View Claim Details (ERAs) in Healthie
Healthie’s integration with Claim.MD allows you to seamlessly view Electronic Remittance Advice (ERA) files directly within the platform — eliminating the need to toggle between systems and enabling faster payment reconciliation.
An ERA provides detailed payment information from insurance payers, including paid amounts, claim adjustments, and remark codes. With Healthie, you can access this information for eligible claims, all in one place. This billing functionality is only available to customers using the ClaimMD integration via Healthie.
How to View an ERA in Healthie
- Navigate to Billing > Claims in your Healthie account.
- Select a claim that has an ERA associated with it.
- Click on “Claim details (ERA)” to view the remittance details.
No setup is required — this feature is automatically enabled for Claim.MD-connected accounts.
Example Claim details (ERA):
Understanding the ERA View
Each line item in the ERA corresponds to a billed service. Here’s what each column means:
| Column | Description |
|---|---|
| Service (CPT Code) | The procedure or service code billed (e.g., 99213). |
| From Date | The date the service began (typically the Date of Service). |
| To Date | The end date of the service (often the same as the start date for single-day visits). |
| Billed | The total amount you submitted for reimbursement. |
| Paid | The total amount the payer has reimbursed for the service. |
| Patient Responsibility | The portion the client owes (e.g., copay, coinsurance, deductible). |
| Contractual Obligation | The amount written off due to payer agreements — typically the difference between the billed rate and the allowed amount under the payer’s contract. This cannot be billed to the patient. |
| Other Adjustments | Any additional changes to the claim amount not covered in the other columns. May include interest payments, secondary payer adjustments, or provider-specific policy adjustments. |
| Payer-Initiated Reductions | Reductions made by the payer outside of contractual agreements — for example, reductions due to coding errors, late filing, or bundling policies. These may require follow-up or appeal. |
Understanding CARCs and Remark Codes
Healthie displays both Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) directly within your claim details, giving you clear insight into how and why a claim was processed the way it was.
- CARCs explain why a claim or service line was adjusted or denied. For example,
CO-45indicates the charge exceeds the contracted fee schedule. - RARCs (also known as Remark Codes) provide additional context or guidance — for example,
N435may indicate missing documentation, orMA15might clarify coordination of benefits details.
Together, these codes tell the complete story behind each adjustment. By surfacing both CARCs and RARCs inline with each claim, Healthie helps you:
- Understand payment decisions without leaving the platform
- Streamline denial management and appeals
- Reduce manual back-and-forth with payers
You can reference the full list of CARC codes here and RARC codes here.
Questions about specific claim details or codes? Please contact the payer directly, as they can provide the most accurate insight into how the claim was processed.