First-Pass Acceptance Rate
ERA Posting Turnaround
Denial Rate Post-Outsourcing
Active Practices Served
Free Audit Results Delivered
A denied claim announces itself. A payment posting error doesn’t — the payer just pays less than your contract requires, and if nobody checks, the difference disappears as a routine adjustment.
The payer pays — just less than what your contract requires — and if nobody compares that remittance to your contracted rate, the difference gets written off as a routine adjustment. The money is gone. No denial code. No queue. No alarm.
This is not a rare edge case. A February 2025 MGMA poll found that.
52% of medical group practice leaders audit payer payments against contracted rates annually or less. For most of those practices, underpayments accumulate for months before anyone looks — often past the payer's timely filing window for appeals.
The margin environment makes this worse. CMS cut the Medicare Physician Fee Schedule conversion factor by
2.83% in 2025 — dropping it to $32.3465 — while practice overhead costs rose
4.9% per the Medicare Economic Index in the same year. Writing off recoverable underpayments as routine adjustments is a practice management failure, not a billing inconvenience.
Of annual net revenue lost to undetected commercial payer underpayments
Becker's Hospital Review
Of practice leaders audit payer payments against contracted rates annually or less
MGMA Stat Poll, Feb 2025
Recoverable revenue permanently written off at a $2.5M practice with a 3% underpayment rate
QlaimPro Client Analysis
Payment posting covers 4 distinct categories of financial transactions. Each requires a different workflow, different validation logic, and a different routing path for exceptions. Treating them as one process is where most posting errors originate.
Every CPT code on a claim is posted at the line level — billed amount, allowed amount, paid amount, contractual adjustment, and patient responsibility recorded separately. QlaimPro never lump-sum posts, regardless of claim volume.
Out-of-network and non-enrolled payers send paper EOBs. Each line is entered manually with the same contract-rate validation as ERA posting — before any contractual adjustment is written off.
Every denied line is posted with its CARC and RARC codes and routed to the correct work queue — coding review, clinical documentation, modifier appeal, or the patient ledger.
Remaining balances post to the patient ledger, and secondary claims for Medigap, Medicare Advantage, and dual-eligible patients go out within 48 hours of primary posting.
Every payment QlaimPro processes moves through 6 defined stages, from remittance receipt to bank reconciliation. Nothing is posted without passing through each one.
ERA files arrive within 24–48 hours of adjudication and are validated against expected claim count, payment amount, and payer ID before posting begins. Failed files are held and the clearinghouse is contacted same-day.
Each payment line is matched by claim number, account number, date of service, and rendering provider NPI. Unmatched payments go to an exception queue — never force-posted to a default account.
Each CPT line is posted individually and compared to the contracted rate. Any amount below that rate is flagged for underpayment review — no write-off until the comparison clears.
Denied lines are posted with CARC/RARC codes and routed by category — documentation gaps, medical necessity, timely filing, or bundling — to the team with the matching appeal strategy.
Dual-eligible accounts trigger COBA crossover review. Medigap patients receive secondary claims sourced from the primary ERA. Remaining balances queue for statement generation.
Posted totals are reconciled against the actual deposit by end of the next business day. Physician owners receive a morning cash report with postings, confirmation, and open exceptions.
A contractual adjustment and an underpayment can carry the identical CARC 45 code. The only way to tell them apart is to compare every remittance to the contract — before the write-off is applied.
QlaimPro maintains an up-to-date contracted rate schedule for each client practice, updated at every renewal, rate adjustment, and fee schedule change.
At posting, every payment amount is compared to the contracted allowed amount for that specific CPT code and payer — automatically for ERA, manually for paper EOBs.
Underpaid lines are flagged with the ERA reference number, payer ID, CPT code, date of service, contracted amount, remitted amount, and dollar discrepancy — and sent to AR follow-up with a full audit trail.
CARC 45 frequency is analyzed by payer and CPT code every 90 days. Recurring patterns get flagged for a contract review and a batch appeal — not just individual corrections.
A posting team trained on general E/M billing will make specific, predictable errors on specialty claims — not from carelessness, but from not knowing what to look for.
Reimbursement is base units plus time units times the conversion factor, plus modifiers. QlaimPro runs that calculation independently before accepting a payer's posted amount as correct
Carve-out plans adjudicate through a separate behavioral health organization. We configure ERA routing to the correct payer entity during onboarding, before the first posting cycle.
Reductions on CPT 97110, 97530, and 97140 may reflect the 8-minute rule, or incorrect bundling. We run that calculation on every timed-code reduction before routing it.
Medicare maintenance reclassifications require the CO-97 group code, not PR-96. Misclassifying it sends legitimate write-offs to the patient ledger — we apply chiropractic-specific logic to prevent that.
Add-on codes 77002/77003 are frequently bundled into the primary procedure under NCCI edits. We compare remitted amounts against both contracted rates before accepting a bundled payment.
Internal medicine, OB-GYN, podiatry, cardiology, and more. If your specialty has non-standard posting requirements, we train to it before your first claim is posted.
These numbers come from practices that switched from in-house posting to QlaimPro. Not projections. Not industry averages.
Average reduction in days in AR within 60 days
MGMA-benchmark net collection rate practices reach
Of payments compared to contracted rate before write-off
Secondary claims submitted after primary posting
“Our in-house team was posting ERA files three to four days after receipt. Secondary billing was running almost a week behind. QlaimPro moved us to same-day ERA posting and 48-hour secondary submission. Days in AR dropped from 44 to 27 in the first 60 days.”
