Payment Posting Services

What payment posting in medical billing covers

Medical payment posting is the step where each payer's decision is recorded against the claim: what was paid, what was adjusted, what the patient owes and why. Our payment posting services combine ERA posting services for 835 files with paper EOB entry, keeping that record accurate inside your existing EHR/PM system as part of our wider medical billing services.

Payment posting in medical billing is more than data entry. Every posted line either closes out a charge, moves a balance to someone else, or signals that the claim needs work. When posting is rushed or batched, errors spread into AR reports, patient statements and collection totals.

Patient payments are posted too: co-pays collected at the front desk, payments made against statements and payment plan installments. Each one is applied to the right visit, so a patient who has paid does not receive another statement for the same balance.

At Fastora, posting is part of the back-end phase of our workflow, alongside claim submission, denial management, AR follow-up and patient billing.

ERA posting and 835 remittance files

An electronic remittance advice (ERA) is the HIPAA-standard X12 835 transaction a payer sends to explain a payment. Each 835 remittance lists the claims included in a payment and, for every service line, the billed amount, the allowed amount, the payment, and the adjustments with their reasons.

Adjustments are explained with standard codes:

• Group codes show who is responsible for the adjusted amount, such as CO (contractual obligation), PR (patient responsibility), OA (other adjustment) and PI (payer-initiated reduction).
• Claim Adjustment Reason Codes (CARCs) explain why a service was paid differently from how it was billed.
• Remittance Advice Remark Codes (RARCs) add detail to a CARC, such as missing or invalid information.

Our posters read those codes line by line rather than accepting an automatic batch post without review. For a closer look at common codes, see our guide to CARC and RARC denial codes.

Manual EOB posting for paper remittances

Some payers, smaller plans and secondary carriers still send paper explanations of benefits (EOBs) with a check, or post them only in a portal. EOB posting means entering the same detail an ERA would carry: allowed amount, payment, adjustments and patient responsibility for each line.

Paper remittances need extra care because nothing is loaded for you. We match each check to its EOB, post line by line, and keep an image or reference of the EOB with the claim so the next person working it can see exactly what the payer said.

Auto-posting versus manual posting

Most practice management systems can auto-post an 835 file. Auto-posting is fast for clean, fully paid lines, but it will post whatever the payer sent, including denials as zero payments and short payments as contractual adjustments. We review auto-posted batches for exceptions and post paper EOBs, recoupments and unusual lines manually, so speed does not come at the cost of accuracy.

Payment reconciliation and cash reconciliation

Payment reconciliation confirms that the money you posted is the money you received. Electronic payments usually arrive by EFT separately from the 835, and the two are linked by a trace number, so each deposit can be tied to its remittance.

ERA reconciliation works in three directions:

1. Deposit to remittance. Each EFT or check matches the total of its ERA or EOB.
2. Remittance to posting. Everything on the remittance was posted, including zero-pay and denied lines.
3. Posting to deposit. Posted totals for the period match bank deposits, with any gap explained.

Credit balances and refunds

Duplicate payments, payer overpayments and patient overpayments create credit balances. We identify them during posting and report them to you so refunds or payer offsets can be handled under payer rules and your own policies. Handling credit balance refunds in medical billing promptly matters: Medicare requires providers to report and return identified overpayments, generally within 60 days after identification under 42 CFR 401.305, and commercial contracts and state rules often set their own refund terms.

• Confirm the cause: a true overpayment, or a posting error such as a payment applied to the wrong visit.
• Check for other open balances: your policy may allow a patient credit to be applied to another balance on the same account.
• Decide who is owed: the patient, the primary payer or the secondary payer.
• Document the refund: the amount, the reason and the date, so the ledger and any payer offset match.

Good remittance management also covers ERAs that arrive without a matching payment, payments that arrive without an ERA, recoupments and payer offsets. Each one is tracked until it is resolved, rather than left as an unapplied balance.

Underpayment flags during medical payment posting

Posting is the first moment anyone sees what the payer actually did. That makes it the cheapest place to catch a problem.

• Underpayments. When the allowed amount is below what the payer's fee schedule or contract should pay, the line is flagged for our underpayment recovery team instead of being adjusted off as contractual. A common example is a CO-45 adjustment, which shows the charge exceeded the payer's fee schedule or contracted amount; it is expected, but the allowed amount behind it still needs checking against your contract.
• Denials. Zero-pay lines are recorded with their reason codes and routed to denial management for correction or appeal.
• Unexpected adjustments. Bundling, modifier or multiple procedure reductions are reviewed to see whether they match payer policy.

Posting a denial as a write-off hides it from follow-up. Keeping denial and contractual adjustments separate lets your reports show where revenue is actually being lost.

Patient responsibility transfer and secondary claims

After the primary payer pays, the remaining balance has to go to the right place. Amounts with a PR group code, such as deductible, coinsurance and copay, are the patient's share under the primary plan.

If the patient has secondary coverage, that balance usually goes to the secondary payer first, with the primary payer's payment information included. Only what remains after the secondary pays moves to the patient. Transferring too early produces statements that later need to be corrected or refunded.

Once the balance is final, it moves to patient billing for statements and follow-up. Unresolved insurance balances stay with our AR follow-up team. Payments that fail because a provider is not enrolled with the payer are routed to credentialing and enrollment.

What you receive from our posting team

• Posting inside your existing EHR/PM system, with no software to install and no hidden setup fees.
• Remittance management covering ERAs, paper EOBs, recoupments and payer offsets.
• Period-end reconciliation with any gaps between deposits and postings explained.
• Credit balances listed for your review, with the recommended refund or offset.
• Transparent dashboards, monthly performance reporting and a monthly review call.

Posting is quoted as part of the overall scope of work; see our pricing page for how that works, or start with the free billing assessment.

Posting Errors We Catch Before They Become Write-Offs

Payment posting is the last line of defense for your revenue. Errors here are quiet: the claim was paid, yet the money landed in the wrong place — and nobody notices until the account ages out and gets written off. Reviewing payments against remittances catches these errors while still fixable.

Misapplied payments are the most common: a payment lands on the wrong patient, date of service, or line item, usually from matching by amount instead of claim number. The cleared account still shows a balance.

Missed contractual adjustments are the most expensive. The gap between billed and paid should only be written off if the payer met the contracted rate. Posting the adjustment without checking the allowed amount buries underpayments as write-offs instead of flagging them for appeal.

Unposted ERAs happen when electronic remittances never reach the posting queue — a clearinghouse mapping issue, a rejected file nobody reviewed, or a payer format change. The money is in the bank, but accounts still show open balances, inflating AR and triggering calls on patients who owe nothing.

Duplicate postings occur when the same payment enters twice — ERA plus paper stub, or a corrected remit without reversing the original. The account shows a phantom credit, and refunds go out on money never received.

Our review checks every batch before it closes: correct claim and line, adjustments against contract terms, ERA files fully posted, duplicates flagged by reference. Errors caught at posting take minutes to fix; at write-off, they take an appeal.

ERA Enrollment Assistance

Electronic Remittance Advice (ERA) enrollment connects your practice to each payer’s electronic payment files, so remittances arrive as structured data instead of paper. Enrollment typically involves registering through your clearinghouse or directly with the payer, linking your NPI and tax ID, and confirming the file format your system expects. Practices that receive ERAs post payments faster, with fewer keying errors, and reconcile deposits against claims in a fraction of the time paper remits require. We handle the enrollment paperwork and follow-up so your posting team gets clean electronic files instead of envelopes.