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Every adjudicated claim (should) result in an explanation of benefits (EOB). These are mostly delivered electronically as an 835 (or ERA - “Electronic Remittance Advice” - basically an EOB delivered in X12 format so it’s machine readable) from the payer, through your clearinghouse, to you.
To close out a claim, a practice needs to “post” an ERA. This means reconciling what was paid, to the claim that initiated it. Most PMs (practice management systems) can post between 50% - 70% of postings automatically. The remainder are done by hand, and this process is colloquially called “Payment Posting”. Supstrate Posting handles those
So we built a system to do this.
Common reasons why payments need to be posted by hand
And how Substrate solves them.
There are several “exception” cases that can occur when an EOB is received. Substrate Posting is designed to handle most of them.
Straightforward ERA posting
The Substrate Rules Engine allows you to customize exactly how payments, denials, adjustments and transfers are handled based on CPT codes, CARCs, Payers, and more.
Already-posted, partially-posted, and duplicate claims
If a payment has already been posted the system first checks your PM then determines whats left before posting.
Recoups and reversals
Payers often reverse previous payments, sometimes multiple times. We post these to the correct claims and ensure you don’t accidentally end up with improper credit balances.
Provider-level adjustments
Provider Level Adjustments can be posted to the identified invoice (if available) or to a holding account. Where they are posted is up to you, based on your practice rules.
Bundling, case rates, and globals
Rollup Rules handle bundling, case rates and flat rates, so that ancillary codes that should be written off, don’t sit in your queues, taking time away from denials that really need to be worked. During implementation, we’ll configure these according to your practice’s payer contracts
Payer mismatches
The Substrate Recon agent has been trained over millions of claims to identify when a claim has been forwarded or when you’ve received an 835 from a Third Party Administrator. During implementation, we calibrate based on your payer mix, and the system learns over time from there.
Payment variance
Because we configure your payer contracts during implementation, we can automatically detect when payers are underpaying you, and easily assemble report packets for use in your next payer negotiation.
Why This Matters
Faster payment posting means different things to different people
- If you’re a finance leader or CFO, this means
- faster month end close. All your insurance payments are now posted on the date they’re received, and your team only has to handle true exceptions.
- Accelerated cash flow. An instantly reconciled EOB ensures that patient responsibility is sent to the patient right away.
- If you’re an RCM or billing leader, this means fewer remits stuck in work queues.
- You’ll get true visibility into what denials need to be worked, instead of having your team clear out bundled denials that should be written off.
- You’ll free up your team to focus on complex denials that really need their attention, and to flex up on trending denials.
Substrate Posting is already processing millions of claims each year, with success rates greater than 90%. This means more transactions posted, faster turnaround, and lower operating cost. Check out the demo here.
