Logic for auto-posting of ERA payments

As explained in the topic about managing ERA payment options, you can configure how Dentrix Ascend handles the quick posting and automatic posting of insurance payments for claims that pertain to a given ERA. In addition to the minimum threshold of accuracy for those quick-post and auto-post settings, there is other criteria that must be met for a quick-post/auto-post payment to be posted. Also, Dentrix Ascend provides indicators and messages to let you know if manual entry is required.

Criteria for determining if a quick-post/auto-post payment is posted

• If the patient has only one (1) insurance plan:

  • If the quick/automatic posting of ERA payments is active (in the ERA Payment Options dialog box):

    • If the amount paid by insurance on a given ERA is greater than or equal to the specified percentage (in the ERA Payment Options dialog box) of the amount expected from insurance:

      • If the automatic posting of contracted write-offs is active (on the Ledger Options page):

        • The ERA payment and write-off adjustment are posted.

          A green success message appears at the bottom of the page.

          

          A green success icon appears next to the patient's name. If you position your pointer over the green checkmark icon, "Payment successfully posted" appears.

          

      • If the automatic posting of contracted write-offs is inactive (on the Ledger Options page):

        • Manual entry is required. The ERA payment and write-off adjustment are not posted.

          A yellow warning message appears at the top of the page.

          

          A red alert appears at the top of the claim details.

          

          A red alert icon appears next to the patient's name. If you position your pointer over the red alert icon (a red triangle inside a circular arrow), "Matched but did not meet auto posting criteria" appears.

          

    • If the amount paid by insurance on a given ERA is less than the specified percentage (in the ERA Payment Options dialog box) of the amount expected from insurance:

      • If the automatic posting of contracted write-offs is active (on the Ledger Options page):

        • Manual entry is required. The ERA payment and write-off adjustment are not posted.

          A yellow warning message appears at the top of the page.

          

          A red alert appears at the top of the claim details.

          

          A red alert icon appears next to the patient's name. If you position your pointer over the red alert icon (a red triangle inside a circular arrow), "Matched but did not meet auto posting criteria" appears.

          

      • If the automatic posting of contracted write-offs is inactive (on the Ledger Options page):

        • Manual entry is required. The ERA payment and write-off adjustment are not posted.

  • If the quick/automatic posting of ERA payments is inactive (in the ERA Payment Options dialog box):

    • Manual entry is required. The ERA payment and write-off adjustment are not posted.

• If the patient has multiple insurance plans:

  • If the quick/automatic posting of ERA payments is active (in the ERA Payment Options dialog box):

    • If the automatic posting of contracted write-offs is active (on the Ledger Options page):

      • Manual entry is required. The ERA payment and write-off adjustment are not posted.

        A yellow warning message appears at the top of the page.

        

        A red alert appears at the top of the claim details.

        

        A red alert icon appears next to the patient's name. If you position your pointer over the red alert icon (a red triangle inside a circular arrow), "Matched but did not meet auto posting criteria" appears.

        

    • If the automatic posting of contracted write-offs is inactive (on the Ledger Options page):

      • Manual entry is required. The ERA payment and write-off adjustment are not posted.

  • If the quick/automatic posting of ERA payments is inactive (in the ERA Payment Options dialog box):

    • Manual entry is required. The ERA payment and write-off adjustment are not posted.

Note: There is an indicator to help you identify payments that were posted automatically or quickly for claims on ERAs versus payments that were posted manually. (For more information about quickly posting payments, see the topics about quickly posting a payment for a claim on an ERA and quickly posting a payment for all claims on an ERA.) For an automatically or quickly posted payment, an "A" appears in the following areas:

• The entry in a patient's ledger.

  

• The upper-right corner of the Edit Payment dialog box.