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PDF Editor FAQ

What does Era payer denial mean?

Forgive me for my verbose answer….When it comes to electronic billing (the actual electronic submission of claims, receiving the confirmation, and the receipt of any electronic EOBs) there are rejections and denials. A rejected claim is rejected by either your electronic scrubber, the clearinghouse electronic scrubber, or by the insurance company at the front end. Often, they are rejected for simple typographical errors (sometimes as simple as a special character or even a misplaced space.) These rejected claims have not even made it into the insurance’s adjudication system, so they can be corrected and resubmitted as appropriate. These rejections come on a electronic report, usually by the next time you submit claims.On the other hand are the denials received on the ERA (electronic remittance advice - the check stub, for an electronic payment, or nonpayment.) Denials in general are claims that have been through the insurance company’s adjudication system, but did not meet all the criteria for payment. The advice codes will tell you specifically why the claim was denied and who is responsible. CO - contractual obligation, PR - patient responsibility…sometimes the denial of payment is generated for a claim that is approved but applied to deductible (PR - 1).To answer your question, the ERA payment denial would be the latter. A denial EOB received electronically.

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