EFT, ERA and EPS: Beyond the Basics, Part 2 - Published August 2010

In July, we shared feedback from providers who expressed interest, but needed more information prior to enrolling for Electronic Funds Transfer (EFT), Electronic Remittance Advice (ERA) and Electronic Payment Summary (EPS). The first Beyond the Basics article focused primarily on enrollment details and prerequisites. The collection of questions included in this month’s article examines how you will receive your payment and remittance information, as well as how EFT, ERA and EPS work better when utilized together.

  1. How often will the electronic checks be deposited?
    Upon enrollment for EFT, you have a choice between daily and weekly payments, or you can remain on your current payment cycle. If no option is selected on the EFT enrollment form, the default is weekly. Once your EFT enrollment is processed, you will receive a letter from our Electronic Commerce Services department with your effective date and related information.
  2. How does ERA work?  
    The ERA is just one of many electronic solutions that can help you streamline the administrative process and bring each claim full circle as quickly and easily as possible. The ERA is a HIPAA-compliant electronic file that contains claims payment reconciliation data. The purpose of the ERA is to support automated posting of payments to your patient accounts. Once you enroll for ERA, you will also receive the EPS—an electronic companion file that replaces your paper PCS. The EPS file contains the same information as the PCS, including individual claim details on each patient, along with the total amount of the payment you are due. The big advantage of the ERA and EPS files is that you receive them the day after claim finalization. This means that, if you are also enrolled for EFT, you will be able to reconcile your patient accounts prior to receiving your payment from Blue Cross and Blue Shield of Texas (BCBSTX).
  3. How do I retrieve the ERA? 
    You must be registered with Availity prior to enrolling for ERA. Once your ERA enrollment process is completed, you or your billing agent will use an assigned Receiver ID to obtain your ERA and EPS information, which is delivered to your electronic mailbox on Availity’s online provider portal. If you currently have a Submitter ID for Electronic Media Claims (EMCs), the same Submitter ID may be used to retrieve the ERA. If your software is ERA-capable, you can transfer an ERA to your computer. Some software also offers the option to print the ERA data for review. If you have designated a billing agent (billing service or clearinghouse) to receive the ERA and EPS on your behalf, it’s a good idea to contact your billing agent directly with any questions about how they will utilize the information and/or pass it along to you.
  4. In what format will I receive the EPS?
    The EPS is delivered by BCBSTX as a text file so that you can receive it in conjunction with your ERA. You can save the EPS as an electronic file for future retrieval; or, you may choose to select and print some or all of the document. The EPS contains all of the same information as your paper PCS. You can even make the electronic document look like the paper PCS by opening the file in Microsoft Word or a similar application, setting the page layout as landscape, and selecting 8-point Courier New for the font. If you use a billing agent or clearinghouse, check with them to make sure they are aware of your formatting preferences.
  5. Do I need to have a person with advanced computer skills to set up and use the ERA? 
    No. You don’t need a technical person on your staff, but you do need to consult your software vendor to ensure that your practice management system can accept and "translate" the electronic data. This is because the ERA, also known as the ANSI 835, is a HIPAA-compliant transaction that must be configured according to specific regulations and guidelines. These regulations and guidelines are available for your vendor to access on the BCBSTX provider website at bcbstx.com/provider. Ask your vendor if there is any additional charge for ERA-compatible or auto-posting software. A partial listing of ERA-compatible software vendors is available on the Availity website at availity.com  (click on Info for Providers, then select View Availity technology company partners).

Ready to move on to the next level?
Watch for our next EFT, ERA and EPS: Beyond the Basics article, which will continue to address recent questions and concerns from providers. Meanwhile, we invite you to visit the BCBSTX Provider website at bcbstx.com/provider for the Electronic Options Tutorial, EFT and ERA enrollment forms, and a schedule of upcoming Webinars and other learning opportunities available to BCBSTX physicians & other professional providers. If you have questions about EFT and ERA enrollment, contact our Electronic Commerce Center at (800) 746-4614.