as

described below.

Summary Report

Select EDI Lockbox (ePayments) Reports Menu <TEST ACCOUNT> Option: EFT Transact

ion Audit Report

(S)ummary or (D)etail Report format? SUMMARY// Summary Information Only

Start Date: T// 090115 (SEP 01, 2015)

End Date: T// (SEP 17, 2015)

Do you want to capture report data for an Excel document? NO//

DEVICE: HOME// HOME (CRT) Right Margin: 80//

EFT TRANSACTION AUDIT REPORT - SUMMARY Page: 1

RUN DATE: 9/17/15@11:21:24

DATE RANGE: 9/1/15 - 9/17/15 (DATE DEPOSIT ADDED)

EFT# DATE RECVD DEPOSIT# EFT TOTAL AMT DATE MATCHED DATE POSTED

TRACE #

PAYER NAME/ID

--------------------------------------------------------------------------------

**3052.1 09/01/15 TT7964771 2727.50 09/01/15 09/01/15

ABC637964X7703

AETNA/10660X33492

*3053.1 09/08/15 TT8035484 9000.00 09/09/15 09/08/15

ABC638035X4846

AETNA/10660X33492

*3054.1 09/15/15 TT8104218 2202.50 09/15/15 09/15/15

ABC638104X2181

AETNA/10660X33492

3055.1 09/15/15 TT8104351 2202.50 <No History> 09/15/15

ABC638104X3449

AETNA/10660X33492

3056.1 09/15/15 TT8104351 2202.50 <No History> 09/15/15

ABC638104X3480

AETNA/10660X33492

Enter RETURN to continue or '^' to exit:

Detail Report

114 ePayments User Guide (EDI Lockbox) November 2018

You have the ability to look up a single EFT by Deposit#, Deposit Date, Receipt# or Trace#.

Search for EFT# by:

1. Deposit (N)umber

2. Deposit (D)ate

3. (R)eceipt#

4. (T)race#

Search for EFT# by://

All selection options include logic to assist you to select a single EFT as follows:

(1) Deposit (N)umber:

If the you choose to find a SINGLE EFT by Deposit#, the selection list displays as follows:

Select DEPOSIT: 569601

1 569601 by: ARUSER,ONE on: 03/31/10 amt: $ 148.17 CONFIRMED

2 569601 by: ARUSER,TWO on: 08/21/15 amt: $ 0.00 OPEN

3 569601 by: ARUSER,TWO on: 09/02/15 amt: $ 0.00 OPEN

CHOOSE 1-3: 1

(2) Deposit (D)ate:

Once the DEPOSIT is selected, the system displays all EFTs on that Deposit for the user to

select a SINGLE EFT.

Select DEPOSIT DATE: T// 032410 (MAR 24, 2010)

Select single EFT:

1. 819 AETNA LIFE INS 8100X775500X01276 144.61 569597 03/24/10

2. 819 AETNA LIFE INS 8100X773700X01185 87.20 569597 03/24/10

3. 819 AETNA LIFE INS 8100X775400X01163 88.00 569597 03/24/10

4. 819 UNITEDHEALTHCARE 10319X01081 3545.01 569597 03/24/10

5. 819 UNITEDHEALTHCARE 10319X01083 20.88 569597 03/24/10

(3) (R)eceipt#:

If you choose to find a SINGLE EFT by Receipt#, the selection list will display as follows:

Select RECEIPT: e10040

1 E10040101 by: ARUSER,ONE on: 04/01/10 EDI LOCKBOX CLOSED

2 E10040200 by: ARUSER,TWO on: 04/02/10 EDI LOCKBOX CLOSED

3 E10040201 by: ARUSER,TWO on: 04/02/10 EDI LOCKBOX CLOSED

4 E10040202 by: ARUSER,TWO on: 04/02/10 EDI LOCKBOX CLOSED

5 E10040203 by: ARUSER,TWO on: 04/02/10 EDI LOCKBOX CLOSED

Press <RETURN> to see more, '^' to exit this list, OR

CHOOSE 1-5: 1

Once the RECEIPT is selected, the system displays all EFTs on that Receipt for you to select a

SINGLE EFT. This display is as follows:

November 2018 ePayments User Guide (EDI Lockbox) 115

Select RECEIPT: e10040101

Select single EFT:

1. 824 SF MUTUAL 12051X8936GH0330 2.14 569603 04/01/10

2. 824 SF MUTUAL 12051X8937GH0330 8.59 569603 04/01/10

3. 824 UNITEDHEALTHCARE 10321X87875 0.02 569603 04/01/10

(4) (T)race#:

Once the Trace# is entered, if there is only ONE EFT that matches the entered Trace#, the EFT

Audit Report will display for the selected SINGLE EFT. If there are multiple EFTs that match

the entered Trace#, you are given the following display to select a SINGLE EFT for the Audit

Report.

Select TRACE: ABC6369

1 ABC63692X49313 1052 AETNA 385.40 05/20/15

2 ABC63692X49473 1053 AETNA 385.40 05/20/15

3 ABC63692X51402 1054 AETNA 550.55 05/20/15

4 ABC63692X52144 1055 AETNA 1345.01 05/20/15

5 ABC63692X53837 1056 AETNA 2202.50 05/20/15

Press <RETURN> to see more, '^' to exit this list, OR

CHOOSE 1-5:

Once a single EFT is selected, the EFT Transaction Audit Report displays the entire EFT history.

116 ePayments User Guide (EDI Lockbox) November 2018

7.14. EEOB Move/Copy/Remove Audit Report Acronym: MCR

When to run this report

Review the EEOB Move/Copy/Remove Audit Report on a regular basis, as determined by your site, to

monitor EEOBs moved or copied from one claim to another

How to run this report

To run the report EEOB Move/Copy/Remove Audit Report, proceed with the following selections:

Select division: ALL//

START DATE: 05/28/14 (MAY 28, 2014)

END DATE: MAY 28, 2014// T (FEB 21, 2017)

Move/Copy/Remove or All (M/C/R/A): All//

Select division: ALL//

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

Export the report to Microsoft Excel? NO//

Display in List Manager format? (Y/N): NO//

DEVICE: HOME// TELNET TERMINAL

EEOB Move/Copy/Remove - Audit Report Page: 1

Run Date/Time: 2/21/17@14:18:42

Divisions: ALL

Date Range: 05/28/14 - 02/21/17 (Date EEOB was Moved/Copied/Removed)

MEDICAL/PHARMACY/TRICARE:TRICARE

Action(s) Selected: ALL

Orig Bill# Trace #

Moved/Copied/ Total Amt User Who Moved/

ERA # Date/Time Removed Paid Copied/Removed

================================================================================

999K222ZZZ 00629417

78862 7/31/14@07:26:16 MOVED $163.00 Patient, One

New Bill: KZZZ123 Other Bill Number(s): NONE

Justification Comments: EEOB moved from Claim K222ZZZ

Automatically by AUTOPOST

999K999BBB 02164161

77032 6/6/14@08:27:15 REMOVED $1122.41 Patient, One

New Bill: K999ABC Other Bill Number(s): NONE

Justification Comments: EEOB removed from claim K999BBB

Automatically by AUTOPOST

999K222XXX 1157381779

85552 2/2/15@07:37:50 COPIED $48.15 Patient, Two

New Bill: K111ZZZ Other Bill Number(s): K111AAA

Justification Comments: EEOB from claim K222XXX copied to claim(s)

K000XXX, K999YYY by automatically by AUTOPOST

***** END OF REPORT *****

7.15. Provider Level Adjustments (PLB) Report Acronym: PLB

When to run this report

Run the PLB Report regularly, as determined by your site, to extract report data, as well as view and

manage refund requests, for all PLB adjustment codes (FB, WO, 72, IR, J1, L6, CS, WU, etc.)

How to run this report

To runthe PLB Report, proceed with the following selections:

November 2018 ePayments User Guide (EDI Lockbox) 117

Select EDI Lockbox Reports Menu Option: PL Provider Level Adjustments (PLB) Report

Select Division: ALL//

(S)UMMARY or (D)ETAIL FORMAT: SUMMARY//

<=Defaults to SUMMARY

SELECT (C)ODE, (R)ANGE of CODEs or (A)LL: ALL//

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

Select Insurance Company by NAME or TIN:TIN//NAME

RUN REPORT FOR (A)LL,(S)SPECIFIC, OR (R)ANGE OF INSURANCE COMPANIES?:ALL//SPECIFIC

Select Insurance Company NAME: TRICARE WEST 8169029303

SORT BY (C)ODE or (P)AYER?: CODE//

<=Defaults to CODE

START DATE: 08/10/15

END DATE: 8/17/15

DEVICE: HOME// UCX/TELNET Right Margin: 80//

PLB Report – Summary:

EDI LOCKBOX 835 PROVIDER LEVEL ADJUSTMENT (PLB) REPORT - SUMMARY Page: 1

SORT by PLB CODES REPORT RUN DATE: Sep 17, 2015@10:16:15

DIVISION: ALL Codes: ALL

835 PAYERS: ALL 835 PAYER TINs: SELECTED MEDICAL/PHARMACY/TRICARE:TRICARE

EOB PAID DATE RANGE: 08/10/15 - 08/17/15

===============================================================================

GRAND TOTALS FOR ALL PLB CODES & PAYERS ON REPORT

TOTAL #ERAs: 5 ADJ: -5% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: $ -960.55 AMT BILLED: $ 21154.95 AMT PAID: $ 19895.76

===============================================================================

ADJ CODE: 50 # ERAs: 1 ADJ: -1% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: -50.00 AMT BILLED: 6102.20 AMT PAID: 6064.70

ADJ CODE TEXT: Late Charge

-------------------------------------------------------------------------------

PAYER NAME/TIN: AETNA/10660X33492

#ERAs: 1 ADJ: -1% [ADJ: -50.00/ BILLED: 6102.20] PAID: 6064.70

-------------------------------------------------------------------------------

ADJ CODE: 51 # ERAs: 1 ADJ: 0% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: -15.00 AMT BILLED: 6102.20 AMT PAID: 6067.20

ADJ CODE TEXT: Interest Penalty Charge

-------------------------------------------------------------------------------

PAYER NAME/TIN: AETNA/10660X33492

#ERAs: 1 ADJ: 0% [ADJ: -15.00/ BILLED: 6102.20] PAID: 6067.20

-------------------------------------------------------------------------------

ADJ CODE: J1 # ERAs: 2 ADJ: -1% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: -101.55 AMT BILLED: 7450.00 AMT PAID: 7013.31

