Payment Posting
US Medical Billing posts every remittance — electronic 835 files and paper EOBs alike — against the right claim and service line, reconciles what was posted to what actually reached the bank, applies contractual adjustments correctly, flags underpayments, and moves each remaining balance to the secondary payer or the patient.
- ERA/835 and manual EOB posting
- Reconciled to every deposit
- Underpayments flagged, not buried
- Balances routed to secondary or patient
What payment posting does
Payment posting is the step where money meets the claim. Every remittance a payer sends — an electronic 835 delivered through the clearinghouse, or a paper explanation of benefits — is recorded against the specific claim and service line it pays, along with the allowed amount, the contractual adjustment, the patient responsibility, and the reason codes that explain each.
Posted carefully, this is where the revenue cycle tells the truth: it shows what a payer actually paid versus what your contract says it owed, surfaces denials and underpayments the moment they arrive, and hands every open balance to the next responsible party. Posted carelessly, it hides denials inside adjustments, writes off revenue that should have been appealed, and lets the books drift away from the bank.
US Medical Billing posts at the line level and reconciles to your deposits, so what your practice management system shows matches what actually landed in the account — and nothing that needs to be worked slips past.
Who it's for
Payment posting matters most where remittance volume is high, contracts are complex, or posting has fallen behind.
Practices buried in paper EOBs
When some payers still remit on paper and no one has time to key them in, posting backs up and denials sit unworked. A dedicated team clears the paper and, where possible, moves you onto electronic remittance.
Multi-payer, multi-contract groups
When you bill many payers under different fee schedules, catching underpayments by eye is impossible. Systematic posting compares each payment to the expected contracted rate.
Practices whose books don't match the bank
When posted payments no longer reconcile to deposits, month-end becomes guesswork. Reconciled posting keeps the ledger tied to the cash actually received.
What's included
Accurate posting is more than data entry — it is reading each remittance correctly and closing the loop back to the bank. These are the core capabilities that make up the service.
Electronic remittance (ERA/835) posting
Auto-post 835 files received through the clearinghouse, with exceptions routed for manual review rather than force-posted.
Manual EOB posting
Key paper explanations of benefits and any payer remittance that does not arrive electronically, at the service-line level.
Deposit reconciliation
Tie posted totals to EFT and check deposits using the remittance trace (TRN) so the ledger matches the bank.
Contractual adjustments
Apply the write-off between billed and allowed per the payer contract, kept distinct from patient responsibility.
Reason code capture (CARC/RARC)
Record the adjustment and remark codes on every line, so denials and reductions stay visible instead of being absorbed.
Underpayment identification
Compare each payment to the expected contracted rate and flag variances for review and recovery.
Patient responsibility posting
Post deductible, coinsurance, and copay amounts so patient statements bill the correct balance.
Secondary and balance routing
Move the remaining balance to the secondary payer or to the patient once the primary has adjudicated.
How posting works
Follow a remittance from arrival to a balanced, reconciled batch. Each stage is where accuracy is protected — or lost.
Remittance intake
Electronic 835 files are pulled from the clearinghouse and paper EOBs are gathered, so every remittance for the period is accounted for before posting begins.
Inputs and outputs
Posting turns raw remittances into a reconciled, worked ledger — these are the concrete artifacts in and out.
What you provide
- 835 electronic remittance files from the clearinghouse
- Paper explanations of benefits and payer remittance advice
- EFT and check deposit records from the bank
- Payer contracts and fee schedules for expected-rate comparison
- The open claims and charges in the practice management system
What you get back
- Payments posted to the correct claim and service line
- Contractual adjustments and patient responsibility recorded separately
- CARC/RARC reason codes captured on each line
- A posting batch reconciled to the deposit
- Denials, underpayments, and balances routed to the next step
Responsibilities and boundaries
Posting owns the accurate recording and reconciliation of what payers send; some steps are shared, and some stay with the practice or its bank.
