Posting Best Practices
This should always be verified to ensure the payment is applied to the correct patient.
What is the patient's name and account number?
This document explains how a claim was processed and paid.
What is an Explanation of Benefits?
This is the term for the amount not paid by insurance and not billable to the patient
What is a contractual adjustment?
This is the amount a patient must pay before insurance begins to pay.
What is a deductible?
This type of insurance is provided by the federal government for individuals aged 65 and older.
What is Medicare?
Payments should be posted within this number of days of receipt.
What is 1–2 business days?
This electronic version of an EOB is sent by payers.
What is an ERA/835?
This code indicates a claim was denied due to missing information.
What is CO-16?
This is the fixed amount a patient pays for a service.
What is a copay?
This insurance is jointly funded by state and federal governments for low-income individuals.
What is Medicaid?
Before posting, this should be matched to confirm the payment is for the correct service.
What is the date of service?
This code on an EOB indicates why a payment was reduced or denied.
What is a remark code?
This code means the claim was denied because the patient was not eligible on the date of service.
What is CO/PR-27?
This is the percentage of costs a patient pays after the deductible is met.
What is coinsurance?
This type of insurance is purchased by individuals or provided by employers.
What is commercial insurance?
This should be done when a payment is posted incorrectly.
What is a payment correction or reversal?
This is the payer’s internal reference number for the claim.
What is the claim control number?
This denial reason indicates that the claim was submitted after the payer’s timely filing limit.
What is CO-29?
This document is sent to the patient to explain what insurance paid and what they owe.
What is a patient statement?
This is the part of Medicare that covers hospital services.
What is Medicare Part A?
This step ensures that payments are not duplicated or missed.
What is reconciliation?
This is the standard format used for transmitting ERAs electronically.
What is the ANSI 835 format?
This is the term for the difference between billed and allowed amounts.
What is an adjustment?
This is the term for the portion of the bill that is not covered by insurance and must be paid by the patient.
What is out-of-pocket cost?
This is the process of determining which insurance is primary when a patient has multiple plans.
What is coordination of benefits (COB)?