Remittance Receipt
Electronic Remittance Advice files arrive through your clearinghouse (Availity, Change Healthcare, Waystar, Office Ally) and scanned EOBs through secure FTP. Every remittance is logged, batched, and queued for verification within one business hour of receipt.
Verification and Validation
Each remittance is validated against the originating claim before posting begins. Patient names, dates of service, NPIs, CPT codes, and payment amounts cross-checked against the claim file. Mismatches flag for specialist review pre-posting.
Cash Posting
Insurance payments and patient payments posted to the correct account against the correct provider NPI within 24 hours of remittance receipt. Line-item posting separates copay, coinsurance, and contractual write-off cleanly per ANSI X12 standards.
Adjustment and Balance Transfer
Contractual write-offs applied per payer agreement. Patient responsibility transferred only after primary and secondary carriers have processed. Credit balances flagged for refund processing. Every adjustment carries documentation for audit.
Denial Posting and Identification
Denied claims posted using ANSI standard denial codes and payer-specific reason codes. Each denial routes automatically to the denial management team within 48 hours, with root-cause classification feeding back into front-end workflows to prevent repeats.
Internal link — denial management and appeals →Underpayment Flagging
Every payer payment compared against your negotiated contract rates. Underpayment variances flagged at posting, not at month-end AR review. Recovery routing handled by certified specialists who appeal underpayments before timely-filing windows close.
Reconciliation and Reporting
Daily batch reconciliation. ACH and lockbox deposits matched against posted payments. Monthly posting accuracy reports, denial trend analysis by payer, and credit balance tracking delivered through your existing reporting layer. Audit-ready documentation per claim.
