Payment tracking and reconciliation

Purpose

1.1. Automate the full cycle of payment tracking and reconciliation for ABA therapy providers: capturing client payments, verifying against claims, flagging discrepancies, updating records, reconciling remits, and triggering follow-ups.
1.2. Ensure revenue visibility, accuracy in postings, reduced manual workload, and real-time payment status for streamlined billing and insurance workflows.
1.3. Integrate multiple payment sources (insurers, clients, clearinghouses) with EHR and accounting systems for audit-ready payment trails.

Trigger Conditions

2.1. New Payment file uploaded (ERA/EOB remittance or direct ACH notification)
2.2. Update posted in PMS/EHR (invoice status changed, partial payment added)
2.3. Payment mismatch detected between insurer deposit and billed claim.
2.4. Manual intervention required flag set in EHR or billing portal.

Platform Variants

3.1. Waystar
• API: Payment Posting API — configure webhook for inbound ERAs, map to patient account.
3.2. Office Ally
• Feature: Automated Remittance — enable automatic EOB/ERA imports to billing queue.
3.3. Availity
• API: ERA Retrieval — schedule job to pull new remittance advices and parse payments.
3.4. SimplePractice
• Feature: Payment Reports sync — configure auto-download of daily statements.
3.5. TherapyNotes
• Feature: Payment Integration — enable auto-post for insurance remittances.
3.6. TheraNest
• API: Ledger Entry — automate creation of payment and adjustment entries from files.
3.7. CentralReach
• Feature: Claims Payment Reconciliation — set up job to flag under/overpayments.
3.8. Kareo
• API: Payment Record POST — auto-post insurer and client payments to ledgers.
3.9. QuickBooks Online
• API: Payment Import — use payments endpoint to sync receipts and reconcile deposits.
3.10. Xero
• Feature: Bank Feed Matching — configure rule to auto-match insurance deposits to invoices.
3.11. Stripe
• Webhook: Payment Successful — auto-sync patient co-payments to clinic billing record.
3.12. Square
• API: Transaction Reports — schedule download and map patient self-pays to accounts.
3.13. Cleardent
• Feature: Integrated EFT Posting — enable auto-match of remit files to appointments.
3.14. Change Healthcare
• API: Remittance Manager — poll for new ERAs and process incoming payment data.
3.15. Athenahealth
• API: Payments — fetch ERA data and cross-reference patient account numbers.
3.16. Medisoft
• Feature: Payment Import Utility — configure batch import jobs for insurer payments.
3.17. CareCloud
• API: Payments Module — set rule for ERAs to auto-update client balances.
3.18. Denmaar
• Feature: Remittance Parsing — auto-extract payment info from files to the patient ledger.
3.19. PracticeSuite
• API: Payment Automation — auto-apply payments, write-offs, and denial codes.
3.20. AdvancedMD
• Feature: ERA Automation — enable background process for real-time pay/post.

Benefits

4.1. Reduction in manual errors and posting delays, eliminating missed or duplicated payments.
4.2. Real-time payment status visibility for therapists, administrators, and finance teams.
4.3. Faster monthly reconciliations and more accurate end-of-day closings.
4.4. Automatic triggers for denial or mismatch follow-up, speeding revenue recovery.
4.5. Audit-ready and transparent records meeting payer and compliance requirements.
4.6. Scalable operations, able to handle high-volume multi-payer transactions.