Trusted by 1000+ providers
MedCare MSO’s medical payment posting services team processes ANSI 835 ERA files and paper EOBs with 99.2% field accuracy. Our specialized team will post all elements at the CPT line level, maintain all the CARC/RARC codes exactly as received from the insurer, and flag every item that varies from a contract before an item gets written off. We reconcile deposits daily so your accounts receivable reflects reality, not simply estimates.
They stack up quietly and go unnoticed as a result of false A/R Aging, undetected underpayments, and missing the opportunity to appeal denied claims on time, resulting in your revenue reports not matching up with factual data.
Unprocessed electronic remittances mean that your staff continues to chase after paid claims, and that you risk missing the opportunity to subsequently bill the corresponding denials. Every downstream decision is made based on inaccurate data.
Transposing a single digit during manual entry creates a false credit balance, an incorrect patient statement, and obscures an underpayment pattern that the CFO has never quantified.
Payers routinely underpay, yet without doing variance detection during posting, those underpayments become permanent write-offs and cannot be seen by anyone with the ability to appeal.
Reduction in AR
Collection Ratio
Revenue Increase
First Pass Clean Claims Rate
Turnaround
Our payment posting services in medical billing cover every remittance type, including electronic ANSI 835 files to paper EOBs. Each service type posts with line-level precision, preserved denial codes, and full audit documentation.
We offer the processing of ANSI835 ERA files, providing full segment parse capability, including BPR (financial), CLP (claim), SVC (service), and CAS (adjustment) segments. Therefore, all lines posted with CARC/RARC codes intact to facilitate accurate tracking of claims denials and produce meaningful analytics in the future.
ERA totals are reconciled against BAI/NACHA bank deposit files before posting begins. Each batch will balance down to the penny.
Our medical payment posting specialists handle paper and scanned Explanation of Benefits documents with accuracy applied to electronic ERA files. We read thoroughly into the remarks, calculate the appropriate amounts that can be billed to you, post the contractual adjustments to the patient’s account balance based on your EOBs and then post the difference between the allowed amount and your balance as patient responsibility.
Paper EOBs are digitized, extracted, and posted within 24 hours.
We post zero-payment EOBs with complete denial capture. We maintain visibility to each denial code as you need to use it to take action on a denial management team level, without collapsing it into generic write-off categories to hide the root cause.
Denial trend reporting from clean posting data enables upstream corrections through the AI Rule Engine, therefore, reducing the same denial reason recurring across future claims.
Payments from all channels (the portal, via the phone, etc.) are processed for patients on a daily basis. Copays, deductibles, coinsurance, and self-pay balances are adequately posted to their corresponding service lines with clear audit trails, and patients should receive accurate statements for all of these payment types.
By accurately posting payments from patients, the likelihood of billing disputes is reduced. Patients collect money more quickly, and statements to the patients will accurately communicate their actual balances, with balances for copays, deductibles, and coinsurance.
Understanding what payment posting in medical billing is requires knowing the full workflow. This includes remittance receipt and account reconciliation. Every dollar gets accounted for within our 6-step process, and any denied payments and their follow-ups.
Three-way match: ERA total = bank deposit = posted amount + exceptions
Code fidelity: Original CARC/RARC preserved for denial analytics
Exception discipline: Categorized by denial type, not just date received
We receive secure ERAs from a clearing house (via SFTP, VPN, API), and EOBs via an encrypted portal, along with the batch of ERAs that are verified against bank deposits (BAI/NACHA) before these are posted. The ERA total should match the total deposits.
Our system parses all ANSI 835 files by segment, such as ISA/GS envelope, BPR (financial), TRN (trace number), CLP (claim payment), SVC (service), CAS (adjustment), and PLB (provider balance), with exception flags being reviewed by a specialist.
All line items are posted at the CPT/HCPCS level, with the original CARC codes (CO-45, CO-97, CO-16, CO-22, PR-1, PR-2, PR-3, OA-23) and all RARC comments preserved. CPTs and HCPCS have been posted to three separate buckets; i.e., contractual adjustments, patient responsibility, and payer payments.
All contract-typical contractual obligations (COs) are written off as a non-billable adjustment. All patient responsibilities are reflected as A/R, and all other adjustments (OAs, PIs, CRs) are categorized accordingly in accordance with the G/L mapping provided by you.
If a primary remittance has any indication of a secondary insurance coverage, we keep patient responsibility, create a secondary claim with attached EOB, and send it for crossover processing. Patient responsibility will not be finalized until all insurance carriers have responded.
All batches will match to the penny: (ERA total = total of amounts posted + total of cash not posted/retained + total of exceptions). When a deposit doesn’t match, automated research is initiated. Exceptions are categorized by CARC type and financial risk for prioritized resolution.
As a medical payment posting service provider, we ensure you see a difference with our services. With our services. You can expect faster collections, cleaner A/R, and fewer denied claim write-offs.
