Posting a remittance that does not balance to the ledger
The amount in the bank rarely equals the amount on the file. A PLB segment carries adjustments belonging to the provider rather than to any one claim, so a WO recovery for something paid months ago sits inside the payment for today, and an FB forward balance pushes what could not be recouped into the next file. Tying the deposit back to the remittance runs on the reassociation trace number, which the bank passes through in the CCD+ addenda only when somebody has asked it to do that.
Electronic eligibility answers whether a patient is covered, and then somebody opens the payer portal anyway to find out what is actually payable.
There is a mandated electronic standard for eligibility, and it works. It confirms that a plan is active. What it routinely omits is the detail the front desk actually needs: frequency limitations, waiting periods, alternate benefit provisions and remaining annual maximum. That gap is the origin of most manual verification in this sector.
- Open Dental
- athenahealth
- QuickBooks Online
When this is the wrong thing to build
Pick something else if most payers reimburse by virtual card, since a card number faxed over has no remittance file behind it to reconcile against, or if a billing company already posts every payment and the practice never touches the file it worked from.
The constraint that shapes it
A practice is a covered entity, and any vendor that creates, receives, maintains or transmits protected health information on its behalf is a business associate, which requires a written agreement in place before any disclosure. More on how this sector works.
Two sources of truth. One queue of the rows that do not line up. Read what this shape is, or start from one of these.
- Rebuilding an annual operating expense reconciliation from the lease
- Reconciling a broker trust account three ways every month
- Matching a closed transaction back to the lead that produced it
- Collapsing two overlapping MLS feeds into one property list
- Widening a conflicts search past exact spelling
- Rebuilding a billable day from the trail the systems already keep
- What does a PLB segment mean on an 835 remittance?
- Why does the deposit not match the total on the remittance file?
- How do I find which claim a payer took money back from?
- Why did the payer pay by virtual card instead of electronic funds transfer?
- What is a reassociation trace number and where does it come from?
Back to medical and dental practices, or see how this is priced and scoped.