Payments & Posting
Understand what a paid claim actually says — the allowed amount, the adjustments, and the patient's share — how it is posted, reconciled, and where the money quietly goes missing.
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What are payments and posting?
When a payer decides, it sends two things by separate routes: the money, and an explanation of what the money was for. Payment posting is recording that explanation against the claims — and almost everything the back office believes afterward comes from what posting wrote.
This section covers the claim after adjudication: how a billed charge resolves into an allowed amount, a write-off, a plan payment and a patient balance; how that decision is posted and why the level of detail matters; how the record is proven against the bank; what happens when a second plan is involved; and the two variances — underpayments and overpayments — that arrive as money and therefore never look like problems.
It picks up where Claims ends. A claim that was refused belongs to Denials & Appeals; this section is about the claims that paid, and about the surprising number of ways a paid claim can still be wrong.
Where to start
A path through a paid claim, from the arithmetic to the things that hide inside it. Each article assumes the one before it.
Understand the arithmetic
How a billed charge becomes an allowed amount, and how that splits into a contractual adjustment, the plan's payment, and the patient's share. Every other article here refers back to this.
Read: From Billed Charge to Collected DollarLearn how posting works
What posting decides downstream, why money arriving is not the same as a payment being posted, and why posting at the line level rather than the lump sum is the difference between data and a number.
Read: How Payment Posting WorksProve the cash
Why reconciliation is a control rather than a second look, and the two exceptions it exists to catch — neither of which produces an alarm.
Read: Payment Reconciliation: Proving the CashBill the next plan
Coordination of benefits, secondary claims, and the point at which posting quality stops being an internal matter.
Read: Secondary Billing and Coordination of BenefitsUnderstand what the patient owes
Deductibles, copays, and coinsurance — decided by the plan, calculated on the allowed amount, and billed by you exactly as assigned.
Read: Patient Responsibility: Deductibles, Copays, and CoinsuranceFind what hides inside a payment
Underpayments and overpayments: two variances that point in opposite directions and share the property that makes both hard — each arrives as money.
Read: Underpayments and Overpayments
Featured articles
Start here if you are new to payments.
From Billed Charge to Collected Dollar
A paid claim is arithmetic: the allowed amount is set by contract, then split between a write-off, the plan's payment, and the patient's share.
Updated · 8 min readHow Payment Posting Works
Posting looks like data entry and decides what everything downstream believes — what a patient is billed, which denials get worked, and what every metric reports.
Updated · 6 min readAll articles
6 articles in this section.
Related services
The service that runs this work for a practice.
Related topics
Where payments sit in the wider revenue cycle.
Claims
What happens before the payer decides — and where the claim this section posts came from.
Denials & Appeals
The claims that did not pay, and the reason codes posting has to read.
Revenue Cycle Management
The end-to-end process this section is the last stage of.
Credentialing
Why a provider's claims may not pay regardless of how well they are posted.
Related tools
Calculate the collection metrics from your own figures.
Key terms to understand
Plain-language definitions, defined once on their glossary pages.
About this section
What does the Payments & Posting section cover?
The claim after the payer decides: how a billed charge resolves into an allowed amount, a contractual adjustment, a plan payment and a patient balance; how that decision is posted and why line-level detail matters; how the record is proven against the bank; what happens when a second plan is involved; and the underpayments and overpayments that arrive as money and never look like problems. Claims that were refused belong to Denials & Appeals.
I'm new to posting — where should I start?
Start with “From Billed Charge to Collected Dollar” and follow the roadmap in order. The arithmetic comes first because every other article refers back to it: once you can see that the allowed amount is the pivot and everything else is that figure being divided up, posting, secondary billing, patient balances, and variances all become the same idea seen from different angles.
Where do I learn to read the codes on a remittance?
In Reading a Denial, under Denials & Appeals — that article is the canonical home for CARCs, RARCs, and the group codes, so this section links to it rather than restating it. The group code matters enormously here, because it is what decides whether an amount is written off or billed to the patient, but it is explained once and in one place.
Does this section explain what we can bill a patient for?
It explains the operational rule — bill what the plan assigned as patient responsibility, and bill it only once the plans that owe anything have paid. It deliberately does not go further. What a patient may be billed when a service is non-covered, when a provider is out of network, or where specific protections apply are legal questions that depend on your contracts, on state law, and on federal rules, and they change. Those belong with your counsel and your agreements, not with a summary on a website.
Authoritative sources
- X12 — EDI standards (opens in a new tab)
Maintains the 835 remittance transaction that carries the payer's decision, and the reassociation identifiers that link it to the payment.
- Centers for Medicare & Medicaid Services (CMS) (opens in a new tab)
Publishes Medicare payment, cost-sharing, coordination-of-benefits, and overpayment rules, and the electronic funds transfer and remittance standards providers follow.
- Healthcare Financial Management Association (HFMA) (opens in a new tab)
Publishes standard definitions for the revenue-cycle metrics computed from posted data, including the collection rates and days in A/R.
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