ADJ CODE TEXT: Nonreimbursable

-------------------------------------------------------------------------------

PAYER NAME/TIN: AETNA/10660X33492

#ERAs: 2 ADJ: -1% [ADJ: -101.55/ BILLED: 7450.00] PAID: 7013.31

-------------------------------------------------------------------------------

ADJ CODE: WO # ERAs: 1 ADJ: -33% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: -500.00 AMT BILLED: 1500.55 AMT PAID: 750.55

ADJ CODE TEXT: Overpayment Recovery

-------------------------------------------------------------------------------

PAYER NAME/TIN: AETNA/10660X33492

#ERAs: 1 ADJ: -33% [ADJ: -500.00/ BILLED: 1500.55] PAID: 750.55

-------------------------------------------------------------------------------

ADJ CODE: WU # ERAs: 2 ADJ: -7% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: -294.00 AMT BILLED: 3950.55 AMT PAID: 2955.85

ADJ CODE TEXT: Unspecified Recovery

-------------------------------------------------------------------------------

118 ePayments User Guide (EDI Lockbox) November 2018

PAYER NAME/TIN: AETNA/10660X33492

#ERAs: 2 ADJ: -7% [ADJ: -294.00/ BILLED: 3950.55] PAID: 2955.85

-------------------------------------------------------------------------------

PLB Report – Detailed:

EDI LOCKBOX 835 PROVIDER LEVEL ADJUSTMENT (PLB) REPORT - DETAIL Page: 1

SORT by PLB CODES REPORT RUN DATE: Sep 17, 2015@10:18:20

DIVISION: ALL Codes: ALL

835 PAYERS: ALL 835 PAYER TINs: SELECTED MEDICAL/PHARMACY/TRICARE:TRICARE

EOB PAID DATE RANGE: 08/10/15 - 08/17/15

===============================================================================

GRAND TOTALS FOR ALL PLB CODES & PAYERS ON REPORT

TOTAL #ERAs: 5 ADJ: -5% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: $ -960.55 AMT BILLED: $ 21154.95 AMT PAID: $ 19895.76

===============================================================================

ADJ CODE: 50 # ERAs: 1 ADJ: -1% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: -50.00 AMT BILLED: 6102.20 AMT PAID: 6064.70

ADJ CODE TEXT: Late Charge

-------------------------------------------------------------------------------

PAYER NAME/TIN: AETNA/10660X33492

#ERAs: 1 ADJ: -1% [ADJ: -50.00/ BILLED: 6102.20] PAID: 6064.70

-----------------------------------------------------------------------------

#ERA DATE %ADJ ADJUST BILLED PAID CHECK#

TRACE#

REFERENCE#

43551 08/14/15 0 -50.00 6102.20 6064.70

ABC63778X42734

PATIENT CHECK BOUNCED

-------------------------------------------------------------------------------

ADJ CODE: 51 # ERAs: 1 ADJ: 0% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: -15.00 AMT BILLED: 6102.20 AMT PAID: 6067.20

ADJ CODE TEXT: Interest Penalty Charge

-------------------------------------------------------------------------------

PAYER NAME/TIN: AETNA/10660X33492

#ERAs: 1 ADJ: 0% [ADJ: -15.00/ BILLED: 6102.20] PAID: 6067.20

-----------------------------------------------------------------------------

#ERA DATE %ADJ ADJUST BILLED PAID CHECK#

TRACE#

REFERENCE#

43552 08/17/15 0 -15.00 6102.20 6067.20

ABC63781X39044

INTEREST CHARGE

-------------------------------------------------------------------------------

ADJ CODE: J1 # ERAs: 2 ADJ: -1% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: -101.55 AMT BILLED: 7450.00 AMT PAID: 7013.31

ADJ CODE TEXT: Nonreimbursable

-------------------------------------------------------------------------------

PAYER NAME/TIN: AETNA/10660X33492

#ERAs: 2 ADJ: -1% [ADJ: -101.55/ BILLED: 7450.00] PAID: 7013.31

-----------------------------------------------------------------------------

#ERA DATE %ADJ ADJUST BILLED PAID CHECK#

TRACE#

REFERENCE#

43543 08/10/15 0 -55.00 2450.00 2205.30

ABC637746X7154

notes here on J1 PLB Adjustment - TW

43544 08/10/15 0 -46.55 5000.00 4808.01

November 2018 ePayments User Guide (EDI Lockbox) 119

ABC637746X7490

TW entered comments for J1 PLB adjustment

-------------------------------------------------------------------------------

ADJ CODE: WO # ERAs: 1 ADJ: -33% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: -500.00 AMT BILLED: 1500.55 AMT PAID: 750.55

ADJ CODE TEXT: Overpayment Recovery

-------------------------------------------------------------------------------

PAYER NAME/TIN: AETNA/10660X33492

#ERAs: 1 ADJ: -33% [ADJ: -500.00/ BILLED: 1500.55] PAID: 750.55

-----------------------------------------------------------------------------

#ERA DATE %ADJ ADJUST BILLED PAID CHECK#

TRACE#

REFERENCE#

43540 08/10/15 -33 -500.00 1500.55 750.55

ABC637746X5961

User entered comments here.... TW

-------------------------------------------------------------------------------

ADJ CODE: WU # ERAs: 2 ADJ: -7% [TOT AMT ADJUSTED / TOT AMT BILLED]

AMT ADJUST: -294.00 AMT BILLED: 3950.55 AMT PAID: 2955.85

ADJ CODE TEXT: Unspecified Recovery

-------------------------------------------------------------------------------

PAYER NAME/TIN: AETNA/10660X33492

#ERAs: 2 ADJ: -7% [ADJ: -294.00/ BILLED: 3950.55] PAID: 2955.85

-----------------------------------------------------------------------------

#ERA DATE %ADJ ADJUST BILLED PAID CHECK#

TRACE#

REFERENCE#

43540 08/10/15 -17 -250.00 1500.55 750.55

ABC637746X5961

wu comments --- TW

43543 08/10/15 0 -44.00 2450.00 2205.30

ABC637746X7154

user comment entered here - TW

-------------------------------------------------------------------------------

120 ePayments User Guide (EDI Lockbox) November 2018

7.16. ERAs Posted with Paper EOB Audit Report Acronym: POSR

When to run this report

Review the ERAs Posted with Paper EOB Audit Report on a regular basis, as determined by your site, to

identify usage of the Update ERA Posted to EOB option.

How to run this report

To run the ERAs Posted with Paper EOB Audit Report, proceed with the following selections:

Select EDI Lockbox Reports Menu Option: ERAs Posted with Paper EOB Audit Report

Select division: ALL//

START DATE: 1/1/2011 (JAN 01, 2011)

END DATE: JAN 1,2011// T (SEP 20, 2011)

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

Export the report to Microsoft Excel? NO//

Display in List Manager format? (Y/N): NO//

DEVICE: HOME// TELNET TERMINAL

ERAs Posted with Paper EOB - Audit Report Page: 1

Run Date: 9/20/11@16:04:34

DIVISIONS: ALL

Date Range: 1/1/11 - 9/20/11 (DATE ERA UPDATED)

MEDICAL/PHARMACY/TRICARE:TRICARE

Date/Time User Who EFT Match Status

ERA # Receipt # ERA Updated Updated Detail Post Status

===============================================================================

14083 1012006 7/27/11@16:19:11 User,Five MATCHED TO PAPER CHECK

MANUALLY POSTED

14094 E11020100 7/29/11@17:50:43 User,Four MATCHED TO PAPER CHECK

MANUALLY POSTED

14201 2362006 9/12/11@14:03:33 User,Four MATCHED TO PAPER CHECK

MANUALLY POSTED

14124 13804836 9/16/11@07:31:28 User,One MATCHED TO PAPER CHECK

MANUALLY POSTED

******** END OF REPORT ********

7.17. Payer Implementation Report Acronym: PX

When to run this report

Review this report on a regular basis, as determined by your site, to identify all payers that have been

associated with ERAs in the system. This report will show all payers, regardless of whether the payer is,

or is not, excluded from auto-posting or auto-decreasing.

How to run this report

To run this report, select an output device.

Select EDI Lockbox Reports Menu <TEST ACCOUNT> Option: PX Payer Implementation Report

DEVICE: HOME// UCX/TELNET Right Margin: 80//

PAYER IMPLEMENTATION REPORT Page: 1

RUN DATE: 6/10/14@08:15:01

November 2018 ePayments User Guide (EDI Lockbox) 121

PAYER ID PAYER NAME DATE ADDED

================================================================================

12345678999 INSURANCE PAYER NAME 1 02/03/04

12345678988 INSURANCE PAYER NAME 2 09/01/10

12345678977 INSURANCE PAYER NAME 3 09/29/10

Press enter to continue, '^' to exit:

7.18. CARC/RARC Quick Search Acronym: QS

When to run this report

Run the CARC/RARC Quick Search regularly, as determined by your site, to display all data associated

with the entered code.

The CARC/RARC Quick Search displays as follows:

EDI LOCKBOX CARC/RARC QUICK SEARCH Page: 1

REPORT RUN DATE: Sep 17, 2015@10:04:11

CODE START DATE STOP DATE DATE MODIFIED CARC/RARC LAST VISTA UPDATE

CODE DESCRIPTION

===============================================================================

9 01/01/95 09/20/09 CARC 09/10/15

The diagnosis is inconsistent with the patient"s age. Note: Refer to the

835 Healthcare Policy Identification Segment (loop 2110 Service Payment

Information REF), if present.

7.19. Remove ERA from Active Worklist Audit Report Acronym:

REMR

When to run this report

Review this report on a regular basis, as determined by your site, to identify all ERAs that have been

removed from the Worklist.

How to run this report

To run the report, proceed with the following selections:

Remove ERA from Active Worklist Audit Report

Select Start Date: (W/R/B): Both Dates

START DATE: T-100 (OCT 19, 2011)

END DATE: OCT 19,2011// T (JAN 27, 2012)

(M)EDICAL,(P)HARMACY,(T)RICARE,(A)LL: ALL/

Select division: ALL//

EXPORT THE REPORT TO Microsoft Excel (Y/N): ? NO//

Display in List Manager format? (Y/N): NO//

DEVICE: HOME// TELNET TERMINAL

ERAs Removed from Active Worklist - Audit Report Page 6

Run Date/Time: 1/27/12@10:39:49

DATE RANGE: 10/19/11 - 1/27/12 (Received & Removed)

DIVISIONS: ALL

MEDICAL/PHARMACY/TRICARE: TRICARE

122 ePayments User Guide (EDI Lockbox) November 2018

ERA# Payer Name

Date/Time Date ERA Total Amt User Who

Removed Received Paid Removed

================================================================================

14215 PRINCIPAL FINANCIAL GROUP

1/19/12@12:04:04 2/26/07 34.85 User,One

Removed Reason: ERA does not belong; check returned to payer

14241 BANKERS LIFE & CASUALTY

1/18/12@14:35:41 2/26/07 4.66 User,Four

Removed Reason: check was returned to payer before deposited

14244 BANKERS LIFE & CASUALTY

1/27/12@10:11:46 2/26/07 14.07 User,Four

Removed Reason: ERA belongs to another site; check returned to payer

******** END OF REPORT ********

7.20. Link Payment Tracking Report Acronym:SR

When to run this report

Review this report on a regular basis, as determined by your site, to identify all entries going in and out of

Suspense including information on where the payment was dispersed by the user via the Link Payment

option.

