Post an ERA (Receivables walkthrough)

Outcome

An incoming 835 file is parsed, every line is matched to a claim, payments and adjustments are posted, variances are reviewed and reconciled, and the secondary / tertiary claim auto-builds where COB applies.

Prerequisites

Scope	What it lets you do
billing.receivable.read	View list / detail
billing.receivable.write	Confirm posting; manually match unmatched lines
billing.receivable.override	Force-match a low-confidence pairing

A trading partner whose inbound 835 capability is enabled (see 5.6 — Trading partner credentials), so 835 files arrive automatically. You can also upload an 835 by hand.

Receivables list

/receivables shows every received 835 with status:

Status	Meaning
RECEIVED	File parsed pending review.
AUTO_MATCHED	All lines matched at high confidence; safe to confirm.
REVIEW_REQUIRED	Some lines need manual matching.
EXCEPTIONS	Variances remain after auto-match.
POSTED	All lines applied.
CLOSED	Fully reconciled.

Detail page — the 6 tabs

/receivables/:id opens with the parsed 835. The tabs are processed left-to-right:

Tab	Purpose
Auto-matched	Lines linked to claims with confidence ≥ threshold. Review and confirm.
Review	Lines linked to claims at low confidence — confirm or reject the suggestion.
Unmatched	Lines with no candidate claim. Manual match or write-off.
Exceptions	Variances — posted amount disagrees with expected. Resolve before close.
Adjustments	Claim-level CAS rows — typically PR-1/2/3 routed to patient AR.
Trace	Raw 835 segments and provenance — which loop produced which UI row.

Steps

1. Pick a RECEIVED row at /receivables. The detail page opens; the Auto-matched tab is the default.

2. Review the Auto-matched tab. Each row shows claim ID, payer claim control number, billed, paid, adjustments. Click into any row for line- level detail. Confirm the page is sane (totals look right, payer matches), then click Confirm auto-matched.

3. Work the Review tab. Each row carries the engine's suggestion with a confidence score and a reason ("payer claim control number partial match", "member ID match only"). For each row, either:

   • Confirm the suggestion → posts the line.
   • Reject → moves the line to Unmatched for manual handling.

4. Work the Unmatched tab. For each line, use the Manual match dialog: search for a claim by member, payer claim control, or amount; pick one; confirm. The platform records the manual match and the user.

5. Work the Exceptions tab. Each variance shows expected vs. posted with the delta. Common causes:

   Cause	Resolution
   Payer applied a different fee schedule than your contract	Update the contract / fee schedule and request a corrected ERA, or accept the variance.
   Modifier was downcoded	Tag the denial appropriately; auto-correct or appeal.
   Patient liability greater than expected	Confirm member's deductible / coinsurance is current.

   For each, either resolve and re-confirm, or accept the variance with a reason note.

6. Click Post. The platform applies every confirmed line in a single transaction:

   • Updates each claim's balance.
   • Writes remittance_adjustment rows.
   • Routes patient liability (PR-1/2/3) to the patient AR.
   • Triggers secondary / tertiary claim build if COB applies (see 6.2 — COB & dual-eligibility).
   • Generates denials for any DENIED lines (CARC group CO, denied amount), which then enter the worklist.

7. Confirm closure. Once all variances are resolved, the row moves to CLOSED.

Manual ERA upload

If a payer mailed a paper EOB and a CSV, or a partner you have not yet fully integrated with sent an ERA file out-of-band:

1. Click Upload ERA on the list page. Drop the 835 file.

2. The platform parses, dedupe-checks against prior receivables, and either creates a new receivable or returns 409 if the same BPR-trace + TRN02 pair already exists.

3. Proceed through the standard tab flow.

Validation

Check	Expected
All tabs reach 0 unconfirmed rows	Yes.
Post finishes with no error	Yes.
Each claim's balance updates within seconds	Yes.
Secondary claim auto-built for COB cases	Yes; visible on the original claim's Relationships tab.
report.export audit row written if you exported variance lines	Yes.

Troubleshooting

Symptom	Cause	Fix
Confirm auto-matched is greyed	Some auto-matched rows fall below the post-confirmation threshold	Open them to confirm individually.
Manual match dialog finds no candidate	Claim was archived / never built / belongs to a different tenant	Use the Trace tab to see the payer claim control number; cross-reference with the /claims search.
Variance with OA-23 adjustment	Informational impact-of-prior-payer; common on secondary claims	Accept; not an error.
Posting fails with transaction_aborted	One line referenced a claim that was deleted between confirm and post	Re-open the receivable; the platform shows the now-orphaned line; re-match or skip.

Next

2.5 — File an appeal