Post an ERA file

For: RCM Specialist · Time: 5–15 min per ERA file · Frequency: Daily (multiple ERAs per day for busy agencies)

Trigger

An 835 ERA file arrived from a payer (via clearinghouse pull, SFTP download, or manual download from payer portal). It contains payment data for multiple claims and needs to be posted to Credentik so claim balances reflect reality.

Outcome

Every claim in the ERA has its payment recorded, allowed amount captured, adjustments split (contractual vs non-contractual), denials extracted (with CARC/RARC), and patient responsibility flagged. The check/EFT trace number is on file. Balances are accurate.

Where

• RCM Hub → Payments tab — list of posted ERAs
• RCM → Upload ERA — drag-drop 835 file or click Upload
• RCM → Denials — denials extracted from ERA show up here
• Tools → ERA History — every ERA the platform has imported

Steps

1. Get the file. Where you fetch the 835 depends on the payer and how your agency is enrolled. Most agencies eventually consolidate everything in Availity, but the default for new agencies is per-payer portal downloads. See "Where ERAs come from" below for the source per payer.
2. Validate filename is .835 or .txt and the file is not zero bytes. Some payer portals double-zip; unzip first.
3. Upload. Payments tab → Upload ERA → drop the file. The platform parses it with the Era835Importer service.
4. Preview the import. The import shows: claim count, total paid, total denied, total adjustments, claims it can match (by claim # or patient + DOS) and claims it CAN'T match. Review before confirming.
5. Handle unmatched claims. Unmatched usually means: claim doesn't exist in Credentik yet (the practice billed via a different system), or the claim # in the ERA doesn't match your claim # exactly (payer sometimes reformats). For each unmatched:
   • Click → search by patient name + DOS to find a candidate match.
   • If found, click Match. If not, the ERA row stays unmatched and the payment lands in a holding bucket.
6. Confirm posting. Click Post. The platform writes:
   • claim_payments row per claim line
   • Updates claim.total_paid, claim.balance, claim.status (paid / partial / denied)
   • claim_denials rows per denied/adjusted line, with CARC/RARC + classification category
   • Patient responsibility extracted into patient_balance if the ERA shows it
7. Cross-check the deposit. Total paid in the ERA should equal what hits your client's bank. If it doesn't, investigate — sometimes ERAs include multiple checks, sometimes the check is for multiple ERAs.
8. Review extracted denials. Open Denial Inbox — new denials from this ERA should appear, auto-classified. Work them → playbook.

Where ERAs come from

There's no single "ERA inbox" out of the box — each payer delivers ERA files through their own channel. Until a payer is enrolled with a clearinghouse to relay ERAs (see Enroll ERA delivery), you fetch them manually from the payer's portal.

Once enrolled with Availity for ERA delivery, every payer that supports Availity ERA routing drops files into your Availity Remittance Viewer instead of their own portal. This is the long-term goal — fewer portals, one routine — but enrollment takes 2–6 weeks per payer plus a CMS-588 form for Medicare. See Enroll ERA delivery.

Per-claim EDI ID lookup: When you're searching a payer's portal for a specific claim's remit, the EDI Payer ID shown on each claim detail page (e.g. 00590 (availity) for Florida Blue) is the routing code that maps your claim to the payer's record. Useful when a payer says "we don't have that claim" — quote the EDI ID + your claim # back to them.

Watch-outs

• Recoupments are payments that go BACKWARDS. A negative payment line on an ERA means the payer is clawing back money on a previously-paid claim. The platform handles this — the original claim balance increases, audit log records the recoupment. Do NOT manually "re-deny" the claim.
• Mass-adjustment ERAs (PR-118, CO-45 contractual write-offs across many claims) are normal. Don't panic at a wall of "denials" — most are contractual adjustments per the fee schedule, automatically handled by the importer.
• CARC vs RARC. CARC (Claim Adjustment Reason Code) — WHY the adjustment happened (e.g. "CO-45 Charge exceeds fee schedule"). RARC (Remark Code) — additional context (e.g. "N115 This decision was based on a Local Coverage Determination"). Both are extracted. Use RARC when responding to a denial — it's usually more specific.
• Patient responsibility math. ERA shows allowed_amount minus payer_paid minus adjustment_amount = patient_responsibility. The platform computes this. If it's negative, something's wrong (likely a misread CARC). The importer flags negatives for manual review.
• Don't import the same ERA twice. The platform deduplicates by check/EFT trace number, but a corrupted file with the trace stripped will slip through. Check ERA History before re-importing if you're unsure.
• Holding-bucket payments need follow-up. Unmatched ERA lines = money the payer paid but you can't allocate to a claim. These DO get banked, but until you match them they're "unapplied cash" — bad for reconciliation. Clear the holding bucket weekly.
• Availity Remittance Viewer caps at 31 days. There's no native "download everything" button — the date picker enforces a 31-day window. Three workarounds:
  1. EDI File Management (preferred) — once ERA enrollment is active for a payer, raw 835 files land in Availity's EDI File Management mailbox (a flat list, not paginated by date). This is the real bulk source. Requires payer-level ERA enrollment, see Enroll ERA delivery.
  2. Remittance Inquiry → Export to Excel — Claims & Payments → Remittance Inquiry → leave check number blank → set From/To across multiple months → Search → Export to Excel. Sometimes accepts wider ranges than the Viewer UI for report-level data (claim #, amount, date), though not the raw 835.
  3. Availity API integration (coming soon) — automatic ERA download from Availity is built but not yet verified with a live Availity account. Until then, download the files and upload them here.

Related jobs

• Work the Denial Inbox — what to do with denials extracted from the ERA
• Work A/R aging — what gets cleared by posting payments
• Recover an underpayment — when the ERA shows a payment below fee schedule

Something on this page doesn’t match what you see in the app? Email support@credentik.com and we’ll fix the guide.