The LINK PAYMENT TRACKING REPORT displays as follows:

LINK PAYMENT TRACKING REPORT NOV 20, 2017@15:59:29 PAGE 1

FOR THE DATE RANGE: RECEIPT#: E17112005

RECEIPT# TRANS# DATE AMOUNT CLAIM USER DISPOSITION

REASON CLAIMS

--------------------------------------------------------------------------------

E17112005 11/20/17 38.92 PH In Suspense

Multi-Trans Split

K100015 $15.00

K100007 $23.92

E17112005 1 11/20/17 15.00 K100015 PH Paid

E17112005 2 11/20/17 23.92 K100007 PH Paid

***** END OF REPORT *****

7.21. CARC/RARC Table Data Report Acronym: TB

When to run this report

Review this report on a regular basis, as determined by your site, to display all CARC/RARC data that

has been transferred from FSC, stored in VistA and available for use.

How to run this report

To run the report, proceed with the following selections:

Select EDI Lockbox Reports Menu Option: TB CARC/RARC Table Data Report

SELECT (N)O CARCS OR (A)LL CARCS: ALL//

<=Defaults to ALL

SELECT (N)O RARCS OR (A)LL RARCS: ALL//

<=Defaults to ALL

November 2018 ePayments User Guide (EDI Lockbox) 123

Include (A)ctive codes, (I)nactive codes or (B)OTH?: ACTIVE//

<=Default ACTIVE

REPORT DATE: T//

<=Defaults to T (today)

DEVICE: HOME// UCX/TELNET Right Margin: 80//

7.22. View/Print ERA Acronym: VP

This option allows you to select an ERA and print or view its contents.

When to run this report

This option is used on an “as needed” basis.

How to run this report

To run the View/Print Report proceed with the following selections:

Select EDI Lockbox Reports Menu Option: VP View/Print ERA

Select ELECTRONIC REMITTANCE ADVICE ENTRY: 123456TN 03-10-03 704.03

IBinsurance Company One MATCHED

DO YOU WANT TO INCLUDE EXPANDED EEOB DETAIL?: NO// YES <RET>

EDI LOCKBOX WORKLIST - ERA DETAIL 10/10/03 Page: 1

==============================================================================

**ERA SUMMARY DATA**

TRACE NUMBER: 55555555555-55555555-55555555

INSURANCE CO ID: 4444444444

ERA DATE: MAR 07, 2003 TOTAL AMOUNT PAID: 1165.99

PAYMENT FROM: IBinsurance Company One Hundred

FILE DATE/TIME: OCT 07, 2003@14:28:16

EFT MATCH STATUS: MATCHED TO PAPER CHECK

ERA TYPE: ERA INDIVIDUAL EOB COUNT: 4

MAIL MESSAGE: 256 CHECK #: 55555-555555555

DETAIL POST STATUS: NOT POSTED

**ERA LEVEL ADJUSTMENTS**

REFERENCE NUMBER: Reference Identification

ADJUSTMENT CODE: 50 ADJUSTMENT AMOUNT: -14.00

ADJUSTMENT TEXT: These are non-covered services because this is not deemed a `me

dical necessity' by the payer.

**EEOB DETAIL DATA**

SEQUENCE #: 1 EOB DETAIL: KXXXXXX

AMOUNT PAID: 0

Enter RETURN to continue or '^' to exit:

EDI LOCKBOX WORKLIST - ERA DETAIL 10/10/03 Page: 2

==============================================================================

INSURANCE COMPANY ON BILL: IBinsurance Company One Hundred

FREE TEXT PATIENT NAME: XXXXX,XXXX X BILLING PROVIDER NPI: XXXXXXXXXX

PATIENT: IBpatient,One A/5555 CLAIM #: XXX-KXXXXXX

ECME #: 123456789121

**EOB PROVIDER(S)/NPI CLAIM PROVIDER(S)/NPI**

--------------------- -----------------------

BILLING: /XXXXXXXXXX XXXXXXXX VAMC/XXXXXXXXXX

124 ePayments User Guide (EDI Lockbox) November 2018

RENDERING: Ibclerk,One/XXXXXXXXXX

EOB GENERAL INFORMATION:

Type : NORMAL EOB EOB Paid DT : 02/07/07

Entry Dt/Tm :02/09/07 4:32 pm Claim Status : PROCESSED

Entry Dt/Tm :02/09/07 4:32 pm Review Status: ACCEPTED-COMPLETE EOB

Entered By : Insurance Seq: PRIMARY

Last Edited : 02/09/07 6:50 pm Last Edit By : POSTMASTER

Patient Name: IBpatient,One A Pt. Relation : PATIENT

Insured Name: IBpatient,One A Insured ID : XXXXXXXXX

Claim Rec'd Date :

Other Subscriber Name: XXXXX,XXXX X

Enter RETURN to continue or '^' to exit:

EDI LOCKBOX WORKLIST - ERA DETAIL 10/21/10 Page: 3

==============================================================================

PAYER INFORMATION:

Payer Name : IBinsurance Company One

Payer Id : 555555555

ICN : XXXXXXXXX

Contact Phone : 555-555-5555

Contact e-Mail : XXXXXX@XXXX.COM

Payer Web Site : http://www.WebSite.com

Policy Reference: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Cross Ovr ID : XXXXXXXXXX

Cross Ovr Nm: XXXXXXXXXX XXXXXX

Enter RETURN to continue or '^' to exit:

EDI LOCKBOX WORKLIST - ERA DETAIL 10/21/10 Page: 4

==============================================================================

CLAIM LEVEL PAY STATUS:

Tot Submitted Chrg: 1000.07 Covered Amt : 0.00

Payer Paid Amt : 993.28 Patient Resp. Amt : 3.03

CLAIM LEVEL ADJUSTMENTS:

GROUP CODE: Contractual Obligations

REASON CODE: 122 Psychiatric reduction.

Amount: 3.76 Quantity: 0

MEDICARE INFORMATION:

NONE

LINE LEVEL ADJUSTMENTS:

# SV DT REVCD PROC MOD UNITS BILLED DEDUCT COINS ALLOW PYMT

1 01/27/10 99214 25 1 1850.95 1.01 0.00 0.00 997.04

ADJ: PR 1 Deductible Amount

ADJ AMT: 1.01

ADJ: PR 45 Charges exceed your contracted/ legislated fee arrangement.

ADJ AMT: 2.02

-REMARK CODE(1): MESSAGE TEXT UNAVAILABLE

Enter RETURN to continue or '^' to exit:

7.23. EFT Deposit Reconciliation Report Acronym: DEP

November 2018 ePayments User Guide (EDI Lockbox) 125

The EFT Deposit Reconciliation Report has been removed from the EDI Lockbox Reports Menu tree.

126 ePayments User Guide (EDI Lockbox) November 2018

8. National Reports for ePayments Data

The EDI Diagnostic Measures Reports menu is located under the Finance AR Manager Menu:

Clerk's AR Menu ...

Supervisor's AR Menu ...

EDI Diagnostic Measures Reports…

Select Finance AR Manager Menu Option:

There are 2 EDI Diagnostic Measure reports plus the Extracts submenu to choose from:

VS EDI VOLUME STATISTICS Report

TD ERA/EFT TRENDING Report

EX EDI Diagnostic Measures Extracts Menu…

Select EDI Diagnostic Measures Reports Option:

8.1. EDI VOLUME STATISTICS Report

The EDI VOLUME STATISTICS Report to display metrics on #837s/NCPDP claims and 835s with

#days between the claim and payment transactions. The report can be run for ALL payers or selected

payer(s).

Select EDI Reports Option: VS EDI VOLUME STATISTICS Report

Select Division: ALL//

SELECT (A)LL PAYERS, RANGE of PAYER NAMES: ALL//

(S)UMMARY by Payer or (G)RAND TOTALS ONLY; G//

Start with DATE:

Go to DATE:

DEVICE: HOME// UCX/TELNET Right Margin: 80//

EDI VOLUME STATISTICS REPORT Page: 1

ALL DIVISIONS PAYERS:AETNA-1 – AETNA-2

DATE RANGE: 01/01/14 – 01/31/15 RUN DATE: 02/07/15@15:30:14

--------------------------------------------------------------------------------------

PAYER NAME: AETNA-1 INSURANCE

--------------------------------------------------------------------------------------

NUMBER OF 837s TRANSMITTED TO MEDICAL PAYERS 12345

NUMBER OF NCPDP CLAIMS TRANSMITTED TO PHARMACY PBMs 54321

NUMBER OF 835s RECEIVED FROM MEDICAL PAYERS 10000

NUMBER OF 835s RECEIVED FROM PHARMACY PBMs 1323

NUMBER OF 837 WITH CORRESPONDING 835 (MRA Excluded) 2921

NUMBER OF NCPDP CLAIM WITH CORRESPONDING 835 610

AVG #DAYS BETWEEN 837 TRANSMIT AND 835 RECEIVED 9.0

AVG #DAYS BETWEEN NCPDP CLAIM TRANSMIT AND 835 RCVD 14.5

--------------------------------------------------------------------------------------

PAYER NAME: AETNA-2 INSURANCE

--------------------------------------------------------------------------------------

NUMBER OF 837s TRANSMITTED TO MEDICAL PAYERS 100

NUMBER OF NCPDP CLAIMS TRANSMITTED TO PHARMACY PBMs 100

NUMBER OF 835s RECEIVED FROM MEDICAL PAYERS 100

November 2018 ePayments User Guide (EDI Lockbox) 127

NUMBER OF 835s RECEIVED FROM PHARMACY PBMs 100

NUMBER OF 837 WITH CORRESPONDING 835 (MRA Excluded) 100

NUMBER OF NCPDP CLAIM WITH CORRESPONDING 835 100

AVG #DAYS BETWEEN 837 TRANSMIT AND 835 RECEIVED 9.0

AVG #DAYS BETWEEN NCPDP CLAIM TRANSMIT AND 835 RCVD 14.5

--------------------------------------------------------------------------------------

GRAND TOTAL ALL PAYERS

--------------------------------------------------------------------------------------

NUMBER OF 837s TRANSMITTED TO MEDICAL PAYERS 12445

NUMBER OF NCPDP CLAIMS TRANSMITTED TO PHARMACY PBMs 54421

NUMBER OF 835s RECEIVED FROM MEDICAL PAYERS 10100

NUMBER OF 835s RECEIVED FROM PHARMACY PBMs 1423

NUMBER OF 837 WITH CORRESPONDING 835 (MRA Excluded) 3021

NUMBER OF NCPDP CLAIM WITH CORRESPONDING 835 710

AVG #DAYS BETWEEN 837 TRANSMIT AND 835 RECEIVED 9.0

AVG #DAYS BETWEEN NCPDP CLAIM TRANSMIT AND 835 RCVD 14.5

Enter RETURN to continue or '^' to exit:

8.2. ERA/EFT TRENDING Report

The ERA/EFT TRENDING Report to display metrics on #ERAs, #EEOBs, #EFTs with #days between

ERA and EFT transactions. The report can be run for ALL payers or selected payer(s).

