ERA Posting - Applying an 835 (Fusion Enterprise)

  Permissions! Clinic Staff must have Administrator, Billing Manager, Billing Assistant, or Operations Manager Permissions assigned in order to manage 835 Postings.

Fusion Enterprise understands that billing is a critical function of any practice. As such, we have ensured that you can run all of your practices billing through Fusion Enterprise and make it as easy as we can. This series of introductory articles will cover the important aspects of managing 835 Postings with Fusion Enterprise.

Applying an 835

Once the 835 has a payment associated with it, it is time for application. Selecting Post Claims from the right-click menu displays the 835 Claim screen.

The screen is divided into 3 sections. The top section is the 835 Information panel and looks as follows:

This section describes the details of the 835 that is currently being worked.

Claim Fields

Check Amount	The total amount represented in the EOB.
Check/EFT #	Check / EFT # as reported in the 835.
Check/EFT Date	Check / EFT Date as reported in the 835.
Handling Code	Handling code as reported by the carrier in the 835.
Payment Code	Additional information codes reported in the 835 by the carrier.
Receiver ID	ID code reported in the 835 by the carrier. May be required in communicating back with the carrier about the given carrier.
PLB Amount	Policy Level Adjustment reported in the 835.

The second section is the claim list and is found on the left side of the dialog.

This list contains 4 columns and is defined as follows:

Claim List Columns

Status Icon	Displays the current status of the individual claim.
Page No	If the 835 was printed, this number would correspond to the page number where the claim would be found.
Patients Last Name	Last name of the patient identified in the claim.
Amount	Amount of money from the associated payment that will be posted to this claim.

The Status Icon can take on 1 of the following 5 values:

835 Status Icons

	The claim is ready and able to be auto-posted.
	Claim HAS been auto-posted.
	The claim has been manually taken care of and marked as complete.
	The claim is not postable.
	A non postable claim has been acknowledged by the user.
	The claim has been denied by the carrier. These claims can be manually posted; the invoice state will not be affected.

At the bottom of the claim list is the status of the currently selected visit.

Selecting a claim in the list will display the claim information in the claim information panel on the right side of the dialog. As shown below:

This format should look very familiar to you as it reads very much like a standard paper EOB. The header contains the following information:

Claim Header Fields

Claim Status	Status of the claim as reported by the carrier.
Claim ID	Claim ID as assigned by Fusion Enterprise when the claim was sent.
Patient ID	Patient ID as reported back from the carrier. Is equivalent to the Insured ID in the policy.
Payer Control	Control number assigned by the carrier.
Remark Codes	Remark codes returned by the carrier. A key explaining the remarks is found in the code glossary at the bottom of the claim.
XO Carrier	If Medicare does a crossover to secondary, the crossover carrier will be listed here.
XO Carrier ID	If Medicare does a crossover to secondary, the crossover ID will be listed here.
Claim Adjustments	If any claim level adjustments were made then they will be displayed to the right of the claim header in bright orange text (not shown).

Under the header is the actual claim with the following columns:

Claim Columns

Visit	Date of service of the claim.
Units charged, units paid	Claim ID as assigned by Fusion Enterprise when the claim was sent.
Billed Amount	Amount billed in the original claim.
Paid	Amount paid for the line item.
Code	Reason code for the adjustment.
Adjustment Amount	Amount of adjustment.
Contract	The amount specified in Fusion Enterprise contract manager for this particular carrier and charge code.

After selecting a claim, the right-click menu will display the following options:

Claim Header Fields

Post	Auto posts the selected claim.
Manual Post	Displays the EOB Posting dialog and allows you to manually post the claim. This is the same dialog as is used in the regular posting dialog.
Post All	Posts ALL claims in the 835 that are postable.
Mark Complete	Marks the claim as complete. This indicates that you have handled this claim elsewhere and no longer want to deal with it in this dialog.
Set Invoice State	Allows you to change the invoice state for the visit represented in the claim.
Open Case	Opens the case dialog for the case.
Open Transactions	Opens the transactions dialog for the case.
Billing Note	Opens the billing note for the case.
Case Note	Opens the case note for the case.
View Payment	Displays a report showing everywhere the current payment has been posted.
Print EOB	Prints out the current page of the EOB. The entire EOB may be printed from the previous screen.