Claims

Remittance processing

Posting a remittance turns the payer's decision into money on the books, line by line. This page is what posting does; ERA and EOB handling covers how the files get in.

Written for: Billing and RCM teams · Finance

How a remittance arrives

From the clearinghouse mailbox when it is configured, by upload on Insurance → ERA/EOB Posting, or as a manual EOB entry on the same screen for a paper remittance. All three post through the same code. See ERA and EOB handling.

What posting does

Field or control	What it means
Finds the claim	By the claim number the payer echoes back (CLP01). A claim that is Void cannot receive a remittance; every other status can, including Paid, so a re-adjudication posts.
Matches each line to a charge	By procedure code, date of service and modifiers. A line that matches no charge, or more than one, posts nothing and becomes an exception for a person.
Payer payment	Applied to the charge's paid amount and written as one row in the payment ledger.
Contractual adjustments	An adjustment outside PR reduces the charge's balance only when its group is CO, PI or OA and its reason code is on the practice's write-off list (for example CO-45, charge over the fee schedule). ArkCloud ships a short default list; an administrator can change it on Settings → Remittance policy.
Patient responsibility	PR amounts (deductible, coinsurance, copay) are recorded on the charge as the patient's share. They do not change the balance - they say who owes it.
Denials	Every other non-PR adjustment (for example CO-16, CO-50, CO-197) creates a denial record on its line and stays in the charge balance, so a person appeals, corrects, transfers or writes it off. A claim the payer denied outright writes nothing off.
The claim	Its paid, adjusted and patient amounts and its status are restated from its charges: Paid, Partially paid or Denied.
The account	Its balance is restated from the ledger identity, and the patient's share becomes what statements bill.

Why the same remittance cannot post twice

Each posting is keyed on the payer's own identifiers - payer, the remittance trace or check number, and the payer's claim control number - and the database refuses a second remittance with the same key. A replayed file reports "already posted" and moves no money. A different payment on the same claim (a correction, a secondary payer, a second partial payment) has a different key and posts.

After posting

Field or control	What it means
Exceptions	Unmatched lines, duplicates and unknown claim numbers wait on ERA/EOB Posting for a person to resolve.
Secondary payer	A decided primary with a balance and secondary coverage appears on Ready for secondary.
Patient balance	The patient's share is billed on statements; see the patient revenue cycle.