Select Division: ALL//

SELECT (A)LL PAYERS, (R)ANGE of PAYER NAMES: ALL//

SELECT (A)LL PAYER TINs, (R)ANGE of PAYER TINs: ALL//

Select RATE TYPE NAME: 8 REIMBURSABLE INS. Who's Responsible: INSURER

Print (M)AIN Report, (S)UMMARY by Payer or (G)RAND TOTALS ONLY: GRAND// <=default

Start with DATE:

Go to DATE:

EXPORT THE REPORT TO Microsoft Excel (Y/N): ? NO// <= MAIN Report format only

DEVICE: HOME// UCX/TELNET Right Margin: 80//

ERA/EFT TRENDING Report Page: 1

ALL DIVISIONS ALL PAYERS ALL PAYER TINs

DATE RANGE: 01/01/14 – 01/31/15 RUN DATE: 02/07/15@15:30:14

--------------------------------------------------------------------------------

*************************** ERA MATCHED TO an EFT **************************

--------------------------------------------------------------------------------

TOTAL NUMBER OF CLAIMS 4

TOTAL AMOUNT BILLED 2212.50

TOTAL AMOUNT PAID 2212.50

PERCENTAGE AMOUNT PAID: (%Total Paid/Billed) 100%

AVG #DAYS BETWEEN BILLED/ERA 6.5

AVG #DAYS BETWEEN ERA/EFT 1.8

AVG #DAYS BETWEEN ERA+EFT REC’D/PMT POSTED 4.5

AVG #DAYS BETWEEN BILLED/PMT POSTED 13.0

TOTAL NUMBER OF ERAs 2

TOTAL NUMBER OF EEOBs 214

TOTAL NUMBER OF EFTs 2

128 ePayments User Guide (EDI Lockbox) November 2018

TOTAL AMOUNT COLLECTED 2112.50

TOTAL DIFFERENCE BETWEEN ERAs (PAID) – EFTs (COLLECTED): 100.00

--------------------------------------------------------------------------------

*************************** ERA MATCHED TO a PAPER CHECK ********************

--------------------------------------------------------------------------------

TOTAL NUMBER OF CLAIMS 3

TOTAL AMOUNT BILLED 4190.00

TOTAL AMOUNT PAID 4190.00

PERCENTAGE AMOUNT PAID: (%Total Paid/Billed) 100%

AVG #DAYS BETWEEN BILLED/ERA 5.3

AVG #DAYS BETWEEN ERA/CHK 6.3

AVG #DAYS BETWEEN ERA+CHK REC’D/PMT POSTED 5.7

AVG #DAYS BETWEEN BILLED/PMT POSTED 17.0

TOTAL NUMBER OF ERAs 3

TOTAL NUMBER OF EEOBs 147

TOTAL NUMBER OF EFTs 0

TOTAL AMOUNT COLLECTED 0.0

--------------------------------------------------------------------------------

*************************** PAPER EOB MATCHED TO an EFT ********************

--------------------------------------------------------------------------------

TOTAL NUMBER OF CLAIMS 2

TOTAL AMOUNT BILLED 90.00

TOTAL AMOUNT PAID 90.00

PERCENTAGE AMOUNT PAID: (%Total Paid/Billed) 0%

AVG #DAYS BETWEEN BILLED/EOB 16.0

AVG #DAYS BETWEEN EOB/EFT -3.0

AVG #DAYS BETWEEN EOB+EFT REC’D/PMT POSTED 4.0

AVG #DAYS BETWEEN BILLED/PMT POSTED 20.0

TOTAL NUMBER OF ERAs 0

TOTAL NUMBER OF EEOBs 0

TOTAL NUMBER OF EFTs 1

TOTAL AMOUNT COLLECTED 90.00

ERA/EFT Trending Report by PAYER /TIN displays as follows:

ERA/EFT TRENDING Report Page: 1

ALL DIVISIONS PAYERS:AETNA-1 – AETNA-2 ALL PAYER TINs

DATE RANGE: 01/01/14 – 01/31/15 RUN DATE: 02/07/15@15:30:14

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

PAYER NAME/TIN: AETNA-1 INSURANCE/9999X99966X99

**************************************************** ERA MATCHED TO an EFT *******************************************************

----------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------

CLAIM# DOS AMT BILLED AMT PAID BILLED ERA/EOB REC’D EFT/PMT REC’D POSTED TRACE# AUTOPOST/MANUAL

ETRANS TYPE ERA# #EEOBs EFT# #DAYS:(BILL/ERA) #DAYS:(ERA/EFT) #DAYS:(ERA+EFT REC’D/PMT POSTED) TOTAL #DAYS(BILLED/PMT POSTED)

K999991 01/15/15 1200.00 1200.00 01/30/15 02/04/15 02/07/15 02/10/15 123xxx7890 AUTOPOST

ERA/EFT 123456 20 555001 5 3 3 11

K999992 01/15/15 300.00 300.00 01/30/15 02/04/15 02/07/15 02/17/15 123xxx7890 MANUAL

ERA/EFT 123456 66 555001 5 3 10 18

K999994 01/15/15 200.00 200.00 01/30/15 02/06/15 02/05/15 02/10/15 123xxx7890 AUTOPOST

ERA/EFT 123458 51 555000 7 -1 4 11

K999997 01/15/15 512.50 512.50 01/30/15 02/08/15 02/10/15 02/11/15 123xxx7890 AUTOPOST

ERA/EFT 123458 77 555000 9 2 1 12

November 2018 ePayments User Guide (EDI Lockbox) 129

************************************************** ERA MATCHED TO a PAPER CHECK **************************************************

---------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------

CLAIM# DOS AMT BILLED AMT PAID BILLED ERA/EOB REC’D EFT/PMT REC’D POSTED TRACE# AUTOPOST/MANUAL

ETRANS TYPE ERA# #EEOBs EFT# #DAYS:(BILL/ERA) #DAYS:(ERA/EFT) #DAYS:(ERA+EFT REC’D/PMT POSTED) TOTAL #DAYS(BILLED/PMT POSTED)

K999993 01/15/15 550.00 550.00 01/30/15 02/04/15 02/10/15 02/13/15 123xxx7890 AUTOPOST

ERA/PAPER 123500 81 N/A 5 6 3 14

K999995 01/15/15 3340.00 3340.00 01/30/15 02/03/15 02/11/15 02/21/15 123xxx7890 MANUAL

ERA/PAPER 123501 22 N/A 4 8 10 22

K999996 01/15/15 300.00 300.00 01/30/15 02/05/15 02/10/15 02/14/15 123xxx7890 AUTOPOST

ERA/PAPER 123504 44 N/A 6 5 4 15

************************************************** PAPER EOB MATCHED TO an EFT ***************************************************

----------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------

CLAIM# DOS AMT BILLED AMT PAID BILLED ERA/EOB REC’D EFT/PMT REC’D POSTED TRACE# AUTOPOST/MANUAL

ETRANS TYPE ERA# #EEOBs EFT# #DAYS:(BILL/ERA) #DAYS:(ERA/EFT) #DAYS:(ERA+EFT REC’D/PMT POSTED) TOTAL #DAYS(BILLED/PMT POSTED)

K999998 01/15/15 30.00 30.00 01/30/15 02/15/15 02/12/15 02/22/15 123xxx7890 MANUAL

PAPER/EFT N/A N/A 55700 16 -3 7 23

K999999 01/15/15 60.00 60.00 01/30/15 02/15/15 02/12/15 02/16/15 123xxx7890 AUTOPOST

PAPER/EFT N/A N/A 55700 16 -3 1 17

PAYER NAME/TIN: AETNA-1 INSURANCE/9999X99966X99

**************************************************** ERA MATCHED TO an EFT ******************************************************

TOTAL NUMBER OF CLAIMS 4

TOTAL AMOUNT BILLED 2212.50

TOTAL AMOUNT PAID 2212.50

PERCENTAGE AMOUNT PAID: (%Total Paid/Billed) 100%

AVG #DAYS BETWEEN BILLED/ERA 6.5

AVG #DAYS BETWEEN ERA/EFT 1.8

AVG #DAYS BETWEEN ERA+EFT REC’D/PMT POSTED 4.5

AVG #DAYS BETWEEN BILLED/PMT POSTED 13.0

TOTAL NUMBER OF ERAs 2

TOTAL NUMBER OF EEOBs 214

TOTAL NUMBER OF EFTs 2

TOTAL AMOUNT COLLECTED 2212.50

TOTAL DIFFERENCE BETWEEN ERAs (PAID) – EFTs (COLLECTED): 100.00

************************************************** ERA MATCHED TO a PAPER CHECK *************************************************

TOTAL NUMBER OF CLAIMS 3

TOTAL AMOUNT BILLED 4190.00

TOTAL AMOUNT PAID 4190.00

PERCENTAGE AMOUNT PAID: (%Total Paid/Billed) 100%

AVG #DAYS BETWEEN BILLED/ERA 5.3

AVG #DAYS BETWEEN ERA/CHK 6.3

AVG #DAYS BETWEEN ERA+CHK REC’D/PMT POSTED 5.7

AVG #DAYS BETWEEN BILLED/PMT POSTED 17.0

TOTAL NUMBER OF ERAs 3

TOTAL NUMBER OF EEOBs 147

TOTAL NUMBER OF EFTs 0

TOTAL AMOUNT COLLECTED 0.00

************************************************** PAPER EOB MATCHED TO an EFT ***************************************************

TOTAL NUMBER OF CLAIMS 2

TOTAL AMOUNT BILLED 90.00

TOTAL AMOUNT PAID 90.00

PERCENTAGE AMOUNT PAID: (%Total Paid/Billed) 100%

AVG #DAYS BETWEEN BILLED/EOB 16.0

AVG #DAYS BETWEEN EOB/EFT -3.0

130 ePayments User Guide (EDI Lockbox) November 2018

AVG #DAYS BETWEEN EOB+EFT REC’D/PMT POSTED 4.0

AVG #DAYS BETWEEN BILLED/PMT POSTED 20.0

TOTAL NUMBER OF ERAs 0

TOTAL NUMBER OF EEOBs 0

TOTAL NUMBER OF EFTs 1

TOTAL AMOUNT COLLECTED 90.00

PAYER NAME/TIN: AETNA-2 INSURANCE/9999X99966X88

**************************************************** ERA MATCHED TO an EFT ******************************************************

Claim line items here…..

