How to match insurance deposits to ERAs

What you're matching

• The deposit (EFT). The money itself. It arrives in your bank account as an electronic transfer. Your bank statement shows who sent it, the amount and the date.
• The ERA. The explanation. It's an electronic file (its formal name is the "835") that lists each claim in the payment: the patient, the procedure codes, what you billed, what was allowed and what was paid. It comes from your clearinghouse or the insurance company's website.
• Paper EOB and check. The same pair on paper. The EOB explains the check.

Matching means pairing each deposit with its ERA and checking that the totals agree before you post.

The number that links them

Every electronic insurance payment has a trace number. The ERA carries it in a section called TRN. Under the federal rules for health care payments, the insurance company also puts the same number on the bank transfer itself, in an extra field that travels with the deposit.¹

Same trace number on both sides means it's a match. For a paper check, the check number does the same job.

Tip: many banks don't show that extra field on your statement unless you ask.² Call your bank and ask them to show the "reassociation trace number" for insurance deposits, in online banking or on your statement.

Why one deposit covers many claims

An insurance company usually bundles many claims, often for many patients, into a single payment. One deposit has one trace number and one ERA. The ERA's total should equal the deposit, and the claims inside it add up to that total.

So don't look for one deposit per patient. Look for one ERA per deposit.

Why the amounts don't always line up

• Claim adjustments. Write-offs, deductibles, coinsurance and frequency limits change what each claim pays. They're explained with adjustment codes on each claim line. They don't change whether the ERA total equals the deposit.
• Adjustments at the bottom of the ERA. Some changes aren't tied to one claim. They sit in a section at the end of the ERA called PLB. A common one is code WO, which takes back an earlier overpayment.³ These lines can make the deposit smaller (or larger) than the claims added together.
• Take-backs from later payments. If an insurance company overpaid you before, it may take that money out of a later payment. The claims on the ERA look fully paid, and a line at the bottom takes money back.
• Timing. The ERA and the deposit don't always arrive the same day. The industry rule asks insurance companies to send them within three business days of each other.¹

Virtual credit cards

Some insurance companies pay with a virtual card: a card number sent by fax, mail or email that you run like a card payment, usually with card processing fees. Federal guidance says a health plan can't require you to accept virtual card payments, and you can ask for electronic transfers (EFT) instead.⁴ To get EFT and ERAs, you sign up with each insurance company you bill.

A simple routine

Pick a regular time, daily or a few times a week, and follow the same steps.

1. List new insurance deposits from your bank: date, who sent it, amount and trace number.
2. Download new ERAs from your clearinghouse or the insurance companies' websites.
3. Match by trace number first. If there's no trace number, match by insurance company, amount and date.
4. Check the totals. The ERA's total paid, after the lines at the bottom, should equal the deposit.
5. Explain any difference. Look at the bottom of the ERA for take-backs, interest or fees.
6. Post the claims in your practice software from the ERA, then mark the deposit as matched.
7. Follow up on leftovers. A deposit with no ERA: ask the insurance company for the remittance. An ERA with no deposit: check for a paper check, a virtual card or a payment that's still on its way.
8. Keep a simple log of what matched and what's still open.

Common mistakes

• Posting from the ERA before checking that the money arrived.
• Matching by amount only. Two payments from the same insurance company can be close in size.
• Skipping the lines at the bottom of the ERA, so take-backs never get recorded.
• Not asking the bank to show trace numbers.
• Letting unmatched items wait. A short weekly follow-up keeps the list small.

Checklist you can print