Payment Posting | Substrate

Exception Posting Automation

Automated payment posting that processes ERAs, reconciles variances and posts payments to your ledger with zero intervention.

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Autonomous posting agents read every ERA line, match it to the correct encounter and post payments directly to your PM. Variances, denials and underpayments are flagged and routed instantly.

Built-in exception handling catches clawbacks, recoupments and contract rate mismatches before they become write-offs. Every posted transaction has a full audit trail back to the original remittance.

Account Ledger

Cameron Mitchell

Source

ERA #847291

99214

01/15/2025

+$149.60

90837

01/15/2025

-$49.20

Posted

$0.00

Exceptions

Balance

$0.00

Posts every ERA line automatically
‍Each remittance line is matched to the correct encounter, validated against expected amounts and posted to your ledger. Adjustments, co-pays and secondary balances are handled in the same pass.

Catches what humans miss
Clawbacks, recoupments and retroactive adjustments are detected and flagged before they silently erode revenue. The agent cross-references historical payments to surface discrepancies other systems overlook.

Reconciles across every payer
Whether it's a large national payer or a regional Medicaid plan, the agent normalizes remittance formats and maps them to your internal codes. No manual reformatting or payer-specific workarounds.

How does it work?

Rules

Define your custom posting rules for payer-specific routing and exception thresholds upfront. The agent your logic and processes.

Read

The agent ingests every ERA and EOB as it arrives, parsing line-level detail including codes, reasons and amounts.

Match

Each payment line is matched to the correct claim and encounter in your PM using intelligent matching that handles formatting differences.

Post

Payments, adjustments and denials are posted directly to your system of record. Secondary claims and balances are queued automatically.

Reconcile

The agent flags exceptions like clawbacks, duplicate payments and contract rate variances, then routes them with full context.

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85%

ERA lines posted without human intervention

Payment posting shouldn't require a full-time team. Our agent handles the volume while your staff focuses on the exceptions that actually need attention.

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Post payments to your PM with zero manual data entry.

Flag and route exceptions before they become write-offs.

Reconcile faster than any team could manually.

AI Agents that are designed & built for the way your payment posting works.

ERA & EOB parsing reads and interprets every remittance format across payers, extracting line-level payment detail, adjustment codes and patient responsibility amounts.

Intelligent claim matching fuzzy-matches payment lines to encounters even when payer formatting varies. Handles split payments, bundled procedures and multi-line remittances.

Exception detection flags clawbacks, recoupments, duplicate payments and contract rate variances automatically. Routes exceptions with full context so your team resolves them faster.

Secondary billing triggers when primary payments create secondary or tertiary balances, the agent queues follow-up claims automatically based on your billing rules.

Direct PM integration lets payments, adjustments and notes post directly into your practice management system or data warehouse. No CSV exports or manual uploads.

Full audit trail so that every posted transaction links back to the original ERA, with a complete record of what was posted, when and why. Built for compliance reviews and payer audits.

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FAQ

What data do you need to get started?

We connect to your ERA/EOB feed and your practice management system. Most teams are live within days with no engineering work required on your end.

How does the agent handle exceptions?

When the agent encounters a clawback, recoupment, contract rate mismatch, or any line it can't confidently post, it flags the transaction with full context and routes it to your team for review. Over time, it learns your resolution patterns to handle more edge cases automatically.

What PM systems do you integrate with?

We're agnostic to the system of record you use. Payments post directly into your PM, EHR, or data warehouse. No code or engineering resources required on your end.

Can it handle secondary and tertiary billing?

Yes. When a primary ERA reveals a remaining patient or secondary payer balance, the agent queues the appropriate follow-up claim based on your billing rules.

How do you handle clawbacks and recoupments?

The agent detects retroactive adjustments and clawbacks by cross-referencing historical payment data. It flags the affected claims, calculates the net impact and routes them to your team with the original remittance context attached.

What happens with denied lines on an ERA?

Denied lines are parsed with the full CARC/RARC codes and routed to your denial workflow. If you use our Denials Agent, they can be picked up automatically for appeal.

Is there a full audit trail?

Every transaction includes a complete record of the original ERA, what was posted, the matching logic used and any exceptions flagged. Built for compliance reviews and payer audits.

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Put your revenue cycle on Autopilot