Internal Medicine Group, Dallas, TX — 4 Providers
“UnitedHealthcare was consistently bundling CPT 77003 with our CPT 64483 claims and our team posted it as a contractual adjustment every time. QlaimPro’s contract-rate comparison flagged the pattern in the first week. We recovered $28,000 in the first quarter.”
Interventional Pain Management, Chicago, IL — 3 Providers
“Manual EOB posting was running 48 to 72 hours behind and bank reconciliation was three to four days late. QlaimPro posts ERA files within 4 hours and our senior partner gets a cash report before 9 a.m. The transition took one week. Zero disruption.”
Anesthesia Group, Houston, TX — 6 Physicians
Payment posting is the moment an overpayment is identified. What happens in the next 60 days determines whether the practice stays in compliance.
Effective January 1, 2025 under CMS Final Rule CMS-1807-F, providers must report and return Medicare and Medicaid overpayments within 60 days of identification.
Failure to return a known overpayment within that window is a False Claims Act violation — not a billing clerical error.
QlaimPro flags every overpayment at posting — duplicates, above-billed, above-contracted — and starts the 60-day clock the day it's identified.
No platform migration is required. QlaimPro’s posting team is trained on Tebra, PrognoCIS, Practice Q, TheraNest, and other major PMS platforms. ERA files import directly via your clearinghouse connection, and the practice retains full access to its own financial records at all times.
A signed HIPAA Business Associate Agreement is executed before any data access begins. Every posting decision is documented end to end.
Executed before data access
Maintained per client, per payer
Documented for every denial
Delivered each morning
Every answer here is complete. You should not need a sales call to understand what you are considering.
Payment posting is the process of recording every payment received from insurance payers and patients into the practice management system. It covers 4 transaction types: insurance payments via ERA and paper EOB, patient co-pays and balances, denial postings with CARC and RARC codes, and contractual adjustments. Errors here don’t generate denial notifications — they disappear quietly into the aging report.
ERA posting uses an Electronic Remittance Advice file (ANSI X12 835 format) that imports directly into the PMS and auto-matches against open claims — typically 4 business hours. EOB posting uses a paper or PDF document requiring manual line-by-line entry — typically 24 hours. Both require the same contract-rate comparison to catch underpayments.
A contractual adjustment is the write-off applied when the billed charge exceeds the payer’s contracted allowed amount — expected and correct under CARC 45. The same code also appears when a payer underpays, which is why a contract-rate comparison is required to tell the two apart before any write-off is applied.
After primary posting, every account is assessed for secondary coverage. Dual-eligible patients route through the CMS COBA crossover process. Medigap patients receive secondary claims sourced from the primary ERA. Medicare Advantage patients with supplemental coverage are billed manually — all within 48 hours of primary posting.
Claim Adjustment Reason Codes are the standardized codes (358 active, maintained under HIPAA by the X12 committee) payers use to explain a payment adjustment. The 4 most common are CARC 45 (contractual adjustment), CARC 97 (bundling), CARC 50 (not medically necessary), and CO-16 (missing information). The code determines routing — a misrouted denial may never get worked before the filing deadline.
Within 4 business hours of receipt from Medicare, Medicaid, UnitedHealthcare, Aetna, BCBS, Cigna, and Humana. Paper EOBs are processed within 24 hours, and bank deposit reconciliation completes by the end of the following business day. Exceptions are reviewed by a supervisor the same business day they’re identified.
An underpayment is a payer remittance below the contracted allowed amount for a given CPT code and date of service. Detection requires comparing each payment to the contracted rate. When the remitted amount falls short, QlaimPro flags it with the full audit trail and sends it to AR follow-up for appeal — recovering revenue that would otherwise be written off.
A write-off is the portion of billed charges the provider has no contractual right to collect — correct under CARC 45. An underpayment is the gap between the contracted allowed amount and what was actually remitted — the provider has the right to appeal it. Both can carry CARC 45. The only way to tell them apart is a contract-rate comparison.
Effective January 1, 2025 and codified in CMS Final Rule CMS-1807-F, the rule requires providers to report and return Medicare and Medicaid overpayments within 60 days of identification. Failure to do so is a False Claims Act violation. QlaimPro flags every overpayment at posting and documents the 60-day clock from the moment of discovery.
Every day ERA posting is delayed adds a day to the billing cycle before secondary payers and patients can be billed — inflating days in AR. The MGMA benchmark for high performers is under 40 days. Net collection rate improves when underpayments stop being written off as adjustments; high performers reach 96%–99% NCR.
QlaimPro works inside your existing PMS — no migration required. The posting team is trained on Tebra, PrognoCIS, Practice Q, TheraNest, and other major platforms. ERA files import via your clearinghouse connection, and the practice retains full access to its own financial records at all times.
Anesthesia requires unit-based calculation verification. Physical therapy requires 8-minute rule reconciliation. Mental health requires carve-out ERA routing. Chiropractic requires AT modifier and maintenance therapy distinction. Pain management requires fluoroscopy add-on reconciliation against NCCI rules. QlaimPro assigns posting to specialty-trained team members before the first cycle begins.
QlaimPro audits your current payment posting workflow and delivers a written report within 48 hours, covering 5 specific areas:
