Match each insurance deposit to the payment behind it.

Why deposits and claims do not line up

Your bank shows a single deposit from a payer. Your billing software shows a dozen claims paid on four different days. Neither number is wrong. Insurance payments are built in a way that makes them hard to match by eye:

• One deposit, many claims. A payer pays every claim it finished in a cycle as one electronic funds transfer (EFT), across patients and dates of service.
• Two channels. The money travels through the banking system. The explanation, the electronic remittance advice (ERA), travels through your clearinghouse. They arrive on different days.
• Adjustments that belong to no claim. A payer can take back an overpayment from months ago, or add interest, out of today’s payment. The deposit then differs from the claims you posted.

The way through is to stop matching deposits to claims. Match each deposit to one ERA, then post the claims from that ERA.

The trace number ties them together

A healthcare EFT and its ERA carry the same reassociation trace number. On the ERA it sits in the TRN segment, near the top of the file; the guide to reading an ERA shows where. On the EFT it travels in the addenda record of the bank transfer, a CCD+ entry whose company entry description is HCCLAIMPMT.

Here is the catch for a small practice: many banks do not show the addenda record on the online statement by default. You see “HCCLAIMPMT” and an amount, but not the trace number. Call your bank and ask for the CCD+ addenda information on your healthcare deposits, by online report, file or statement. It is the single most useful request a practice can make of its bank for insurance billing.

Under the CAQH CORE reassociation rule, a health plan releases the ERA no sooner than three business days before the EFT’s effective date and no later than three business days after it. A deposit with no ERA after that window, or an ERA with no deposit, is worth a question.

The match, step by step

1. Trace number. Find the ERA whose TRN trace number matches the deposit’s.
2. Amount. Check that the ERA’s total payment equals the deposit to the cent.
3. Claims. Post every claim in that ERA, with its adjustments.
4. Provider-level adjustments. Post every recovery, interest amount or forward balance in the ERA against the claim it names.
5. Close it. Mark the deposit matched only when steps one through four agree.

Without the trace number, matching falls back to amount and date, which works until two payments from the same payer share an amount, or one payment covers two locations.

Why a deposit comes in short

When the deposit is smaller than the claims you expected, the ERA nearly always explains it. Look for three things:

• A recovery. A provider-level adjustment for an overpayment takes money back from an earlier claim. Find that claim and post the recovery against it. If the original claim was paid correctly, the recovery is a question for the payer.
• A reversal. A claim with status 22 reverses an earlier payment, usually beside a new entry for the same claim with the corrected amount. Post both, or the visit looks paid twice.
• A forward balance. An amount carried from another payment. It should net to zero across the payments involved.

A recovery posted as nothing, with the deposit simply recorded as received, leaves the earlier visit overstated as paid and the payer’s claim on your money unexamined.

When one side is missing

A deposit with no ERA. Check that you are enrolled for ERAs with that payer and that they route to your clearinghouse, not to a former biller. Ask the payer for the remittance by trace number and payment date. Do not post claims from the payer’s portal until the remittance is in hand.

An ERA with no deposit. Check the payment method on the ERA. NON means no money moved, usually because every claim was denied or the payment was fully offset. CHK means a paper check is in the mail. If it says ACH and nothing has arrived after a few business days, check your EFT enrollment with that payer and whether your bank account changed.

A payment by virtual card. Some payers, or the payment vendors they hire, pay by virtual credit card unless you ask otherwise, and card processing takes a fee out of the payment. Under HIPAA a health plan cannot require you to accept virtual card payments, and when you ask for payment by standard EFT, the plan has to use it. Put the request in writing.

A weekly matching routine

1. Pull every healthcare deposit for the week, with its trace number.
2. Match each one to an ERA by trace number and amount.
3. List deposits with no ERA, and ERAs with no deposit, older than three business days.
4. Trace every provider-level adjustment back to its claim.
5. Hand the list from step three to whoever owns payer follow-up, with the payer, amount, date and trace number.

Once each deposit is matched, the claims inside it are settled, and what is left on each one belongs to the patient, a second payer or a write-off.

How Claims Native matches deposits

We match each bank deposit to the payment behind it, and post the payment into your EHR with every adjustment. Your money keeps going to your bank. We never hold it. When a deposit and its remittance disagree, the difference stays open until we know which claim it belongs to.

Sources

• CAQH CORE, Payment and Remittance (CCD+/835) Reassociation Rule. The three-business-day window around the EFT effective date.
• Nacha, Healthcare EFT. HCCLAIMPMT and the TRN segment in the CCD+ addenda.
• CMS, EFT and ERA reassociation basics.
• X12, request for interpretation 2661: TRN02 in the 835.
• CMS, Guidance letter on virtual credit cards, EFT and ERA.
• American Hospital Association, CMS issues guidance on virtual credit cards.