************************************************** ERA MATCHED TO a PAPER CHECK **************************************************

Claim line items listed here…

************************************************** PAPER EOB MATCHED TO an EFT ***************************************************

Claim line items listed here…

PAYER NAME/TIN: AETNA-2 INSURANCE/9999X99966X88

TOTALS BY CATEGORY listed here…..

---------------------------------------------------------------------------------

Etc…..

GRAND TOTALS ALL PAYERS

------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------

**************************************************** ERA MATCHED TO an EFT ******************************************************

TOTAL NUMBER OF CLAIMS 4

TOTAL AMOUNT BILLED 2212.50

TOTAL AMOUNT PAID 2212.50

PERCENTAGE AMOUNT PAID: (%Total Paid/Billed) 100%

AVG #DAYS BETWEEN BILLED/ERA 6.5

AVG #DAYS BETWEEN ERA/EFT 1.8

AVG #DAYS BETWEEN ERA+EFT REC’D/PMT POSTED 4.5

AVG #DAYS BETWEEN BILLED/PMT POSTED 13.0

TOTAL NUMBER OF ERAs 2

TOTAL NUMBER OF EEOBs 214

TOTAL NUMBER OF EFTs 2

TOTAL AMOUNT COLLECTED 2212.50

TOTAL DIFFERENCE BETWEEN ERAs (PAID) – EFTs (COLLECTED): 100.00

************************************************** ERA MATCHED TO a PAPER CHECK **************************************************

TOTAL NUMBER OF CLAIMS 3

TOTAL AMOUNT BILLED 4190.00

TOTAL AMOUNT PAID 4190.00

PERCENTAGE AMOUNT PAID: (%Total Paid/Billed) 100%

AVG #DAYS BETWEEN BILLED/ERA 5.3

AVG #DAYS BETWEEN ERA/CHK 6.3

AVG #DAYS BETWEEN ERA+CHK REC’D/PMT POSTED 5.7

AVG #DAYS BETWEEN BILLED/PMT POSTED 17.0

TOTAL NUMBER OF ERAs 3

TOTAL NUMBER OF EEOBs 147

TOTAL NUMBER OF EFTs 0

TOTAL AMOUNT COLLECTED 0.00

************************************************** PAPER EOB MATCHED TO an EFT ***************************************************

TOTAL NUMBER OF CLAIMS 2

November 2018 ePayments User Guide (EDI Lockbox) 131

TOTAL AMOUNT BILLED 90.00

TOTAL AMOUNT PAID 90.00

PERCENTAGE AMOUNT PAID: (%Total Paid/Billed) 100%

AVG #DAYS BETWEEN BILLED/EOB 16.0

AVG #DAYS BETWEEN EOB/EFT -3.0

AVG #DAYS BETWEEN EOB+EFT REC’D/PMT POSTED 4.0

AVG #DAYS BETWEEN BILLED/PMT POSTED 20.0

TOTAL NUMBER OF ERAs 0

TOTAL NUMBER OF EEOBs 0

TOTAL NUMBER OF EFTs 1

TOTAL AMOUNT COLLECTED 90.00

132 ePayments User Guide (EDI Lockbox) November 2018

8.3. EDI Diagnostic Measures Extracts Menu

The only option listed on the EDI Diagnostic Measures Extract Menu that is not locked with the security

key ‘PRCFA SUPERVISOR’ is View/Print Extracted Reports.

DE Disable-Enable DM Background Job/Reports

VP View/Print Extracted Reports

MN Manually Start DM Extract

TR Manually Transmit DM Extract

Select EDI Diagnostic Measures Extracts Menu Option:

Report Results imported into Excel

With the exception of the Daily Activity Report and the 835 CARC Data Report Filters, the software has

been modified to allow the user to export the report from VistA to a text file in order to be imported into

Microsoft Excel.

Downloading Reports to Excel

1. Choose report to print to Excel and enter ‘0;256;999’ at the device prompt. Capture report into a text

file.

Select EDI Lockbox Reports Menu Option: MCR EEOB Move/Copy/Remove Audit Report

START DATE: 010106 (JAN 01, 2006)

END DATE: JAN 1,2006// t (AUG 29, 2011)

Move/Copy/Remove or All (M/C/R/A): All//

Select division: ALL//

Export the report to Microsoft Excel? NO// y YES

Before continuing, please set up your terminal to capture the

report data as this report may take a while to run.

To avoid undesired wrapping of the data saved to the

file, please enter '0;256;999' at the 'DEVICE:' prompt.

It may be necessary to set up the terminal display width

to 256 characters which can be performed by selecting the

Display option located within the 'Setup' menu on the

tool bar of the terminal emulation software (e.g. KEA,

Reflections or Smarterm).

DEVICE: HOME// 0;256;999

November 2018 ePayments User Guide (EDI Lockbox) 133

1. Once you have captured the report data onto a text file, open an Excel document, click on Data tab,

choose 'From Text' button located in the 'Get External Data' group

2. The dialogue box will come up that will allow you to browse for the text file for which you cut and

pasted the data from the VistA session. Note: Using a text file with word wrap “off” is

recommended.

3. Click on the import button once you select the text file.

4. The Text Import Wizard box comes up. Select ‘delimited’ radio button and click Next.

134 ePayments User Guide (EDI Lockbox) November 2018

5. Select ‘Other’ from the list of delimiter choices and enter the “^” character in the space

provided. Click ‘next’.

6. Select ‘General’ from the list of data formats. Click ‘finish’.

November 2018 ePayments User Guide (EDI Lockbox) 135

7. Accept the Existing Worksheet default. Click ‘Ok’.

Report Results displayed in List Manager

With the exception of the View/Print ERA Report, the software has been modified to allow the user to

view the report in a List Manager format.

Display Report in List Manager Format

1. Choose to display the report in a List Manager format.

Select OPTION NAME: EFT UNMATCHED AGING REPORT RCDPE EFT AGING REPORT

EFT Unmatched Aging Report

EFT Unmatched Aging

Start date: T-10 (MAY 31, 2014)

End date: MAY 31,2014// T (JUN 10, 2014)

RUN REPORT FOR (A)LL, (S)PECIFIC, OR (R)ANGE OF INSURANCE COMPANIES?: ALL//

Export the report to Microsoft Excel? (Y/N): NO//

Display in List Manager format? (Y/N): NO// YES

136 ePayments User Guide (EDI Lockbox) November 2018

2. The report displays in a List Manager format with default actions.

Enter ?? for more actions

Select Action:Quit//??

The following actions are also available:

+ Next Screen < Shift View to Left PS Print Screen

- Previous Screen FS First Screen PL Print List

UP Up a Line LS Last Screen SL Search List

DN Down a Line GO Go to Page ADPL Auto Display(On/Off)

> Shift View to Right RD Re Display Screen Q Quit

Enter RETURN to continue or '^' to exit:

November 2018 ePayments User Guide (EDI Lockbox) 137

(This page included for two-sided copying.)

138 ePayments User Guide (EDI Lockbox) November 2018

9. Enhancements to non-EDI Lockbox Menus

9.1. Agent Cashier Menu

Extended Check/Trace/Credit Card Search and Link Payment (Acronym: EX

& LP)

The AR option to perform a check search- either by check or money order- has been expanded to allow

for searches based on trace number. This has been specifically tailored for electronic funds processing.

Searching by Trace # can be based on Exact Match or Contains (partial):

Notice the new search options, S1 and S2, under Link Payment:

November 2018 ePayments User Guide (EDI Lockbox) 139

Link Payment to Multiple Claims

The following screen is displayed when you access Link Payment for further processing of suspense

entries.

Link Payments To Accounts Jul 31, 2014@13:11:05 Page: 1 of 129

Transactions for ALL Unapplied Payments

Receipt Tran Unapplied Dep Stat Pay Date Type Ck/Tr/Cd# Amt Paid

1 7080793I 44 7080793I0044 CLOS 03/08/13 CHEC 48363065 963.20

AcctLU: CRdoc: CR-626K3A08CF ACCEPT

2 7080793I 45 7080793I0045 CLOS 03/08/13 CHEC 48363066 666.00

AcctLU: CRdoc: CR-626K3A08CF ACCEPT

3 7080793I 46 7080793I0046 CLOS 03/08/13 CHEC 48363067 473.62

AcctLU: CRdoc: CR-626K3A08CF ACCEPT

4 7080793I 47 7080793I0047 CLOS 03/08/13 CHEC 48363068 138.60

AcctLU: CRdoc: CR-626K3A08CF ACCEPT

5 7080793I 48 7080793I0048 CLOS 03/08/13 CHEC 48363069 54.49

AcctLU: CRdoc: CR-626K3A08CF ACCEPT

6 7081260I 94 7081260I0094 CLOS 04/04/13 CHEC 44234 1421.71

AcctLU: CRdoc: CR-626K3A09U6 ACCEPT

7 7081260I 96 7081260I0096 CLOS 04/04/13 CHEC 44234 3444.37

AcctLU: CRdoc: CR-626K3A09U6 ACCEPT

8 7081407I 11 7081407I0011 CLOS 04/11/13 CHEC 40112515 112.08

+ Enter ?? for more actions

S1 Search Check/Trace# CS Clear Suspense AP Account Profile

S2 Search Credit Card SR Suspense Report RP Receipt Profile

LP Link Payment SP Show Payment EA Exit Action

You are able to disperse the payment to a single or multiple claims. Additional notes:

• You are required to disperse the ENTIRE payment between multiple claims or nothing is linked

and the ENTIRE payment remains in Suspense with no audit records generated. Ultimately, when

linking/dispersing payment dollars, the ENTIRE payment must be accounted for or the ENTIRE

payment remains in Suspense.

