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 · 7 min readAll articles
25 articles in this section.
- From Billed Charge to Collected Dollar8 min
- How Payment Posting Works7 min
- Payment Reconciliation: Proving the Cash7 min
- Secondary Billing and Coordination of Benefits6 min
- Patient Responsibility: Deductibles, Copays, and Coinsurance6 min
- Underpayments and Overpayments8 min
- EOB vs. ERA7 min
- How to Read an 83510 min
- ERA and EFT Enrollment10 min
- EFT and ERA Reassociation10 min
- Contractual Adjustment vs. Write-Off15 min
- Refunding a Credit Balance12 min
- Unapplied Cash11 min
- Lockbox Reconciliation10 min
- Posting Patient Payments10 min
- Posting Capitation Payments11 min
- Posting a Payer Interest Payment11 min
- Posting a Payer Offset12 min
- Zero-Balance Review13 min
- Validating Contractual Adjustments11 min
- Auto-Posting Rules12 min
- Payment Posting Errors10 min
- Cash Application Controls12 min
- Patient Refunds and Unclaimed Property11 min
- The Month-End Cash Close10 min
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
- 45 CFR § 162.1602 — Standards for health care EFT and remittance advice (opens in a new tab)
The adopted standards behind both halves of reassociation: the 835 Health Care Claim Payment/Advice, and the EFT the remittance has to be matched to. Reassociation is a problem because the money and the explanation travel as two standardized transactions, and this is the section that makes them two.
- X12 — Claim Adjustment Group Codes (opens in a new tab)
The group-code list that decides what a posted adjustment means: whether an amount is the contract working or the patient's to pay. Posting that ignores the group code posts the right number to the wrong place.
- 42 CFR § 401.305 — Requirements for reporting and returning of overpayments (opens in a new tab)
The overpayment rule the old CMS entry named, including what it means to have identified one — a definition that decides when a credit balance stops being an accounting item and starts being an obligation.
- HFMA MAP Keys — days in A/R and collection definitions (opens in a new tab)
The published definitions computed from posted data, with equations and data sources: net days in accounts receivable (FM-1) and cash collection as a percentage of net patient service revenue (FM-2), alongside the aged A/R measures AR-1 and AR-2.
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