Payment Posting & Remittance
What Happens After a Claim Is Paid
Once an insurance company processes a claim, it sends back a remittance — a detailed explanation of what was paid, what was adjusted, and what (if anything) is left over. Posting that payment accurately is what turns "the insurance paid something" into an accurate patient account.
Key Terms You'll See
The electronic version of an explanation of benefits. It shows the allowed amount, what insurance paid, any contractual adjustment, and any remaining patient responsibility — line by line, for every service billed.
The difference between what was billed and what the payer's contract allows. This amount is written off — it is not owed by anyone, including the patient.
What is left after insurance pays and the contractual adjustment is applied — copay, coinsurance, or deductible. This is the only portion that can be billed to the patient.
Why Accuracy Here Matters
A misposted payment creates two problems at once: the account looks wrong, and whatever gets billed to the patient next — a statement, a balance, a call — is now based on incorrect information.
Where Posting Errors Usually Start
Watch for these: posting the total check amount without matching each line to the right claim, missing an adjustment code and leaving a balance that should have been written off, and not flagging a denial line within a batch remittance simply because the check itself cleared.
Check Your Understanding
Nice work — continue to Module 2.
Continue to Module 2