Posting is where the practice learns what really happened to every claim. Posting it wrong hides denials, bills patients for amounts they don’t owe, and makes A/R reports useless.
Reading an ERA line
Each service line on an ERA (835) shows:
| Field | Meaning |
|---|---|
| Billed | The practice’s charge |
| Allowed | The contracted rate |
| Paid | What the payer sent |
| CO adjustments | Write-offs the practice can’t bill the patient for (CO-45 contractual, CO-253 sequestration…) |
| PR adjustments | The patient’s share: PR-1 deductible, PR-2 coinsurance, PR-3 copay |
| OA / PI | Other adjustments; read the reason code before posting |
Billed − CO adjustments = Paid + PR amounts. If it doesn’t balance, stop and look again.
Posting rules
- Post ERAs the day they arrive, line by line, against the right claim.
- Post CO amounts as adjustments, PR amounts as patient balance.
- A $0 payment is not “nothing”: it’s a denial or a deductible. Post the reason code so it shows up in reports.
- Reconcile each ERA to the bank deposit (EFT trace number).
- After posting, release patient balances to the coordinator for statements.
Secondary insurance
When the patient has two plans, bill the secondary after the primary pays, with the primary’s EOB/ERA attached. The secondary often covers some or all of the PR amount. Only after the secondary pays does any remainder go to the patient.
Spotting underpayments
Keep the practice’s fee schedule by payer and CPT code. Once a month, compare paid vs. contracted for the top codes. A payer paying $92 when the contract says $118 is money you can recover with a reconsideration citing the contract.
Working the A/R report
Every week, oldest and largest first:
| Age | Action |
|---|---|
| 0–30 days | Clear clearinghouse rejections; most clean claims pay here |
| 31–60 days | Check status on the payer portal; correct and resubmit stuck claims |
| 61–90 days | Call the payer; appeal denials; tell the practice about patterns |
| 90+ days | Last chance before timely filing; document every action |
Write every action in the claim’s notes: date, what you checked, reference number, next step and date. The next person must be able to pick it up without asking you.