Posting Payment When an EOB/ERA is Split (not all CPTs on one claim)

Posting Payment When an EOB/ERA is Split (not all CPTs on one claim)

zHealth has been designed to post payments for a full ERA (not some CPTs on one ERA and others on another). zHealth is looking to accommodate for this workflow in the future. Sometimes, insurance companies split the claim into 2, 3, or more ERAs depending on the CPTs billed. If your clinic is not able to post multiple ERAs for one claim and have the payments calculate correctly OR if your clinic is unable to send a partially paid primary claim to the secondary because the claim has missing CPT codes and the secondary is expecting all the CPTs on the primary claim, then we recommend you to follow the below workflow.

 

Here is the recommended workflow and options available when not all CPTs are on one claim:

  1. Post the split ERAs as one EOB. When a partial ERA comes back, take the action of "close W/O apply" for the ERAs that contain the separated CPT payments. Then, post all the ERA payments as one EOB. This will allow you to post all payments to a claim (the invoice will calculate correctly and if applicable the secondary insurance will get all the detailed information they need).

 

  1. Only apply the ERAs that contain covered CPTs (payments or patient responsibility). Certain codes that are not covered or don't expect to be paid can be added directly as a write-off on the invoice (97140 for example). There may be no need to send those to the secondary insurance or calculate correctly based on multiple ERA postings. If this is the case, you could "close W/O apply" for 97140 and just add that directly to the invoice as a full write-off and post the other ERA that comes back with other paid CPTs.*

 

*Please note, Medicare will crossover the claim to the secondary regardless of sending back multiple ERAs. They may or may not crossover the CPT that was not covered.

 

ERAs were not split as often as we see it today so we are working to make this easier in the future. Please reach out to your Customer Success Specialist or call 800-459-0302 should you have questions. 



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