• The software prevents the user from posting dollars to a bill that causes the balance to go below

zero. If you try to do so you will receive an error message as in the example below.

BILL NUMBER: k602vts TW-RX PAYER 1 ACTIVE $567.79

Amount to apply to Account: (0.01-20666.66): 2000

The requested payment is greater than then amount owed please try again.

Amount to apply to Account: (0.01-20666.66):

• You are required to enter a Reason text (i.e. Comment) when leaving a portion of the payment in

SUSPENSE.

COMMENT: ??

Enter a code from the list.

Select one of the following:

1 Collected/Closed

2 Cancelled

3 Returned refund

4 Overpayment

5 Inactive bill

6 Duplicate payment

7 Policy termed

140 ePayments User Guide (EDI Lockbox) November 2018

8 Service connected

9 Other

The system automatically captures/stores a Final Disposition as Paid or In Suspense as you link payments

via Link Payment. This disposition will be displayed in the new Link Payment Tracking Report.

The user may choose to restore the removed suspense EEOB to active status and move EEOB detail to the

correct claim.

After payment (bill) selection the user will be asked if the payment has an EEOB.

If the response is YES the following detail will be displayed for the EEOB:

- Claim Number

- Trace Number

- Total Amount Paid

- Removed By

- Justification Comment

Users will be prompted to confirm this is the correct EEOB for this payment. On filing, the EEOB will be

moved to the correct claim (if the payment claim number is different from the claim on the EEOB) and

the EEOB removed status will be cleared.

When using the Link Payment functionality, you must already know the Account Number and the

Amounts to be processed. The Link Payment functionality does NOT allow you to search for account

information.

Deposit Processing (Acronym: DP)

The Select Deposit prompt allows you to Select an existing Deposit for review, create a NEW Deposit or

Exit.

If there are multiple deposits within the same Deposit ticket# for different dates, the system displays a list

of ALL matching Deposit tickets with the Deposit Dates so that you can select one.

The display and prompt are written as follows when there are multiple dates for a single Deposit ticket#:

Select Deposit: A999999

1 A999999 by: ARUSER,ONE on: 01/05/12 Amt: $ 888.00 CLOSED

2 A999999 by: ARUSER,TWO on: 12/06/14 Amt: $ 725.00 OPEN

Enter the line# to view an existing deposit or (N) to create a NEW deposit or e(X)it: //

You can create a NEW Deposit ticket # or view an existing one. You can only add to the Deposit for

Today. You will confirm/close the Deposit when appropriate.

NOTE: The user will be able to add a NEW Deposit (with the same Deposit Ticket#) only if the existing

Deposit Ticket(s) are on a different date(s) with status = CONFIRMED.

Example Scenarios:

• If the user selects a line#, the selected Deposit displays and follows the existing process for

displaying/editing information.

November 2018 ePayments User Guide (EDI Lockbox) 141

• If the user selects NEW and the Deposit ticket number to be created already exists for today (i.e.

Deposit Date), the following error message displays:

ERROR: Deposit Ticket# already exists for today – Please select the appropriate line # to modify

the existing Deposit or e(X)it to enter a different Deposit Ticket#”.

• If the user selects NEW and the Deposit ticket number to be created does NOT already exist for today

(i.e. Deposit Date) AND the previous deposit equals CONFIRMED, the system prompts the user for

confirmation before creating a New Deposit:

Add Deposit Ticket# A999999 for today (Y/N)? NO// <=default=NO

o If the user enters Y, the Deposit Ticket will be created - following existing process for

creating the Deposit.

o If the user enters N, the user will return to the “Select Deposit:” prompt.

• If the user selects e(X)it, the system will return to the “Select Deposit:” prompt.

142 ePayments User Guide (EDI Lockbox) November 2018

Receipt# Lookup for Pharmacy Claims

The EDI Lockbox Receipt functionality allows you to enter ECME# or RX# to get the claim# returned.

(i.e. you must enter ECME# or Rx# in Receipt when posting payments).

• Within ePayments: the lookup is available after the user creates the receipt.

• Outside of ePayments: the lookup is available in Receipt processing: Action Option: New

Payment.

Edit a Receipt

The AR option to edit a receipt has been expanded to allow you to edit the type of payment. This has

been specifically tailored for electronic funds processing. You can change the type of payment to

CHECK/MO PAYMENT if the receipt status is open and the current value is EDI LOCKBOX and vice

versa . You can also change the type of payment from CHECK/MO PAYMENT to EDI LOCKBOX on

receipts that have preexisting lines and add/attach a new EFT to the receipt if you have the RCDPEAR

key. The system then marks the EFT as unmatched if appropriate. The RCDPEAR key will allow you to

change the EFT number on receipts when the TYPE OF PAYMENT equals “EDI LOCKBOX.”

Auto-Posted Receipt Report (Acronym: APR)

The APR option allows you to display all auto-posted receipts to ensure payments are posted to patients’

3rd party claims. Refer to the EDI LOCKBOX (EPAYMENTS) REPORTS MENU section within this

document for more information.

November 2018 ePayments User Guide (EDI Lockbox) 143

(This page included for two-sided copying.)

144 ePayments User Guide (EDI Lockbox) November 2018

10. Security Keys

A unique entry in the Security Key file (^DIC(19.1,) which may prevent access to a specific Option by

including the key as part of the options’ entry in the Option file (^DIC (19,). Only users entered in the

Holder field of the Security Key file may access the option.

10.1. New or Modified Security Keys

RCDPE REMOVE DUPLICATES

New security key RCDPE REMOVE DUPLICATES is utilized to restrict usage of the Remove Duplicate

EFT Deposits option. (See Section 6.10 and 6.13 for further information on this security key)

RCDPE MARK ERA

A new security key restricts usage of the Remove ERA from Active Worklist option. (See Section 6.8 for

further information on this security key)

PRCADJ

The existing security key PRCADJ has been modified to lock the Adjust (Inc/Dec) action of the ERA

Worklist Research Menu to restrict its usage. This key should only be given to supervisory personnel.

(See Section 3.3.3.1 for further information on this security key)

RCDPE AGED PMT

New security key RCDPE AGED PMT is utilized to restrict usage of the Unposted EFT Override option.

(See Section 6.14 for further information on this security key)

RCDPE ERA EXCEPT

New security key RCDPE ERA EXCEPT is utilized to restrict usage of the Delete Message action from

the EDI Lockbox 3rd Party Transmission Exceptions. (See Section 3.2.1.1 for further information on this

security key)

RCDPE AUTO DEC

New security key RCDPE AUTO DEC is utilized to restrict usage of all options on the EDI Lockbox

Parameters menu. (See Section 2.2 for further information on this security key)

RCDPE REMOVE EEOB

New security key RCDPE REMOVE EEOB is utilized to restrict usage of the Remove option on the new

EEOB Move/Copy/Remove option. (See Section 6.9 for further information on this security key)

RCDPEAR

Security key RCDPEAR is utilized to restrict usage of the Admin Cost Adj and Re-establish Bill actions

on both the ERA Worklist Scratch Pad Research Menu and the Auto-Post Awaiting Resolution (APAR)

Scratch Pad Research Menu. (See Sections 2.1.2 and 3.5 respectively for further information on this

security key)

Security key RCDPEAR is utilized when editing a receipt to change the TYPE OF PAYMENT from

CHECK/MO PAYMENT to EDI LOCKBOX on receipts that have preexisting lines and allow a clerk to

add/attach a new EFT to the receipt. It will also allow clerks to change the EFT number on receipts when

the TYPE OF PAYMENT equals EDI LOCKBOX.

November 2018 ePayments User Guide (EDI Lockbox) 145

RCDPEPP

Security key RCDPEPP is utilized to restrict usage of the Mark for Auto Post, Refresh Scratch Pad, Look

at Receipt, Verify, and Receipt Processing actions on the ERA Worklist and ERA Worklist Scratch Pad.

Also, the security key RCDPEPP is utilized to restrict the usage of the Split/Edit a Line, Mark for Auto

Post and Verify actions on the Auto-Post Awaiting Resolution (APAR) Scratch Pad. (See Sections 2.1.1 /

2.1.2 and 3.5 respectively for further information on this security key.)

PRCFA SUPERVISOR

The existing security key PRCFA SUPERVISOR has been removed as a lock for the option EDI

Diagnostic Measures Reports menu which is located under the Finance AR Manager Menu. The

following options have been modified to be locked with the existing PRCFA SUPERVISOR security key:

• Disable-Enable DM Background Job/Reports

• Manually Start DM Extract

• Manually Transmit DM Extract

RCDPE PAYER IDENTIFY

Security key RCDPE IDENTIFY allows users to identify payers as being Tricare only, Pharmacy only,

both or none. This functionality is accessed when choosing the Identify Payers option on the EDI

Lockbox menu.

146 ePayments User Guide (EDI Lockbox) November 2018

(This page included for two-sided copying.)

November 2018 ePayments User Guide (EDI Lockbox) 147

11. APPENDIX A – Helpful Links

VistaU – Vista University has online training and documentation for a number of Training Initiatives

including ePayments

http://vaww.vistau.med.va.gov/VistaU/e-bp/e-Payments/default.htm

Revenue Guide - Provides a uniform and standard set of educational and reference materials for the

benefit of Revenue Cycle staff and management.

http://vaww1.va.gov/cbo/revguide.asp

Washington Publishing – Provider of services, publications and products to entities that develop or

consume Electronic Data Interchange Standard Transaction

http://www.wpc-edi.com/custom_html/claimadjustment.htm

ePay Rapid Response Team – email group including POC’s, ePay team, FSC, and EPS.

Provides responses to questions from the field

VHAePaymentsRRT@va.gov

TMS VA Talent Management System (Formerly LMS – VA Learning Management System)

https://www.tms.va.gov/plateau/user/login.jsp

148 ePayments User Guide (EDI Lockbox) November 2018

(This page included for two-sided copying.)

November 2018 ePayments User Guide (EDI Lockbox) 149

12. APPENDIX B – Claim Level Adjustment Codes

12.1. CLAIM ADJUSTMENT GROUP CODE

Code identifying the general category of payment adjustment 1100.

CODE DEFINITION

Code

Definition

Description

Contractual Obligations

Used when a joint payer/payee contractual agreement or a

regulatory requirement resulted in an adjustment.

