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Module 6 · Payment Posting & Accounts Receivable
Lesson 2 of 5

ERA, EFT and Payment Reconciliation

An EFT moves money; an ERA explains the adjudication behind the payment. Reconciliation connects the bank deposit, remittance advice and billing-system posting so all three agree.

Intermediate18-22 minFree lesson

EFT vs. ERA

ItemPurpose
EFTTransfers payment funds electronically to the provider bank account.
ERAExplains claim adjudication and payment/adjustment detail in the standardized X12 835 transaction.

CMS notes that the trace information associated with the EFT and ERA supports reassociation - matching the payment with the remittance that explains it.

Basic reconciliation workflow

  1. Confirm the bank/EFT deposit amount and payer.
  2. Locate the corresponding ERA or remittance.
  3. Compare trace/reference information where available.
  4. Confirm the ERA payment amount matches the deposit.
  5. Post claim and service-line activity.
  6. Balance the posting batch to the ERA and deposit.
  7. Research any variance before closing the batch.

Common unmatched-payment issues

  • ERA received before or after the bank deposit.
  • Multiple claims included in one payment.
  • One payer sending payments under different plan or trading-partner names.
  • Missing or incorrect trace/reference information in internal workflow.
  • Manual deposits or paper checks without an immediately available remit.
  • Recoupments or offsets that change the net payment.
CMS standard: The adopted standard for the electronic remittance advice is X12 Version 5010 835. The ERA contains adjudication and adjustment information that can support automated posting.

Quick knowledge check

What does the EFT do?

It transfers money to the provider bank account.

What does the ERA do?

It explains the claims and adjustments associated with payer adjudication and payment.

What is reassociation?

Matching an EFT payment to the correct ERA/remittance using trace and related information.

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Training note: This material is for education and staff development. Payer rules, plan benefits, coding guidance, contracts and regulations change; learners should verify current requirements with authoritative payer, CMS and coding resources when performing real billing work.