835s (ERAs, or Electronic Remittance Advice)
Overview
835s are an EDI file version of Remittance Advice. It is effectively a state receipt telling you what was paid, what was not paid, and why. Its format is one that Ankota can easily process and apply, so that your AR screen, Accounts Receivable, Collections Report, and Exceptions Report are all updated with your payments and rejection reasons. (Note some states do not use standard rejection reasons and so the Exceptions report may not apply; see your state guide for details.) After receiving and uploading an 835, you can review your exceptions (unpaid claims) on the Exceptions Report, make corrections, and re-submit as needed.
NOTE: for multi-department companies, you will normally want to upload 835s at your parent level.
See below for the sections of this article.
Client Correction Resubmissions
Visit Correction Resubmissions
835 Management Map
Here is an overarching view of the 835 management process:
Uploading an 835 to Ankota
To process an 835, first click on Billing, then click AR Screen.
Next, click on Process Remittance Advice.
Check the box next to Process Merged file, then put in the deposit date next to the 835 file.
Choose the file you want to upload, then click Upload Remittance Advice
NOTE: A PDF remittance advice file is not a format that software can read and process; be sure to get the electronic remittance advice file, or 835, to upload. The 835 file must also end in the extension .remadv. If it is not already in this format, change the extension of the file name to ".remadv" and the type as All Files, then click Save. Without this step the file will not process. Please note that PDF versions of Remittance Advice files will not upload. This portal requires the 835 format.
After you upload the Remittance Advice, you will receive a status message stating that the process has been started. You can check the status at any time, but in general, it's best to wait at least 4 hours to see payments applied and exceptions identified. If you upload a very large 835, you may need to wait for the next day.
Exceptions Review
Depending on your preference, you will review your exceptions in one of several places:
- The Exceptions Report (a list of unpaid visits, with reasons, known as "exceptions," as to why they were unpaid)
- The Collections and Exceptions Report (the same as the exceptions report, but also including successful payments)
- The AR Screen (paid and unpaid, but without reasons)
Once you know why a visit was not paid, you are ready to make the correction in your system and then rebill.
Client Correction Resubmissions
If the problem with the 835 is a client issue (such as a missing or wrong Medicaid ID, client ID, or primary diagnosis code), you can correct the missing or incorrect data in Ankota, then resubmit your claim. The change in the data will be picked up automatically by Ankota, so you do not need to re-build your claims in order for client IDs or primary diagnosis codes to be updated correctly during your export.
Visit Correction Resubmissions
If the problem with the 835 is a visit issue (such as a wrong or missing payer descriptor, visit type, caregiver, date, time, or duration), you will need to cancel the invoice, correct the visit, and then re-invoice and re-bill.
To cancel an invoice, correct, and re-bill,
- Click on Billing, then Billing Report (Client)
- Both the Date From and Date To be should be the date the original invoice or visit was completed. (If there is more than one, you can do a date range also)
- For Search By, select Invoice Date or Visit Date from the drop-down menu, depending on the date you used in Date From and Date To
- You can also search for a specific client
- Click View Report
- Check the box next to the completed invoice you want to re-bill:
- Click Change to Drafts
- Cancel the draft
- Recalculate billing
- Proceed as usual to uploading the Merged Health Care Claim to your appropriate billing portal