Standardizing the insurance payment posting process is essential for maintaining a clean accounts receivable, ensuring accurate financial reporting, and providing a clear ledger for patients. A uniform workflow prevents claim reconciliation errors and allows the practice to track outstanding insurance balances effectively.
Why a Standardized Posting Workflow Matters
Following a consistent insurance posting process helps your team:
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Improve Financial Accuracy Ensure the amount received matches the ledger and bank deposits. |
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Accelerate Claim Closure Properly posting payments closes claims in the system, preventing them from appearing on aging reports. |
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Reduce Ledger Errors Automated adjustments for underpayments or overpayments keep patient |
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Maintain Transparency A complete record of Explanation of Benefits (EOB) linked directly to payments allows for quick reference during patient inquiries. |
Step 1: Create a New Insurance Receipt
Before applying funds to individual patient claims, you must create a receipt in CareStack to document the total payment received from the carrier.
Navigate to Insurance Payments: Click on the System Menu (top right) and select Insurance Payments under the Billing section.
Add Payment: Click the + Add Insurance Payment button in the top right corner.
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Enter Payment Details:
Select Carrier: Choose the insurance carrier that sent the payment.
Payment Amount*: Enter the total amount of the check or EFT.
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Location* & Date(s):
Confirm the practice location (defaults to location set in upper right corner)
Payment Type*: Select the method (e.g., Check, EFT, Virtual Credit Card).
Reference #: Some payment types may require a check number, transaction ID, or some other type of information used as a reference number for the payment receipt. If your payment type does not, then this field will not display. Will be a required field in certain payment types
4. Attach Documents (EOB): Click Add Documents to upload or scan the EOB.
Use Scan Document to acquire a paper copy from your scanner or Browse Document for digital files already saved to your computer.
Select the file and click Link to Receipt to ensure it is permanently attached to this payment record.
5. Finalize Receipt: Click Add Receipt to save it to your pending list
Step 2: Apply Payment to Claims
Once the receipt is created, you must allocate the funds to the specific patients and procedures listed on the EOB.
Select the Receipt: Locate your new receipt in the left-hand sidebar under the Show Insurance Receipts blue bar.
Search Patient: Make sure you’re in the Apply Payment tab (it should be selected by default) and search for the patient by name or ID number.
Identify the Claim: Review the listed claims and verify the Date of Service (DOS), procedure codes, carrier and any other identifying information such as the provider, billed amount, insurance expected amount, claim id etc.
Step 3: Choose the Correct Posting Method
Depending on whether the insurance paid the expected amount, choose one of the following options:
Option A: Paid as Expected (Recommended)
Use this for simple claims where the insurance payment perfectly matches the estimated amount in CareStack.
Click the Paid as Expected button.
Review the pop-up modal showing the claim will be closed and funds applied.
Click Submit.
Option B: Add Line Level Payment
Use this if the insurance paid a different amount than expected or if you need to manually adjust individual codes.
Click Add Line Level Payment.
Edit Individual Codes: Click into the Ins. Payment field for each code and enter the actual amount paid by the carrier.
Confirm Other Fields: Confirm the data in the Ins. Amt. and Allowed Amt. fields also match what is shown on the EOB and make any changes as needed.
Automated Adjustments: CareStack will automatically recalculate the patient responsibility and initiate a transfer adjustment if an overpayment occurred. If an edit to the adjustment code or amount needs to be made, the edit button can be clicked and these details can be modified.
Verify & Submit: Ensure the "Remaining Credits" at the bottom accurately reflects your EOB before clicking Submit. You may also verify this information in the right panel under Account Summary.
Option C: Bulk Payment Posting
Use this for receipts covering multiple patients.
After posting the first patient, stay within the same receipt.
Search for the next patient in the Search Patient bar.
Apply the corresponding portion of the total receipt to their claim using the steps above.
The Unapplied Amount at the top will decrease as you move through each patient on the EOB until the entire amount of the payment has been posted.
Handling Denied Claims
If the insurance rejects a claim, it must be marked appropriately to move the balance to the patient or prepare for an appeal.
