HP Policy and Procedures Missing ERA
The federally mandated CORE requirements for the Phase III CORE EFT & ERA Operating Rule Set specify that a health plan must release for transmission to the healthcare provider the v5010 X12 835 (ERA) corresponding to the Healthcare EFT Standards:
- No sooner than three business days based on the time zone of the health plan prior to the CCD+ Effective Entry Date
- No later than three business days after the CCD+ Effective Entry Date.
The CCD+ Effective Entry Date is a valid banking day. NOTE: Provider must contact its financial institution to arrange for the delivery of the CORE-required minimum CCD+ data elements needed for reassociation of the payment to the ERA.
The following process should be followed by providers for researching and resolving late or missing ERAs. Late or missing is defined as a maximum elapsed time of four business days following the receipt of the EFT payment.
- Provider should first contact the clearinghouse to ensure they have received all 835 transactions.
- If the clearinghouse cannot trace the ERA, the provider should have available their provider ID, the EFT effective date, EFT payment amount, and the CCD+ information on the EFT payment for the missing ERA, then call HP Administrative Services at 1-405-416-1800 or toll-free 1-800-782-5218 to request that HP research it. TDD users call 1-405-416-1525 or toll-free 1-800-941-2160.
- HP Agents will:
- After verifying that the claim has been paid to the correct practice location as billed; take the provider’s name, provider id, contact information, EFT effective date, EFT payment amount, and the CCD+ information and submit a request to research/resolve the missing ERA.
- Mail or fax the paper RA for the missing ERA if requested by the provider.
- Upon receiving the resolution from the technical team, call the provider back with our findings or a status (Target: within 2 business days).