ERA Posting - Surcharge Adjustments, V. 3.19 and Later

In some cases, ERA files will include transactions associated to Regulatory Surcharges, Assessments, Allowances or Health Related Taxes. These transactions, when identified with the Group Code of CO (Contractual Obligation), PR (Patient Responsibility) or PI (Payor Initiated Reduction) and the Reason Code of 137, can be available for posting using ERP if the check box in the Setup Parameter screen has been checked and the business logic rules have been met.

There are several ways the surcharge may be included in the file.

Claim Level Adjustments
Service Line Adjustments
Combination of Case and Service Line Adjustments

Surcharges can affect the payment amount made on a charge; therefore, there are specific rules included in the ERP logic that will determine if the transactions are available for processing.

Any surcharge transactions that are defaulted to the Advice Preview screen with a processing option of Post will also include the user select option to Reject. Those that do not meet the basic ERP rules will default to Reject and the user will not have the option to post.

Business Rules for Surcharges:

Post Surcharge must be checked on the Setup Posting Parameter screen
Default Journal Codes for Surcharge Debit and Surcharge Debit Correction must be set on the Setup Posting Parameter screen

CO-137 (-) will be posted as debit and debit correction on the patient ledger.
CO-137 (+) will post as a debit correction on the patient ledger.

PI-137 will be posted as a write-off or write-off correction on the patient ledger depending if the associated amount is a debit or credit transaction
PR-137 will be posted as a notation only in the Surcharge field located on the Charge Detail screen
There must always be a debit and credit transaction for a Surcharge with a CO adjustment in the same loop and segment of the ERA file in order for the transaction to be available for posting.
Surcharge transactions that have been set to Post can be modified to Reject by the user.

ERA Transaction Examples
CLP\|Acct\|8000\|1161.96\|250\|HM\|6218R02637\|83\|1 CAS\|CO\|137\|-111.9\|\|137\|111.9	Claim level adjustment with both debit and credit transaction in the same segment and net to zero	Transactions will pull to the Advice-Preview screen with Process set to Post
CLP\|Acct\|8000\|1161.96\|250\|HM\|6218R02637\|83\|1 CAS\|CO\|137\|-111.9\|\|137\|111.9 CAS\|PI\|137\|-21.96	Claim level adjustment that does not net to zero	Transactions will pull to the Advice-Preview screen set to Reject. No option will be available to post as the -21.96 would cause the payment amount to be incorrect.
SVC\|HC^G0121\|8000\|690\|0490\|1 DTM\|472\|20161011 CAS\|CO\|137\|-66.45\|\|137\|66.45\|\|45\|7310 REF\|6R\|001 AMT\|B6	Service line level adjustment with both debit and credit transaction in the same segment	Transactions will pull to the Advice-Preview screen set to Post. User will have the option to set Process to Reject.
SVC\|HC^G0121\|8000\|690\|0490\|1 DTM\|472\|20161011 CAS\|CO\|137\|-66.45\|\|137\|36.45\|\|45\|7310 CAS\|PR\|137\|30.00 REF\|6R\|001 AMT\|B6\|690	Service line level adjustments with both debit and credit transactions in the same segment along with PR 137	Transactions will pull to the Advice-Preview screen set to Post. User will have the option to set Process to Reject.
CLP\|ACCT\|1\|4000\|1090.23\|647.66\|13\|EBFBWK9JP0000\|83\|1 CAS\|CO\|137\|104.99 NM1\|QC\|1\|NAME\|NAME\|M\|\|\|MI\|W226537305 NM1\|82\|2\| ASC CENTER, LLC\|\|\|\|\|XX\|999999999 REF\|1L\|0479252-025-00011-JA REF\|CE\|AETNA NET 00357 DTM\|232\|20161103 DTM\|233\|20161103 DTM\|050\|20161107 PER\|CX\|\|TE\|8886323862 SVC\|HC^45385^33\|4000\|1195.22\|0490\|1 DTM\|472\|20161103 CAS\|CO\|137\|-161.88\|\|45\|2319 CAS\|PR\|1\|436.74\|\|2\|210.92 REF\|6R\|659012AMT\|B6\|1681	Surcharge debit at the claim level with surcharge credit at the service line level	Transactions will pull to the Advice-Preview screen set to Reject. No option will be available to Post as the claim level adjustment will cause the payment amount to be incorrect.