By processing same day ERA's and reconciling every day, you'll reduce the number of days in Accounts Receivable by up to 35%. As soon as you post the remittances, payments will show as posted and make your accounts receivable up to date.
All denials post with the original CARC Codes, such as co-97 (bundled), co-16 (missing info), co-22 (other payer), co-50 (medical necessity), and the PR series (responsible for the Patient). This provides your denial management team with clean data for appeals.
With each posting, you will receive the original ERA / EOBS images, trace numbers (EFT's/checks), and CARC/RARC codes as well as timestamps and notes from the specialists. This provides you with complete documentation for payer audits and compliance reviews.
Our analysts identify when allowed amounts fall below contracted fee schedules, when multiple procedure reductions exceed agreement terms, and when bundling edits are applied incorrectly. Underpayments are flagged for reprocessing.
We ensure operations never get delayed due to volumetric spikes, employee turnover, or vacation coverage by managing any lost productivity and maintaining an ongoing business as usual workload; thus, ensuring that your entire revenue cycle remains productive.
Accurate posting and patient statements reflect the actual balance due after deductibles, coinsurance, copays, and non-covered services are itemized separately. By providing accurate statements, the number of denied claims falls considerably.
Late or inaccurate posting creates blind spots that your billing team makes revenue decisions from every day. A 30-minute walkthrough shows you exactly where the gaps are.
Our medical payment posting software stack processes ANSI 835 files with automated segment parsing, validation rules, and exception handling - supported by specialist review for complex scenarios and exception resolution.
This allows the practices to have segment-level parsing of BPR, CLP, SVC, CAS, and PLB segments with 99.7% field accuracy. If a segment has been parsed incorrectly, it will be flagged shortly after being received, enabling easy manual review.
The reconciliation of all deposits can be automated, with BAI/NACHA files being reconciled to the total of all ERAs. If there are any discrepancies, this would trigger an exception workflow for a same-day resolution.
All unmatched payments, split claims, or complex COB rules will be routed through the Al rule engine for pattern recognition-based resolution before being escalated to a specialist.
Upon reconciliation of a batch, real-time updates to BI Reporting dashboards are reflected in terms of payer performance, collection and denial trends, and outstanding A/R.
MedCare MSO operates as a medical payment posting service provider across every practice model. With a turnaround of just 24 hours' time for each payment posting by MedCare MSO as per contract terms (i.e., all remits to be processed) no matter what volume you submit each month, you can rely on their services across the following practice types:
Remove your billing staff's daily burden in processing the ERA's. MedCare MSO processes all remits within the same business. Patients’ account balances always reflect accurate information without adding any additional stress on your staff.
Process multiple payers on a high-volume basis and get daily reconciliation of both electronic remittances and exceptions. MedCare MSO enables the ability to have both professional fee and facility fee billing for a practice in one processing workflow.
Use AI-powered throughput to scale your medical billing payment posting process across multiple client accounts, allowing you to have a verified 99.2% accuracy rate for completed posts and receive posting confirmations within a day of posting.
Are you transitioning your bills from manual, in-house posting to an MC-run managed service? MedCare MSO’s workforce services provide structured support for the process with no interruptions of your daily A/R operations during the transition (handoff).
Payment posting in medical billing is how you record payments, adjustments, and denials from both the insurance company and the patient into the provider’s practice management system. This process is crucial to establishing the provider’s financial record for the entire revenue cycle.
All Original values should be maintained on every CARC code at the time of processing – CARC codes should not be grouped together. The key codes to keep intact when posting include CO-45 (contractual obligation), CO-97 (bundled service), CO-16 (insufficient information), CO-22 (Other or Other Payers), CO-50 (not medically necessary), PR-1, PR-2, PR-3, OA-23. You will also keep RARC codes so your appeals team has additional information to assist them with the appeal process.
ERA payment posting refers to the automation of processing ANSI 835 Electronic Remittance Advice (835) files that insurance companies provide. An 835 file contains the following types of structured data segments – BPR (financial), CLP (claim), SVC (CPT-level service), & CAS (adjustment-related).
Contractual adjustments (CO group codes) represent the difference between the billed amount and the payer contracted rate — these are non-billable and post as contractual obligations based on your payer agreements. Write-offs are the amounts determined to be uncollectible after all means of collection have been exhausted. (Contractual Adjustments) The two different types of adjustments are going to post to two different buckets.
Yes. MedCare MSO connects to Epic, Cerner, Athenahealth, eClinicalWorks, NextGen, Allscripts, Kareo, and 50 additional platforms using HL7, RESTful API, or SFTP. Options for connection include secure clearinghouse SFTP (with encryption), VPN tunnels, API authentication, and encrypted portal upload. Our healthcare integration services take care of all of your technical setups so that your existing platform can start receiving correctly posted payments without the need for a replacement or large changes to your existing system.
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