The Deposit Matched, Yet The Payment Still Needed Reconciling.
A fictional EFT and ERA scenario shows why deposit balancing, remittance detail, and account posting can tell different parts of the story.
One number can balance while three stories disagree
Fictional deposit batch 742 showed an EFT total of $412.37. The bank deposit matched $412.37, so the batch looked finished. The ERA, however, described multiple claims, a reversal, a provider-level adjustment, and a line-level payment that did not match the first account someone opened.
Nothing about the bank match proved that every account was posted correctly. It proved that the money moved. The ERA explained how the payer described the money. The account system showed how the organization translated that description into balances. Reconciliation is the work of making those three stories agree or documenting why they cannot yet agree.
Reconcile the whole payment before chasing the loudest line
The first temptation was to compare one claim’s expected amount to the EFT. That was the wrong unit of analysis. The EFT covered a group of claims and adjustments. The useful sequence was to list every claim and service-line payment, then separately list provider-level adjustments, recoupments, reversals, and any transactions that changed the deposit total.
That sequence makes the “missing” amount visible without pretending that a PLB or reversal belongs to one patient account. It also prevents the opposite error: forcing every difference into a patient balance because the batch has to tie somewhere.
The account posting question comes after the remittance question
Once the ERA is understood, the posting review can ask whether the account received the correct payment, adjustment, responsibility, reversal, and reference information. A posting screen may be internally consistent and still be wrong if the remittance was misunderstood. It may also be correct while the expected amount was built from the wrong contract assumption.
The companion worksheet keeps those questions separate. It has a batch section, a remittance section, an account section, and an unresolved-difference section. That is less glamorous than declaring the batch balanced, but it is more useful.
A clean reconciliation leaves an explanation behind
The final fictional note for batch 742 says the bank total matched, the ERA total was decomposed into claim and provider-level components, the account postings were checked, and one reversal remained on hold pending the payer’s reference. That is a complete status even though one question is still open.
Reconciliation is not the absence of differences. It is knowing which differences are explained, which are actionable, and which still need evidence.
References & further learning
These sources were reviewed on 2026-10-26. A payer, MAC, employer, or organization may publish additional instructions that must be checked separately.
- CMS: Health Care Payment and Remittance Advice — explains the role of remittance advice and adjustment codes.
- CMS: Medicare Claims Processing Manual, Chapter 24 — provides background on electronic administrative transactions.
- X12: Remittance Advice Remark Codes — provides the code-list context for additional remittance explanation.
Revenue Cycle Uncovered is an independent educational resource. Content is provided for general informational purposes and does not represent the policies, practices, or positions of any employer or organization. Workflows, payer requirements, regulations, and operational practices may vary. Information should be independently verified when applied to specific situations.
Companion resource: EFT/ERA/Deposit Reconciliation Scenario
Use this fictional batch worksheet to reconcile the bank amount, remittance detail, provider-level adjustments, and account posting story.
| Reconciliation layer | Amount/detail | Evidence source | Status or next step |
|---|---|---|---|
| Bank/EFT | |||
| ERA claim/service lines | |||
| PLB/recoupment/reversal | |||
| Account postings |
Revenue Cycle Uncovered is an independent educational resource. Content is provided for general informational purposes and does not represent the policies, practices, or positions of any employer or organization. Workflows, payer requirements, regulations, and operational practices may vary. Information should be independently verified when applied to specific situations.
Editable companion
This Word edition preserves the fields and working table of the existing printable companion and includes a completed fictional sample. Edit it offline for another exercise; the original blank printable remains available.
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Revenue Cycle Uncovered is an independent educational resource. Content is provided for general informational purposes and does not represent the policies, practices, or positions of any employer or organization. Workflows, payer requirements, regulations, and operational practices may vary. Information should be independently verified when applied to specific situations.