How to post ERA crossover claims ?
ERA crossover claim posting is a process where an Electronic Remittance Advice (ERA) file is used to automatically post payments for a claim that has been processed by multiple payers, typically Medicare first, then a secondary payer (like Medicaid or a commercial insurance).
When a patient has secondary insurance on file, Medicare will automatically “crossover” the claim to the secondary payer. In this step, Medicare transmits the claim details and payment information electronically, eliminating the need for the provider to resubmit the claim manually. For Medicare to send claim details and payment information to the secondary payer, the patient must ensure that their Coordination of Benefits (COB) information is current and accurately updated with Medicare.
 1. At the top left side of the zHealth Dashboard, you will see a small green circle. Click on it. All ERAs received from insurance payers through the clearinghouse are posted on this tab. |
| 2. If you want to search specific ERAs, you need to: a. Enter the Received From date by clicking on the box and selecting the date you want. b. Enter the date to - by default, it will be today's date. You can change it by clicking on the box and selecting the date. c. From the drop-down list, select the insurance company for which you are searching for ERAs. d. Enter the check number if you have received the insurance amount via check. e. Enter the ERA number emailed to you. f. Click "Search" to search a specific ERA based on the received date, insurance company name, or check number or ERA number. |
| 5. You will see a list of ERAs received from an insurance company. To post a specific ERA, click on the Post ERA Payments link. If you just want to view that specific ERA, click View/Download. The file will be downloaded and saved onto your computer. |
| 6. When you click "Post ERA Payments", a detailed page opens that contains insurance payment explanations. Here are the details you will be able to see on the page: a. Patient Name b. Claim Number c. Check Number |
| 7. Next, you will find: a. ERA Amount b. ERA Received Date - This will populate based on the date the ERA was downloaded from the Clearinghouse. This date can be edited before applying the payment. c. ERA Deposit Date - The date you want the funds deposited and to show as "Date Paid" on the invoice and in reports (same as Deposit Date in EOBs). This date can be edited before applying the payment. |
| 8. Under the Claim Status, the following are the details you can read and edit: a. ERA Amount b. ERA Received Date c. ERA Deposit Date d. Date of service and CPT codes used for the treatment given to the patient. You can view it. e. The insurance amount paid for a given CPT code is shown inside brackets. f. Box provided where providers or billers can enter the modified amount for a given CPT code. zHealth gives you the ability to overwrite what the ERA says. g. If you want the patient to pay a certain amount from the billed amount, you can click the ' + ' icon. On clicking the ' + ' icon, you will be able to add a certain amount as the patient responsibility and enter the reason for the same (Enter a few words for the patient responsibility reason and select the right option from the drop-down list). |
| 9. Under the Reason column, the insurance company provides the insurance adjustment reason number. At the end of the billed amount area, you will see the adjustment reason in an asterisk. You will get to know whether your billed amount is accepted, denied, or rejected by the payor here. |
| 10. In case of Medicare, the system will have the "Action Type" selected "Crossover" by default.  Note: Ensure that the "Claim Filing Indicator Code" in the insurance master is set to "MB – Medicare Part B" so the system can display and populate the "crossover" option in the "Action Type" field when posting an EOB/ERA. |
 11. Once the primary ERA is posted as "crossover", the system will display the paid amount but show the adjustment as $0, even though the primary ERA contains adjustment details. Adjustments are applied only when the clinic posts the secondary remittance.  Avoid clicking the "Update" button, as this will force the primary adjustments to be applied. Doing so may result in overpayments or other discrepancies when the secondary remittances are posted. |
Important Notes :
1. Once the clinic receives the ERA/EOB from Medicare as the primary, and the patient has active secondary coverage, apply the payment in zHealth software at the CPT level, where the “Action” will default to "crossover".
When the clinic submits claims to Medicare as the primary insurance, the system automatically forwards them to the secondary, provided the COB is updated, removing the need for providers to manually submit claims to the secondary payer.
2. Once a crossover payment is posted, the system does not generate the secondary Claim ID.
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