We handle
- Posting ERA/835 and manual EOB remittances at the line level
- Applying contractual adjustments and recording reason codes
- Reconciling posted totals to deposits and balancing each batch
- Flagging underpayments and routing balances to secondary or patient
Shared
- Working denials surfaced during posting, handled with denial management
- Recovering flagged underpayments, pursued with A/R follow-up
- Confirming contracted rates, using the fee schedules the practice provides
You keep
- Bank deposit control and the practice's accounting system of record
- Negotiating and supplying current payer contracts and fee schedules
- Authorizing refunds for genuine patient or payer overpayments
Common process failures
These are the ways posting goes wrong when it is treated as mechanical data entry — and how each is prevented.
Denials hidden inside adjustments
When a zero-pay or reduced line is posted as a contractual write-off instead of a denial, the revenue disappears silently and is never appealed. Posting reads the CARC group code — a contractual obligation is not the same as a denial — and routes anything workable to denial management.
Books that no longer match the bank
When batches are posted without tying back to the actual deposit, the ledger and the bank drift apart and month-end cannot be trusted. Every batch is reconciled to the EFT or check by trace number before it is closed.
Underpayments accepted as full payment
When a payer pays less than the contracted rate and no one compares the two, the shortfall is quietly absorbed. Payments are checked against the expected fee schedule so variances are flagged for recovery.
Balances stranded after the primary pays
When the remaining balance is never moved to the secondary payer or the patient, it ages without anyone billing for it. Posting routes each open balance to the next responsible party as part of the same step.
Reporting and visibility
You can see what was posted, how it reconciled, and what it surfaced — described plainly, with no fabricated benchmarks.
Posting and reconciliation status
See which batches are posted, balanced, and reconciled to deposits for the period, and which are still open.
Adjustments and denials at a glance
Contractual adjustments, patient responsibility, and denial or underpayment flags are visible by payer and reason code.
Open balances by responsible party
See what has moved to secondary payers versus patients, so nothing sits unrouted.
What to expect
How we approach the work — these describe the service, not guaranteed outcomes.
Line-level, not lump-sum
Payments are posted to individual service lines so denials and reductions are captured where they happen, never buried in a claim-level total.
Reconciled before it's closed
A batch is balanced to the deposit before it is considered done, so the ledger stays tied to actual cash.
Adjustments read, not assumed
Reason codes are interpreted rather than blanket-written-off, so a denial is treated as a denial and a contractual write-off as a write-off.
Every balance goes somewhere
Once a payer adjudicates, the remaining balance is routed to the secondary or the patient as part of posting — not left for later.
Related and connected
Posting sits between the payer's decision and everything that happens next — here is where it connects.
Related services
Calculators & tools
From the Knowledge Base
Frequently asked questions
What's the difference between ERA and EOB posting?
An ERA is an electronic remittance advice — the 835 transaction a payer sends through the clearinghouse — and it can be auto-posted against matching claims, with exceptions pulled for review. An EOB is the explanation of benefits, typically the paper remittance a payer mails, and it has to be posted manually at the service-line level. We handle both, and where a payer still remits on paper we look at moving you to electronic remittance.
How do you handle underpayments?
During posting we compare what a payer paid to what your contracted fee schedule says it should have paid. When the payment is short, the line is flagged as an underpayment rather than accepted as paid in full, and it is routed for review and recovery through A/R follow-up. Catching the variance at posting is what makes recovery possible.
What does reconciliation to deposits mean?
It means the total we post for a remittance is tied back to the money that actually reached your bank — the EFT or check — using the remittance trace number. If the posted total and the deposit do not agree, we investigate before the batch is closed, so your ledger stays matched to the bank instead of drifting.
What happens to the balance after the primary payer pays?
Once the primary has adjudicated, the remaining balance is routed as part of posting: to the secondary payer when there is additional coverage, or to patient responsibility for the deductible, coinsurance, or copay the remittance identifies. Moving the balance immediately is what keeps it from aging unbilled.
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