Free checklist
ERA Review Checklist: Efficiently Managing Your ERAs
Effectively reviewing Electronic Remittance Advice (ERAs) is a critical step in behavioral health revenue cycle management. This checklist provides operational guidance to help New Mexico providers systematically review ERAs, identify discrepancies, and manage claim follow-up efficiently. It is designed to support your billing workflows, not to replace specific payer policies or serve as legal or clinical advice. Always refer to current payer manuals and your billing system for exact requirements and processes.
Who it's for: New Mexico behavioral health providers and billing staff managing claim submissions and reimbursements, especially those working with New Mexico Medicaid and managed care organizations (MCOs).
Initial ERA Receipt & Processing
- Confirm ERA receipt matches expected claims submission dates.
- Verify ERA is for the correct provider and NPI.
- Ensure the service dates and patient names on the ERA align with your records.
- Check that the total payment amount matches the expected deposit.
- Electronically post payments to client accounts in your billing system.
- Identify any claims that were paid, denied, or partially paid.
Reviewing Paid Claims
- Confirm the billed CPT/HCPCS codes match the paid codes.
- Verify the paid amount aligns with anticipated reimbursement based on contracts/fee schedules.
- Note any adjustments, deductibles, or co-insurance applied.
- Ensure modifiers used were processed as expected.
- Cross-reference paid claims with your claim submission records.
Addressing Denied/Partially Paid Claims
- Identify each denied or partially paid line item.
- Carefully read denial reason codes and explanations.
- Determine if a denial requires re-submission with corrected information.
- Evaluate if an appeal is necessary for specific denial reasons.
- Prioritize denials based on reason and potential for recovery.
- Note specific MCO policies related to the denial reason.
Follow-Up & Documentation
- Document all actions taken for denied or underpaid claims.
- Create a task or flag in your billing system for claims requiring follow-up.
- Set timelines for re-submissions and appeals according to payer guidelines.
- Maintain organized records of ERA, denial details, and actions.
- Regularly review your aging accounts receivable for unresolved claims.
Practical tips
- Regularly reconcile your bank deposits with posted ERA payments to catch discrepancies early.
- Utilize your billing system's reporting features to track denial trends and identify common issues.
- Familiarize yourself with common MCO denial codes and their specific resolution steps for efficiency.
Sources and verification
- New Mexico HCA — Turquoise Care
- New Mexico Behavioral Health Policy and Billing Manual — Introduction, version dated 4.1.25
- New Mexico Behavioral Health Service Standards — June 1, 2025
- New Mexico HCA — Fee Schedules
- New Mexico Medicaid Behavioral Health Policy and Billing Manual — Refer to the current version for specific behavioral health billing and reimbursement guidelines.
- Applicable MCO Provider Manuals — Consult specific manuals for Molina, Presbyterian, UnitedHealthcare, and other MCOs for their unique ERA formats and denial management protocols.
- Your Billing System's Documentation — Leverage your specific billing software (e.g., TherapyNotes, EMR Bear) for guidance on electronic payment posting and claims management features.
Requirements, manuals, and payer policies may change; confirm the current version before relying on any source. Listed sources do not endorse New Mexico Billing.
Information on this website is educational and operational in nature. New Mexico rules, Medicaid manuals, payer policies, authorization requirements, and ASAM guidance may change. This website is not legal, clinical, coding, compliance, or payer-contracting advice.
Last reviewed: September 2026
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