Remit Balancing Checker
Check one claim from a remittance against the identity every posted claim must satisfy: the total charge equals the payment plus every adjustment. Get the exact delta when it doesn't, before the claim is posted.
The claim as posted
Take the three CLP figures and every CAS adjustment from one claim on the remittance.
What you billed for the whole claim.
What the plan actually paid on this claim.
The summary figure. It should equal the PR adjustments below — the tool checks that separately.
Everything is computed in this browser tab. Nothing you type is sent, stored, saved to this page’s address, or logged.
Enter the claim’s figures to check whether it balances.
No remittance to hand? Load the sample claim.
The rule this checks
Every claim on an electronic remittance advice must account for the whole charge. The total charge (CLP03) equals the plan payment (CLP04) plus every adjustment reported in the CAS segments. If the two sides differ, something on the claim was not reported — and posting it anyway leaves a balance in A/R with nothing explaining it.
Patient responsibility is not a third term. CLP05 summarises the adjustments whose group code is PR — it does not sit alongside them. Adding it to the payment and the adjustments double-counts the patient’s share and reports an imbalance on a claim that is fine. The tool checks CLP05 a different way: against the PR adjustments it is supposed to summarise, reported separately because a claim can balance perfectly and still be about to bill the patient the wrong amount.
Amounts are compared as whole cents rather than decimals. In binary floating point 0.1 + 0.2 is not 0.3, and a checker built on decimals reports phantom one-cent imbalances on claims that balance.
When it does not balance
Route the claim to an exception queue rather than posting it. The usual causes are a CAS row that was not captured, an adjustment posted against the wrong claim in a batch, or a reversal applied twice. Working the exception before posting is the difference between a five-minute correction and a reconciliation problem found weeks later — payment reconciliation covers proving the cash once the claims are posted.
A claim that balances is not necessarily a claim that paid correctly. It only means the remittance accounts for the whole charge. Whether the payment itself was right is a different question — underpayments and overpayments covers that, and if the adjustment is a denial rather than a discount, the denial code decoder takes the CARC and gives you the next step.
Reading the whole remittance rather than one claim? How payment posting works sets out the ordered process this check belongs to.
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