Payment Posting & ERA Reconciliation for SNF
Every 835 line posted right, reconciled to bank deposit, the same day. Line-level ERA posting. Contractual adjustments (CO-45) split from patient responsibility (PR). Underpayments flagged against contracted per-diem. Bank deposit reconciliation. Posting variance research. 800+ providers trust us. Pilot in 2 weeks.
0:55
0:48Cash posted to the wrong claim. Underpayments not caught. Bank deposit does not reconcile.
Most SNF and home health business offices post ERA 835 files at the claim level, not the line level. Underpayments hide inside the claim total. CO-45 contractual adjustments get mixed with patient responsibility. Bank reconciliation drifts and posting variance compounds week over week.
Claim-level posting hides underpayments
Posting the 835 total at the claim level masks line-level underpayments. The per-diem looks paid, but the therapy line was reduced 12 percent. No one catches it.
Bank deposit does not reconcile
The 835 file totals do not match the bank deposit. The variance grows. By month-end the business office cannot explain a 4-figure difference and writes it off to "posting variance."
Posting variance grows untouched
Without dedicated posting specialists, the variance queue grows. CO-45 adjustments get posted as patient responsibility. PR balances go to the wrong AR ledger. Statement generation runs on bad data.
Tell us about your agency.
Send us your situation and our team will scope the right setup, usually within one business day. No obligation.
What is payment posting and ERA reconciliation ?
Payment posting and ERA reconciliation is the daily workflow of taking the 835 Electronic Remittance Advice file from the payer or clearinghouse, posting each line item against the original 837i claim line, and reconciling the file totals to the bank deposit. Line-level posting splits the payment into three buckets: payment, contractual adjustment (CO-45), and patient responsibility (PR). Each split has to match the contracted per-diem or fee schedule.
What your payment posting team handles, day to day
Eight production tasks every 835 ERA file hits before it converts to posted cash.
835 ERA file intake
Pulls 835 ERA files from clearinghouse or payer portal. Validates file integrity. Logs file ID and total deposit amount.
Line-level posting
Posts every 835 service line against the original 837i claim line. Never claim-level. Splits payment, CO-45 adjustment, PR balance.
Bank deposit reconciliation
Reconciles 835 file totals to the bank deposit same-day. Flags any variance over $1. Documents reconciliation in the daily posting log.
Underpayment flagging
Compares each posted payment to the contracted per-diem or fee schedule. Flags underpayments above tolerance. Routes to AR for appeal.
Patient responsibility routing
Posts PR balances to the correct resident ledger. Generates patient statements per facility cadence. Tracks PR aging separately.
Manual posting fallback
When ERA is not available, manually posts from paper or PDF EOB. Same line-level rigor. Same reconciliation discipline.
820 premium payment posting
For MA plan capitation contracts, posts the 820 premium payment transaction separately from claim-level 835 files.
Posting variance reporting
Daily variance against bank deposit. Weekly underpayment dollars by payer. Monthly net collection percentage.
Line-level ERA posting trained, not claim-level posters
Most outsourcing firms post 835 files claim-level and call it a day. We do not. Our posting specialists pass a line-level 835 segment test and a bank-deposit reconciliation procedure before they touch a live ERA in your facility.
835 segment + reconciliation tested
Every specialist passes a written assessment on 835 ASC X12 5010 segment structure (CLP, SVC, CAS, PLB), CARC group decoding for posting (CO vs PR vs OA), and same-day bank deposit reconciliation before placement.
Stacked compliance posture
HIPAA + SOC 2 Type II + ISO 27001 + HITRUST. Plus alignment with 42 CFR 424 conditions of payment and 45 CFR 164.514 de-identification. All four certificates available on request.
2-Week Risk-Free Pilot
Industry offers no trial. We give you 14 days of live ERA posting and bank reconciliation at the same rate. Cancel before day 14, owe nothing. No annual contracts after.
Staffingly vs DIY in-house vs generic offshore
Cost math for a single full-time payment posting specialist at a mid-size SNF or LTC operator.
From "let's talk" to first 835 posted in 1 to 2 weeks
Six steps. Each one is documented.
Discovery call (15 min)
Share your current posting backlog, ERA volume per week, and bank reconciliation variance. We map the worst gap.
BAA + access
BAA signed. Role-based access to your EMR, clearinghouse 835 archive, and bank reconciliation portal.
Posting rules calibration (2 to 3 days)
Per-payer posting rules locked. Underpayment tolerance thresholds set. Bank deposit reconciliation cadence agreed.
Parallel posting starts
Week 2 to 3. Specialist posts the day's 835 files line-by-line and reconciles to bank deposit. Daily 15-minute sync.
Decision point (end of week 2)
Line-level posting accuracy, reconciliation variance, underpayments caught. Go or no-go. No penalty if you cancel.
Full handoff, cadence locked
Daily posting accuracy. Weekly underpayment dollars by payer. Monthly net collection percentage. Quarterly variance audit.
How your payment posting specialist's day actually looks
A real shift, hour by hour. Coverage rotates so your ERA posting queue is never dark during business hours.
How Staffingly works, in practice
Inside the workA trained Staffingly specialist works inside your existing platform, with clear escalation back to your team.
One Flat Weekly Rate. No Surprises.
Dedicated senior care schedulers at a fixed weekly cost. Per scheduler FTE, per week. No contracts, no minimums, no hidden fees.
Want to compare against an in-house hire? Use the savings calculator.
Frequently asked questions
What is the difference between an 835 and an 820 transaction?
The 835 is the HIPAA Electronic Remittance Advice. The payer sends one 835 per check or EFT. The 820 is the HIPAA Premium Payment transaction used by Medicare Advantage plans and self-funded employers for capitation or premium payments. Not interchangeable.
Why line-level posting and not claim-level?
Claim-level posting applies the 835 claim total to the 837i claim total. Line-level matches every SVC service line back to its 837i SV2 line. Underpayments hide at the line level. Claim-level posting misses them; line-level catches them and routes to AR.
What posting accuracy KPI should we target?
Best-in-class line-level posting accuracy sits at or above 99 percent match between posted dollars and bank deposit, with same-day reconciliation. Most in-house teams hover at 92 to 95 percent.
How do you reconcile to the bank deposit?
Same-day. Each 835 carries a TRN02 transaction reference that maps to the EFT or check. We match every TRN02 to a deposit at end of day and flag any 835 with no deposit (or vice versa). Variance over $1 is investigated.
What is the variance threshold for investigation?
Variance of $1 or more triggers investigation. We do not write off to posting variance. Investigation walks: TRN02 mismatch, partial deposit, multi-check deposit, returned check, reversal, or 835 file integrity error.
What happens when an ERA 835 is not available?
Manual EOB posting. Same line-level rigor. Same bank reconciliation discipline. The manual EOB queue runs separately from the ERA queue.
How does pricing work?
Per posting specialist FTE per week. $399 Standard, $349 Volume (3+), $299 Enterprise (10+). No setup fees. No annual contracts.
What is included in the 2-Week Risk-Free Pilot?
Two weeks of live ERA posting and bank reconciliation parallel with your business office. Daily KPI reporting on line-level posting accuracy, reconciliation variance, and underpayments flagged. No penalty if you cancel before day 14.
President and CEO, Staffingly, Inc. 25+ years in IT consulting and healthcare BPO operations. One of the earliest US operators to set up an RPO/BPO delivery network in India. Leads AI-driven home care workflows that help agencies, home health providers, and multi-branch operators cut admin cost without compromising care.