Navigate to Insurance Payments: Click on the System Menu (top right) and select Insurance Payments under the Billing section.
Search for the patient and identify their claim using the same steps as above and then click Mark Claim as Denied.
Specify Reason: Select the appropriate Group Code and Reason Code as listed on the EOB. These are industry-standard codes used for reporting.
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Close or Appeal:
Close Claim: If no further action is possible, the claim will close and the balance will move to the patient.
Appeal: Check the Appeal box if you intend to resubmit with more information. This prevents the claim from closing and stops the balance from transferring to the patient immediately.
5. Click Submit.
When Insurance Pays a Patient Directly
Sometimes an insurance carrier will make a payment directly to a patient and depending on if this is expected or unexpected these scenarios would be handled differently.
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Expected: This would be if your practice is out of network with the carrier/plan and that carrier pays the patient directly in that scenario, you’re a fee for service practice but still bill the patient’s insurance company as a courtesy, or another similar scenario.
Ensure the patient’s insurance plan has been set up to have the benefits assigned to the patient, per the instructions found under the Benefits section of this article: Add a New Insurance Plan
Once this is done CareStack will automatically expect the patient to be responsible for the full cost of treatment and any claims created for this patient will automatically be created as per usual but they will be flagged with an ABP (Assignment of Benefits to Patient) flag.
These claims can then be either billed electronically as per usual or printed and provided to the patient to bill to their insurance themselves.
Once the claim has been billed it can be found in the Claims > Pending Payment > and the status can be changed to Closed.
Unexpected: In the instance that a carrier unexpectedly pays a patient directly and the patient’s plan had not been configured to assign the benefits to the patient, things would need to be handled slightly differently.
Once you’re alerted that the payment has been made to the patient directly, close the associated claims, and the balance will move to the patient.
Close Claim: Clear the Ins. Amt. to $0 and enter $0 for Ins. Payment, select Post $0 Transactions and Close Claim. Enter remark for clarity on the situation. The system will automatically transfer the insurance balance to the patient.
Bill the patient for their balance. *See below for tips to use Text to Pay for the most efficient method.
Best Practices
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Daily Reconciliation Post all insurance checks and EFTs on the same day they are received to keep accounts current. |
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Clear Documentation Always scan and link the EOB to the receipt. This eliminates the need to search through physical files for payment disputes. |
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Pending Cleanup Review the "Pending Posting" list daily to ensure no partial bulk payments are |
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Use Flags Use custom Insurance Payment Flags for payments with known issues or those requiring follow-up by a supervisor. Here’s an article on how to create a custom flag: Create New Insurance Payment Flags |
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Use Text to Pay Once an insurance balance has been completely resolved, you can easily start the process of collecting any remaining patient balance by clicking the Text to Pay link on the right side of the screen and quickly texting the patient a link to collect their portion of the balance. This will get the process of patient collection going quicker than waiting for your normal statement process and is generally quicker and easier for patients to pay, leading to higher collections for your business. |
Electronic Remittance Advice - ERAs
ERA’s are essentially an electronic EOB and when utilized properly can be a powerful tool that allows you to efficiently process a high volume of insurance payments. This does take some time and effort to set up initially, but once this has been achieved you can post the bulk of your insurance payments in a much more efficient manner. In some instances you can even have CareStack automatically post insurance payments, should you choose to do so.
To learn more on ERA Setup: Set Up ERA Posting Preferences
To learn more about managing your ERAs once they have been set up: Manage Electronic Remittances or ERAs
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You will then need to enroll in ERAs with carriers that you bill claims to. Please note that the enrollment process is managed by your clearinghouse, and their requirements or procedures may change at any time. During enrollment, we recommend confirming whether any processing fees apply. While CareStack does not charge any fees, some carriers or payment processors may. |
DentalXChange
Contact CareStack Support to initiate the enrollment process.
DentalXChange’s enrollment team will reach out to the practice with information on how to enroll in ERAs via their process.
Vyne
This is done while enrolling with Vyne’s clearinghouse services. If you need to add carriers, navigate to this link and complete the form.
If you need help identifying your clearing house, please contact Support.