Prerequisites
- ERA enrollment complete and pointing at your current clearinghouse
- Auto-posting configured in the PM system
- Access to the bank account the EFTs land in
- Your fee schedules loaded, so underpayments are flagged
Steps
1
Configure auto-posting properly
Most systems auto-post clean lines. Configure:
- Adjustment mapping, each CARC and group code combination maps to the right adjustment type
- Write-off rules, CO adjustments write off; PR adjustments move to the patient ledger
- Denial routing, $0-paid lines with denial CARCs route to the denial queue, not to a write-off
- Underpayment flagging, allowed amount below the contracted rate flags for review
- Exception thresholds, what a human must see
2
Post daily, not weekly
Same-day posting keeps the patient ledger current, surfaces denials while the appeal window is long, and makes reconciliation a small daily task rather than a month-end reconstruction.
3
Work the exception queue
What lands there and what to do:
4
Balance every remittance to its deposit
Sum of claim payments, plus or minus PLB, equals the EFT amount.One 835 is not one bank deposit. Deposits aggregate remittances; remittances split across deposits; PLB shifts totals. Match using the TRN reassociation trace number, not by hunting for matching dollar amounts. Amount-matching works until two payers send similar amounts on the same day, then it produces silently wrong postings.
5
Route patient balances into the statement cycle
PR amounts move to the patient ledger. Statements go out within days of adjudication, not at month-end. See Run patient statements and balances.
6
Queue denials, don't write them off
Every $0-paid line with a denial CARC goes to the denial queue with a root-cause tag. See Work the denial queue.
Paper EOBs
Every paper explanation of benefits is manual posting, and manual posting is where group-code errors happen. Treat each paper-paying payer as an action item: complete their ERA enrollment. The labor saving is real and the error reduction is larger.Virtual credit cards
Payers that send single-use card numbers instead of EFT cost you 2–3% of the payment in processing fees.- Key them promptly — VCCs expire
- Record the payment gross, with the processing fee as a separate expense, not netted
- Convert the payer to EFT. Complete their EFT enrollment and ask in writing to opt out of the card program. See Paper checks and virtual credit cards.
Multi-entity posting
In a multi-PC group:- Each PC’s 835s post to that PC’s ledger
- Each PC’s EFTs land in that PC’s account
- Reconciliation is per entity
Verify it worked
- Group code mapping tested with a real 835
- Denial routing sends $0 lines to the queue, not to write-off
- Underpayment flagging active against loaded fee schedules
- Posting happens daily
- Exception queue worked daily
- Every remittance balanced to its deposit via TRN
- PLB handled explicitly
- Patient balances routed to statements within days
- Paper EOB payers being converted to ERA
- VCC payers being converted to EFT
- Reconciliation performed per entity