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Need help understanding ERA codes?

06/05/2019

Have questions about an electronic remittance advice (ERA) code? Check this web page from the Centers for Medicare & Medicaid Services (CMS).

ERA codes, in general, explain the payment and adjustments made to any Medicare claims payment. They can also help providers identify if they need to take any additional steps related to a claim, such as resubmitting it with correct information, or whether the member can be billed.

Medicare providers should only bill Medicare members if the claims adjustment code lists “PR,” which stands for patient responsibility or the patient is financially liable. Medicare members should not be billed under the OA (other adjustment – no financial liability) or CO (contractual obligation – provider is financially liable) reason codes.

Check out our provider manual for more details on billing Medicare members.