Correction and

Reversals

Used for corrections and reversals to PRIOR claims

Other adjustments

Payer Initiated

Reductions

Used when, in the opinion of the payer, the adjustment is not the

responsibility of the patient, but there is no supporting contract

between the provider and the payer (i.e., medical review or

professional review organization adjustments).

Patient Responsibility

150 ePayments User Guide (EDI Lockbox) November 2018

(This page included for two-sided copying.)

November 2018 ePayments User Guide (EDI Lockbox) 151

13. APPENDIX C – Provider Level Adjustment Codes

13.1. PROVIDER LEVEL ADJUSTMENT

Provider Level Adjustment Reason Code

Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment

CODE and DEFINITION

Code

Definition

Description

Late Charge

Code for the Late Claim Filing Penalty or Medicare Late Cost Report

Penalty. PLB03-2 identifies the Medicare Late Cost Report Penalty with a

code value of LR.

Interest Penalty

Charge

Code for the interest assessment for late filing. Medicare Part A provides

code “IP” in PLB03-2.

Authorized Return

Monetary amount is the provider refund adjustment. This adjustment

acknowledges a refund received from a provider for previous

overpayment. PLB03-2 should always contain an identifying reference

number when the value is used. PLB04 should contain a negative value.

This adjustment should always be offset by some other PLB adjustment

referring to the original refund request or reason. For balancing purposes,

the amount related to this adjustment reason code must be directly offset.

Medicare A will provide code “PR” in PLB03-2.

Early Payment

Allowance

Applied to Borrower’s

Account

See 2.2.10, Capitation and Related Payments or Adjustments, for

additional information. Use this monetary amount for the loan repayment

amount.

Acceleration of

Benefits

Code to reflect accelerated payment amounts or withholdings.

Withholding or payment identification is indicated by the sign of the

amount in PLB04. A positive value represents a withholding. A negative

value represents a payment. Medicare Part A will provide code “AP” for

accelerated payment amounts and code “AW” for accelerated payment

withholdings in PLB03-2.

Rebate

Code for the refund adjustment. Medicare Part A will provide code “RF”

in PLB03-2.

Recovery Allowance

Code is used by Medicare to represent the check received from the

provider for overpayments generated by payments from other payers. This

code differs from the provider refund adjustment identified with code 72.

Part A or Part B trust fund for Medicare use is identified in PLB03-2.

“RA” is used for Medicare A. “RB” is used for Medicare Part B. PLB04

should contain a NEGATIVE value. This adjustment should always be

offset by some other PLB adjustment referring to the original refund

request or reason. For balancing purposes, the amount related to this

adjustment reason code must be directly offset.

Bad Debt Adjustment

Code for the bad debt pass-through. Medicare Part A will provide code

“BD” in PLB03-2.

Bonus

See 2.2.10, Capitation and Related Payments or Adjustments, for

additional information.

152 ePayments User Guide (EDI Lockbox) November 2018

Code

Definition

Description

Temporary Allowance

Tentative adjustment. Medicare Part A will provide code “TS” in PLB03-

Capitation Interest

See 2.2.10, Capitation and Related Payments or Adjustments, for

additional information.

Adjustment

Provide supporting identification information in PLB03-2. Medicare Part

A will provide code “CA” for Manual Claim Adjustment, “AA” for

Receivable Today. Medicare Part A and Part B will provide code “RI” for

Reissued Check Amount in PLB03-2.

Capitation Payment

See 2.2.10, Capitation and Related Payments or Adjustments, for

additional information.

Capital Passthru

Medicare Part A will provide code “CP” in PLB03-2.

Certified Registered

Nurse Anesthetist

Passthru

Medicare Part A will provide code “CR” in PLB03-2.

Direct Medical

Education Passthru

Medicare Part A will provide code “DM” in PLB03-2.

Withholding

See 2.2.10, Capitation and Related Payments or Adjustments, for

additional information. Medicare Part A will provide code “CW” in

PLB03-2.

Forwarding Balance

Monetary amount for the balance forward. A negative value in PLB04

represents a balance moving forward to a future payment advice. A

positive value represents a balance being applied from a previous payment

advice. A reference number should be supplied in PLB03-2 for tracking

purposes. Medicare Part A will provide code “BF” for negative values and

“CO” for positive values in PLB03-2.

Fund Allocation

See 2.2.10, Capitation and Related Payments or Adjustments, for

additional information. The specific fund should be identified in PLB03-2.

Graduate Medical

Education Passthru

Medicare Part A will provide code “GM” in PLB03-2.

Incentive Premium

Payment

See 2.2.10, Capitation and Related Payments or Adjustments, for

additional information.

Internal Revenue

Service Withholding

Interim Settlement

Number for the interim rate lump sum adjustment. Medicare Part A will

provide code “IR” in PLB03-2.

Nonreimbursable

Offset claim or service level data that reflects what could be paid if not for

demonstration program or other limitation that prevents issuance of

payment.

Penalty

Number for the capitation-related penalty, penalty withholding, or penalty

release adjustment. Withholding or release is identified by the sign in

PLB04. See 2.2.10, Capitation and Related Payments or Adjustments, for

additional information. Medicare Part A will provide code “PW” for

Penalty Withhold, “RS” for Penalty Release, and “SW” for Settlement

Withhold Amount in PLB03-2.

Interest Owed

Monetary amount for the interest paid on claims in this 835. Support the

amounts related to this adjustment by 2-062 AMT amounts, where

AMT01 is “I.”Medicare Part A will provide code “IN” in PLB03-2.

Levy

IRS Levy

Lump Sum

Disproportionate share adjustment, indirect medical education pass-

through, non-physician pass-through, pass-through lump sum adjustment,

November 2018 ePayments User Guide (EDI Lockbox) 153

Code

Definition

Description

or other pass-through amount. The specific type of lump sum adjustment

must be identified in PLB03-2. Medicare Part A will provide code:

“DS” for Disproportionate Share Adjustment,

“IM” for Indirect Medical Education Passthrough

“NP” for Non-physician Passthrough

“PS” for Passthrough Lump Sum

“PO” for Other Passthrough in PLB03-2.

Organ Acquisition

Passthru

Medicare Part A will provide code “KA” in PLB03-2.

Offset for Affiliated

Providers

Part A or Part B trust fund identification for the source of the offset is in

PLB03-2. Use “OA” for the Part A trust fund and “OB” for the Part B

trust fund in PLB03-2.

Periodic Interim

Payment

Monetary amount for the PIP lump sum, PIP payment, or adjustment after

PIP. The sign of the amount in PLB04 determines whether this is a

payment (negative) or adjustment (positive). Medicare Part A will provide

code:

“PL” for PIP Lump Sum

“PP” for PIP Payment

“PA” for Adjustment After PIP in PLB03-2.

Payment Final

Number for the final settlement. Medicare Part A will provide code “FS”

in PLB03-2.

Retro-activity

Adjustment

See 2.2.10, Capitation and Related Payments and Adjustments, for

additional information. Medicare Part A will provide code “TR” in

PLB03-2.

Return on Equity

Medicare Part A will provide code “RE” in PLB03-2.

Student Loan

Repayment

Third Party Liability

See 2.2.10, Capitation and Related Payments or Adjustments, for

additional information.

Overpayment

Recovery

Use for the recovery of previous overpayment. An identifying number

should be provided in PLB03-2. See the notes on codes 72 and B3 for

additional information about balancing against a provider refund.

Medicare Part A will provide code “OR” in PLB03-2.

154 ePayments User Guide (EDI Lockbox) November 2018

(This page included for two-sided copying.)

November 2018 ePayments User Guide (EDI Lockbox) 155

14. APPENDIX D - Definitions

Term

Definition

Austin Information Technology Center

(formerly Austin Automation Center)

Repository for databases located in Austin, Texas.

Accounts Receivable

The financial computer system used by the Department of

Veterans Affairs Medical Centers.

Financial Management System

The financial computer system used by the Department of

Veterans Affairs.

Software Requirements Specifications

Document that outlines the functionality requirements for a

project.

Routines

A unique identifiable containment of software pertinent to a

computer system function. The routines contain the

programming logic to implement the functionality for the EDI

Lockbox Project.

Data Dictionary

The structure of a file, table or any group of related information

as defined for and by VA FileMan.

MailMan Message

The messaging system used to communicate between the users

of the VISTA software. MailMan messages will be used to

process automatic payments and to communicate between the

Accounts Receivable software and the users.

Related SRS Module

The numeric and title of the functionality requested in the SRS,

which the SDD is implementing.

Mail Group

A VA MailMan structure that defines a subset of VA MailMan

users. A Mail Group is used to communicate with a group of

users. The Mail Group user subset can easily be modified

without having to change software logic.

Security Key

A unique entry in the Security Key file (^DIC(19.1,) which may

prevent access to a specific Option by including the key as part

of the options’ entry in the Option file (^DIC(19,). Only users

entered in the Holder field of the Security Key file may access

the option.

Option

A unique method defined in the Option file (^DIC(19,). Options

are usually defined as part of a user driven menu system but may

be invoked as extensions of other options or VA MailMan

messages.

List Manager Screen

A graphical user interface program used by VISTA to present

data to the users. From the List Manager Screen, the user can

select options programmed and set up for the data displayed.

Integration Agreement

Programming agreements made between two VISTA packages

enabling the sharing/management of data and or functions.

Implementation Manager

The person or group whose function is to field questions and

solve problems for the sites that are data or process related to

transmissions from EDI Lockbox.

156 ePayments User Guide (EDI Lockbox) November 2018

Term

Definition

ERA

Electronic Remittance Advice

An electronic record transmitted to the sites with EEOB detail

information included. An Electronic Remittance Advice can

consist of one or more EEOBs from one payer.

EOB

Explanation Of Benefits

EEOB

Electronic Explanation Of Benefits

Explanation Of Benefits

A document from a payer that details the amount of payment on

a claim and if not paid in full, the reasons for it.

Insurance Company ID

ID associating each transaction with the payer; typically the

payer’s tax ID number and is not related to any other Payer ID

stored in VistA for other purposes.

