Common dental payment posting problems and how to fix them

The short version

• Post insurance payments by procedure, not as one total. Open Dental requires it for PPO plans so write-offs are tracked.¹
• Match each deposit to its ERA by the trace number before you post.³
• For EFT payments, a gap of a few days between the ERA and the money is normal. After four business days it counts as late or missing.³
• With two plans, post the write-off only after both have paid.⁷
• When you move or reverse money, leave a note so the next person can follow it.

Insurance paid one lump sum

What you see: One check or one line for the whole claim, with no amount next to each procedure.

Why it matters: A total can't tell you which procedure was paid, which was cut, or which provider gets credit. Open Dental recommends posting by procedure, and says it is "required for PPO plans to track write-offs." ¹ Dentrix also says to itemize every payment by procedure so it lands on "the correct provider of the procedure."²

Fix: Split the payment across each procedure line, using the amounts on the EOB or ERA. If the plan paid on a different code than you sent, put the money on the procedure you actually did. Open Dental notes the payment "may need to be split differently than shown in the EOB."¹ If the plan swapped in a cheaper code, see our guide to downgrades.

One deposit covers many claims

What you see: One bank deposit that doesn't match any single claim.

Why: Plans often pay many claims, even for many patients, in one payment.²⁰ When the payment comes by ACH direct deposit (EFT), the plan must put all of those claims in one ERA, and the EFT and the ERA carry the same trace number.^3,4

Fix: Find the ERA with the same trace number, then post it as one batch payment so the claims add up to the deposit. Dentrix warns you if a multi-claim payment doesn't balance.² Ask your bank to include the trace data on your deposit details.³ The full steps are in our guide to matching deposits to ERAs.

An ERA with no deposit, or a deposit with no ERA

Why: The ERA and the money often arrive at different times.³ For EFT payments, the federal rule says the plan sends the ERA no more than three business days before or after the day the money is set to arrive.^3,5 Plans only have to hit that window 90% of the time in a month, and each plan sets its own business days.^3,5

Fix: Keep the unmatched ERA or deposit on a list and don't post money that hasn't arrived. If four business days pass with no match, it counts as "late or missing." ³ Plans must give you written steps for chasing late or missing payments when you enroll in EFT and ERA, so follow that plan's steps.³

Posting the secondary insurance

Why it trips people up: The secondary plan usually won't take the claim until the primary has paid, and it often wants a copy of the primary's EOB.⁶ Open Dental holds the secondary claim until the primary is received.⁸

Fix: Post the primary payment by procedure. Send the secondary claim with the primary's payment details. Then wait. The ADA says write-offs should not be posted "until all plans have paid accordingly," and posting one after each plan can leave a false credit on the patient's balance.⁷ More in our coordination of benefits guide.

Overpayments and takebacks

What you see: A refund request letter, or an ERA that pays less than expected because money was taken back.

Why: When a plan overpays, it may ask for a refund check or take the money out of another claim payment. That can be a future claim for the same patient "or an entirely different patient."^9,10

Fix:

1. Check the original EOB first. Open Dental says to find the original EOB to verify the payment before you refund.¹²
2. If the plan wants a check, post the refund as a negative insurance payment on the original claim.^9,11
3. If the plan took it from another claim, fix both accounts. On the claim that was paid short, post a $0 payment and a credit adjustment. On the account that owed the refund, post a charge adjustment, with a detailed note on both.¹⁰

In Open Dental, reversals and corrections can also arrive on an ERA, and you process them like any other ERA.²¹

The write-off looks wrong

What it is: The ADA defines a write-off as "the difference between the dentist's full fee and the sum of all other payments." ¹³ In network, for a covered service, the plan's payment plus the patient's share (deductible and coinsurance) equals the plan's allowed fee.¹³

Fix:

• Keep sending your full fee on every claim. The ADA says a contract "does not change a dentist's full fee." ¹⁴
• If you are in network and the service is covered, post the plan payment, write off the gap between your full fee and the allowed fee, and bill the patient their share from the EOB.¹³
• Billing the patient for the gap between your full fee and what the plan pays is called balance billing.¹⁴ In network, your contract usually limits it.¹³ When a plan pays for a cheaper alternate service, the ADA says to "check with the carrier for the amount you can bill the patient."¹⁵
• With two plans, post one write-off, after both have paid (see posting the secondary insurance above).

Paid twice, or posted twice

What you see: A claim that shows more paid than the fee, or a credit you can't explain. For example, a paper check and an EFT for the same claim, or one payment entered twice.

Fix: Before you post, check whether the claim is already paid. If the plan really paid twice, treat it as an overpayment (see overpayments and takebacks above). If someone in the office posted it twice, reverse the extra entry. To correct a payment entered wrong, Open Dental suggests a negative supplemental payment "with notes that it is a correction and not a refund."¹² Open Dental's overpaid procedures report finds these, but only if payments were posted to procedures.¹⁶

Money on the wrong patient or claim

Why: When the software can't match an ERA claim on its own, it asks you to pick one.¹⁹ That's where wrong-claim mistakes happen. Payments also land wrong when they go to the guarantor (the person who pays the family's bill) instead of the patient. Dentrix says payments should "always" go to the individual patient, not the guarantor.¹⁸

Fix: Before you pick a claim, check the same things the software matches on: patient name, subscriber ID, date of service and fee.¹⁹ To fix a payment already in the wrong place, use your software's transfer tool so the move nets to zero and leaves a record. In Open Dental, an income transfer must add up to $0.¹⁷ Check that money goes to the right provider too, since provider totals depend on it.¹⁸

Virtual card payments mixed in

Why: Some plans pay with a one-time card number. Card networks usually charge a percentage fee, and HHS does not regulate those fees.⁴ A card payment is settled through the card network, not sent as an ACH direct deposit, and the federal trace-number rules cover only ACH payments. So don't count on the card deposit carrying the trace number you use to match an ACH payment to its ERA.⁴

Fix: Post card payments under their own payment type so they stay separate from checks and EFTs.¹⁰ If you'd rather get standard EFT and ERA, ask the plan and finish its EFT and ERA enrollment. CMS says the plan must comply, in network or not.⁴ More in our guide to matching deposits to ERAs.

Checklist

• Post every insurance payment by procedure.
• Match each deposit to its ERA by trace number, and post multi-claim payments as one batch.
• Keep unmatched ERAs and deposits on a list. For EFT, chase them after four business days.
• With two plans, post one write-off, after both have paid.
• Check the original EOB before you refund anything.
• Note every takeback on both accounts it touches.
• Send your full fee on claims. In network, check your contract before billing the patient more than their share on the EOB.
• Fix misplaced money with a transfer that nets to zero, and leave a note.
• Give virtual card payments their own payment type.