What dental payment posting covers
- Insurance payments from electronic remittance advice (ERA, the X12 835 file) or scanned paper EOBs.
- Contractual adjustments: the difference between your fee and the plan’s allowed amount under your PPO agreement.
- Denials and zero-pay lines, recorded with the reason so they go to the denial and appeals queue and don’t disappear.
- Patient portions: what remains after insurance, moved to the patient balance only when it is correct.
- Secondary claims, sent once the primary payment is posted, with the primary EOB attached if the secondary payer requires it.
Line-item ERA posting versus lump-sum posting
A single ERA can cover several patients and procedures. Posting by procedure line shows which items were paid, reduced or denied, so fee schedule errors, downgrades and frequency denials become visible. Lump-sum posting hides all of that. Patients often end up with balances they don’t owe, or with no balance when they do owe one.
Daily deposit reconciliation
- Match each EFT deposit on the bank statement to its ERA, and each paper check to its EOB.
- Confirm the total posted in the practice management system equals the deposit.
- List anything unmatched: ERAs without deposits, deposits without ERAs, or takebacks (recoupments) of earlier overpayments.
- Send the list to the office manager for review.
Bank access is sensitive. Many practices give billing support read-only statement access, or send a daily deposit list instead.
Checking insurance payments against PPO fee schedules
If your PPO fee schedules are loaded in the practice management system, the posted allowed amount should match them. Repeated differences can mean the payer is using an outdated schedule or the system has the wrong one loaded. The billing team flags these for the owner, who decides whether to raise it with the payer.
HIPAA and security for payment posting
ERAs and EOBs contain protected health information. Before posting begins, a business associate agreement should be in place, logins should be individual with multi-factor sign-in, and files should stay in your systems instead of being downloaded to personal devices. The HHS sample business associate agreement provisions show what such an agreement usually covers. The about page lists further access practices to ask any billing provider about.
Payment posting questions
Who decides on write-offs that are not contractual?
The practice. Courtesy discounts, small-balance write-offs and collection decisions follow the owner’s policy. A billing team applies the policy and flags exceptions.
What is an ERA?
An electronic remittance advice is the payer’s electronic explanation of a payment, sent as an X12 835 file. It lists what was paid, adjusted or denied on each procedure line.
What is a takeback?
A takeback, or recoupment, is when a payer recovers an earlier overpayment by reducing a later payment. It shows up as an unmatched item in the daily reconciliation and needs to be posted against the original claim.
Tell us how many ERAs and paper EOBs arrive in a typical week.
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