FSC

Financial Services Center; located in Austin, Texas; FSC runs

GENTRAN translator software on FSC servers; FSC servers

parse incoming EFT and ERA data and routes data to the

appropriate VistA AR system based on Provider Tax ID

information within each transaction

GENTRAN

Software used to translate incoming 835 data into VistA readable

flat file data; software is loaded onto FSC server

AITC

Austin Information Technology Center (AITC) located in

Austin, Texas; responsible for maintaining the hardware that

supports the Lockbox system, including FSC servers, the

Mailman routing system, and EPHRA database

EPHRA

EEOB and Payment Healthcare Resolution Application; Web-

based archival repository and research tool; allows user to search

for missing EEOBs that are not received due to incorrect routing

information; allows Austin FSC 224-unit staff to route

unroutable EEOB data

Posted ERA

Indicates the AR processing is complete

Unposted ERA

Indicates the AR processing is not complete; an unposted ERA

needs to be processed, closed, and posted, just like a paper EOB

that must be verified and/or adjusted before closing

Matched

An ERA that has been associated with an EFT, a paper check, or

a zero dollar payment

Not matched

An ERA that has not yet been associated with an EFT, a paper

check, or a zero dollar payment; user will always select

unmatched when searching for an ERA that should match the

paper check received

Worklist

A listing of all ERA information sent from payers. It can be

viewed by posted or unposted ERA’s, specific payers, and

matched or not matched ERA’s.

Sequence number

A sequential number assigned in VistA to each incoming ERA

ICN

Internal control number. This number is sent by the payer and is

unique to each payer and identifies the claim in the payers

system. It can be given by AR to the customer service

November 2018 ePayments User Guide (EDI Lockbox) 157

Term

Definition

representative at the payer to help locate the information in the

payer’s system.

Transaction and code sets

Standard for Electronic transactions set forth by HIPAA.

Compliance is mandatory for payers, providers, clearinghouses

or anyone who receives or submits electronic health information.

835

HIPAA standard terminology for an electronic health care claim

payment or remittance advice

Scratchpad

VistA screen containing ERA #, name and ID of payer, amount

paid, and the trace number. The scratchpad also contains list

manager options that conveniently store frequently used

AR/ePay options in one centralized location.

FMS

Financial Management System. FMS interacts with VistA to

manage VHA financial data.

CR document

Credit document; credits funds to site via FMS

TR document

Transfer document; transfers funds to appropriate revenue source

code

Integrated Billing Package

POC

Point of Contact. The ePay network includes an ePay POC per

VISN.

VistaU

Vista University has online training and documentation for a

number of Training Initiatives including ePayments.

Auto-Post

VistA runs a nightly job to automatically post third party medical

claims by creating and processing receipts for EEOBs that meet

auto-posting criteria.

APAR List

Auto-Post Awaiting Resolution list of EEOBs that were

processed by the auto posting nightly job, but the system was

unable to create and process a receipt.

Auto-Decrease

VistA runs a nightly job to automatically make a decrease

adjustment to a third party medical claim that meets auto-

decrease criteria. The automatic decrease is made with a

contractual decrease adjustment amount that brings the claim

balance to zero.

158 ePayments User Guide (EDI Lockbox) November 2018

(This page included for two-sided copying.)

November 2018 ePayments User Guide (EDI Lockbox) 159

15. APPENDIX E – 3rd Party EDI Lockbox Bulletins

ERRONEOUS TAX ID ON ERA

Message sent when the payer sends an ERA to the EDI Lockbox bank

and they do not include a valid V.A. tax id on the transmission. In

order to correctly route the data to the proper site, the tax id number

must be corrected before the data is transmitted to the site by either

EPHRA or the EDI Lockbox group in Austin. If this occurs, this

bulletin is received by the site to alert them that the payer has either

omitted or has an erroneous tax id for the site.

What to do: Contact the insurance company and provide them with the

correct tax id for the site.

EDI LOCKBOX SERVER OPTION ERROR

Message sent when the EDI Lockbox system receives a message

where:

1. Message code is invalid for EDI Lockbox

2. This message has no ending $ or 99 record.

3. Message file problem - no message stored.

4. Message file problem - message partially stored.

5. Invalid mail group designated for EDI Lockbox errors

6. Message header error – the format of the header record on an

EFT or ERA was not correct.

What to do: For all situations, contact your IRM as there may be

mailman or server problems or EVS if there are software errors.

160 ePayments User Guide (EDI Lockbox) November 2018

EDI LBOX ALERT - ERA/EFT NOT FROM AUSTIN

Message sent when an ERA or EFT is received by the EDI Lockbox

system and the message did not come from Austin.

What to do: Contact your IRM to report this possible breach of

security

EDI LBOX - EEOB FROM <site name> FOR <payer name>

Message sent when an EEOB is transferred into your site from another

site that received it in error.

What to do: In EDI Lockbox Data Exception Processing, find the

EEOB and accept it as yours (via file EEOB) or delete it if it does not

belong to you.

TOTALS MISMATCH ON EFT-ERA MATCH

Message sent when an EFT and an ERA are matched with the same

trace number and insurance company id number, but the totals

indicated on the 2 records do not match.

What to do: Contact the payer to determine why this has occurred.

DUPLICATE EFT DEPOSIT RECORD RECEIVED

Message sent when the EDI Lockbox server receives an EFT message

and VistA already has a deposit and receipt posted to FMS for the

deposit ticket # referenced by the EFT.

What to do: Report this to your IRM and the implementation manager

to determine why it happened.

EXCEPTIONS EFT DEPOSIT AND MATCH EFTs TO ERAs <date>

Message sent when exceptions are encountered when the system

attempts to post EFT deposits or to match EFTs with ERAs.

November 2018 ePayments User Guide (EDI Lockbox) 161

Exception conditions include:

1. The nightly job to post EFT deposits and match EFTs to ERAs

could not be run because another match process was already

running.

2. An invalid checksum value was found for an EFT on file and

the EFT deposit was not sent to FMS.

3. A deposit or a receipt could not be added for an EFT. The

EFT deposit was not sent to FMS.

What to do:

1. Only 1 process to match ERAs to EFTs may be running at any

given time. If happening on the manual process, try again

later. If on the nightly job or the problem persists, show the

bulletin to your IRM as they can research the problem.

2. This indicates the EFT record was modified since it was stored

in VistA. IRM should be notified of the problem and the EFT

will need to be retransmitted to the site from Austin (the

existing record will be overwritten with the retransmitted data

3. This indicates a data problem with the record or a software

problem. Ask Austin to retransmit. If the problem persists,

contact your IRM and/or EVS

EDI LOCKBOX TOTALS RECORD EXCEPTION

Message sent when the EDI Lockbox server stores an ERA record in

different parts. Each EEOB within the ERA is stored in IB in the

EXPLANATION OF BENEFITS file. All the detail pertaining to

payment made regarding the claim is stored here. The ERA total

amount paid and all detail not pertaining to an individual claim is

stored in A/R. This exception is received when the ERA totals record

cannot be stored in A/R.

What to do: Contact EVS.

AR LOCKBOX ERA UNMATCHED AGING REPORT FOR <date>

When received: Produced by the nightly EDI Lockbox job. It contains

an ERA UNMATCHED AGING summary report.

What to do: This is FYI only. No action is needed.

AR LOCKBOX EFT UNMATCHED AGING REPORT FOR <date>

When received: Produced by the nightly EDI Lockbox job. It contains

an EFT UNMATCHED AGING summary report.

What to do: This is FYI only. No action is needed.

AUTO DAILY ACTIVITY SUMMARY REPORT - <date>

INVALID EFT DEPOSIT NUMBER

When received: When the EDI Lockbox server receives an EFT

whose deposit number does not start with a 469 or HAC.

What to do: Contact the implementation manager.

ELECTRONIC EDI LOCKBOX MESSAGE DELETED

162 ePayments User Guide (EDI Lockbox) November 2018

When received: Any time a user uses the delete message action within

EDI Lockbox transmission exception processing to delete an exception

message.

What to do: FYI – you might want to follow up to be sure the deletion

was justified.

ELECTRONIC EEOB DETAIL EXCEPTION REMOVED

Any time a user uses the delete message action within EDI Lockbox

data exception processing to delete an exception message.

What to do: FYI – you might want to follow up to be sure the

exception removal was justified.

LOCKBOX EEOB DETAIL RE-FILE ATTEMPTED TO IB

When received: When an attempt is made to re-file an EEOB that

could not be stored in IB due to a data exception by using the FILE

EEOB in IB action in EDI Lockbox Data Exception Processing.

What to do: FYI only. No action required.

Unmatched ERAs > 30 days

The listed ERAs were received more than 30 days ago and have not

yet been matched.

What to do: Review the ERAs and expedite processing.

Matched/Not Posted ERAs > 30 days

The listed ERAs were received more than 30 days ago and have been

matched but have not been posted

What to do: Review the ERAs and expedite processing.

EFTs greater than 14 days

The listed EFTs were received more than 14 days ago

What to do: Review the EFTs and expedite processing.

EDI CARC_RARC SERVER OPTION ERROR

When received: Any time an error is found while processing CARC &

RARC data from FSC

What to do: Review the type of errors report and expedite processing

with FSC and local IRM.

November 2018 ePayments User Guide (EDI Lockbox) 163

16. Solving ePayment Problems

16.1. How to Remove Aged EFT’s from the EFT Unmatched Aging Report

IRM can use the following process to change the status of an EFT to “PAPER EOB MATCH”, which will allow the EFT to fall off the aged EFT

report. A complete trace number(s) is needed in order to complete the process.

Due to database integrity issue, IRM may elect not to do this workaround.

VA FileMan Version 22.0

1 Enter or Edit File Entries

2 Print File Entries

3 Search File Entries

5 Inquire to File Entries

8 Data Dictionary Utilities ...

Select VA FileMan Option: ENTER or Edit File Entries

INPUT TO WHAT FILE: (file needed)

EDIT WHICH FIELD: ALL// ??

Choose from:

.01 EFT TRANSACTION

.02 PAYER NAME

.03 PAYER ID

.04 TRACE #

.05 PROVIDER TAX ID SENT

.06 TAX ID CORRECTION

.07 AMOUNT OF PAYMENT

.08 MATCH STATUS

.09 RECEIPT #

.1 ERA RECORD

.11 EFT RECORDED AT SITE

.12 DATE CLAIMS PAID

.13 DATE RECEIVED

.14 TRANSACTION #

.15 ACH TRACE #

2 ERROR MESSAGES (word-processing)

164 ePayments User Guide (EDI Lockbox) November 2018

EDIT WHICH FIELD: ALL// .08 MATCH STATUS

THEN EDIT FIELD:

Select EDI THIRD PARTY EFT DETAIL EFT TRANSACTION: <enter trace number>

MATCH STATUS: UNMATCHED// ?

Enter the status to indicate if the payment has been matched to an ERA.

Choose from:

-1 MATCHED WITH ERRORS

0 UNMATCHED

1 MATCHED

2 PAPER EOB MATCH

MATCH STATUS: MATCHED// 2 PAPER EOB MATCH

Epayments User Manual R1118

Navigation menu

Versions of this User Manual:

Views

Navigation