Six moments turn anunreconciled batch into aledger you can defend.

Payment posting is the step where money that's already been paid gets recorded against the exact claim, patient, and line item it belongs to. It happens after adjudication — the payer has already decided what it will pay — so posting isn't billing or collections, it's a three-way match: does the remittance (ERA) match the deposit (EFT), and does the total match what your ledger records? When that match doesn't hold, the difference becomes unapplied cash, a silent write-off, or a patient billed the wrong amount.

They're three views of the same payment decision, sent to different places. The ERA (the X12 835 transaction) is the electronic remittance your practice's system reads — line-by-line adjustment codes and amounts. The EOB is the patient-facing version, mailed or posted to a portal, showing the same decision in plain language. The EFT is the actual bank transfer of funds. The money and the explanation of the money don't always arrive together — a lockbox deposit can show up a day before or after its matching ERA, which is exactly why the three-way match exists.

In almost every case, yes — a $0 EOB isn't a bill; it's your insurer's record that the claim was processed and nothing was left for you to cover. A separate statement only follows if your practice's own ledger shows an actual balance after posting. If you're ever billed an amount that contradicts a $0 EOB, that's a posting mismatch worth flagging.

24 to 48 hours from the remittance landing is the standard a well-run posting desk holds itself to, with posting accuracy at 99% or higher. Without a dedicated workflow, ERAs routinely sit unworked for a week or more — not because the money isn't there, but because no queue is built to close the loop that fast. That delay pushes denial follow-up further from the date of service, where it gets harder to win.

Unapplied cash is money your practice has actually received but that hasn't been matched to a specific patient or claim yet — it sits in a suspense account instead of your ledger. It piles up from missing claim numbers on a lockbox deposit, timing mismatches between the EFT and its ERA, unresolved overpayments, and batches posted in a hurry. It matters because it quietly inflates your true days-in-A/R.

Contractual adjustments — applying the payer's allowed-amount write-off against the billed charge. When a posting rules engine applies an outdated fee schedule or the wrong contract rate, the write-off gets accepted automatically and nobody catches it. A denial gets flagged and can be appealed; a silent misapplied write-off just disappears, which is why every contractual adjustment on our desk runs through a rules engine checked against current payer contracts, not a static table.

CARC codes explain why an amount was adjusted — a write-off, a denial, a patient-responsibility shift. RARC codes add supporting detail alongside a CARC. Together they decide what happens to a line item next: a contractual write-off, patient billing, or a denial follow-up queue. Misreading one code at volume sends claims to the wrong queue systematically.

The drug and the service that administered it were likely billed through two uncoordinated channels. In buy-and-bill, your practice purchases the drug and bills both the drug and the administration on one claim. In white or brown bagging, a specialty pharmacy ships the drug separately, billed on its own. When those paths overlap without coordination, the claim reads as a duplicate charge — an expensive mistake to catch after the drug's already been administered.

Both. As of January 1, 2026, payers covered by CMS-0057-F must give a specific reason for a denied prior authorization rather than a generic code — and every one of those decisions eventually surfaces downstream as a zero-pay or partial-pay ERA in the posting queue. Cleaner denial reasoning upstream means more accurate routing once it reaches posting. The rule's March 2026 requirement that payers publish approval and denial metrics also gives practices a real benchmark to reconcile against.

No. We'll show you your actual unapplied cash balance, where posting is lagging past 48 hours, and where contractual write-offs look off against your real payer contracts — before anything changes on your end and with no commitment attached.