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Quick Answer

What Is Payment Posting?

Payment posting is the revenue cycle step where insurance payments (from 835 ERA or paper EOBs) and patient payments are applied to specific claim lines and patient accounts in the practice management system, including contractual adjustments and denial transfers.

  • Post within 1-2 business days of receipt to keep A/R aging accurate and enable timely secondary billing.
  • Reconcile every 835's BPR amount to the EFT deposit; track exception items (unmatched 835s, virtual credit card payments with surcharges, takebacks) as a separate workflow.
Billing Cycle

Payment Posting

Also known as: Cash Posting; Remit Posting

Payment posting is the revenue cycle step where insurance payments (from 835 ERA or paper EOBs) and patient payments are applied to specific claim lines and patient accounts in the practice management system, including contractual adjustments and denial transfers.

Definition

Posting reconciles received payments against billed charges, applying CARC contractual adjustments, transferring patient responsibility (deductible, coinsurance, copay) to patient accounts, and routing denials and partial payments into denial work queues. Auto-posting from 835 files handles 80-95% of insurance payments; the remainder requires manual review (paper EOBs, virtual credit cards from VCC payments, takebacks/recoupments via PLB segments). Patient payments arrive via card terminals, online portals, mailed checks, or lockbox services and require matching to the correct account and date of service.

Example

An 835 ERA from Cigna posts $98 to a CPT 99213 claim line: $35 contractual adjustment (CARC 45), $30 deductible transfer to patient (CARC 1), $98 plan paid, $30 patient balance created. A subsequent member portal payment of $30 from the patient applies to that balance and zeroes out the line.

Common Misconceptions

Posting is not just data entry — incorrect posting (wrong adjustment codes, missed PLB recoupments, misapplied patient payments) creates phantom A/R, secondary-billing failures, and refund liabilities. Posting must reconcile to the bank deposit at the file/batch level.

Practical Application

Post within 1-2 business days of receipt to keep A/R aging accurate and enable timely secondary billing. Reconcile every 835's BPR amount to the EFT deposit; track exception items (unmatched 835s, virtual credit card payments with surcharges, takebacks) as a separate workflow.

Related Terms

ERA (Electronic Remittance Advice / 835)

The ERA (X12 835 transaction) is the HIPAA-standard electronic file payers send to providers detailing claim adjudication results — payments, adjustments, denials with CARC/RARC codes — typically paired with EFT funds transfer.

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EOB (Explanation of Benefits)

An Explanation of Benefits is a payer-issued document sent to the member (and sometimes the provider) after claim adjudication that itemizes the services billed, allowed amount, plan payment, deductible/coinsurance/copay applied, and patient responsibility.

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CARC

A Claim Adjustment Reason Code is a standardized code maintained by the X12 External Code List committee that explains why a claim line was adjusted (paid less than billed, denied, or transferred to patient responsibility) on a payer's 835 ERA.

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RARC

A Remittance Advice Remark Code is a supplemental code used on the 835 ERA to provide additional information about an adjustment, often clarifying or specifying the reason behind a CARC; RARCs are maintained by CMS and the Remittance Advice Code Committee.

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Adjudication

Adjudication is the payer-side process of reviewing and determining how a claim will be paid: applying eligibility, benefits, coverage rules, contracted rates, and edits to determine the allowed amount, paid amount, patient responsibility, and any denials or adjustments.

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