The client
A multi-location dental group whose accounting team handled insurance claims and payment posting for every practice, working from carrier remittances and paper Explanations of Benefits (EOBs).
The challenge
Once a claim left the practice, it disappeared into a black box. Status lived in carrier portals, payments arrived as ACH deposits and remittance files, and someone had to tie all of it back together by hand — often after hours.
- There was no single view of claim status by patient or by location, so chasing unpaid claims meant digging through portals one at a time.
- Electronic Remittance Advice (ERA) files and EOBs were reconciled manually, line by line, against deposits and the books.
- Payment posting to the general ledger was slow and prone to keying errors.
- Denials were hard to spot in time, so revenue slipped through the cracks before anyone noticed.
What we built
A claims and reconciliation module that tracked every claim through to payment and posted the money automatically, reconciled to the books:
- Claims tracking showing status and amount by patient and by location, in one place rather than scattered across portals.
- Automated ERA/EOB parsing that read remittance files and Explanations of Benefits and matched them to the right claims.
- Automated payment posting reconciled to the general ledger, turning the accounting team's job from re-keying into review.
- Denials visibility that surfaced rejected and short-paid claims early enough to act on them.
We mapped the real claims-to-cash flow first, built reconciliation logic that matched how the books actually worked, and tuned the parsing and posting rules with the accounting team's feedback throughout.
The results
- Claim status was visible in one place, so unpaid and stuck claims could be chased without portal-by-portal hunting.
- Reconciliation shifted from manual line-by-line matching to automated posting the accounting team simply reviewed.
- Denials and short-payments surfaced early enough to work, instead of being discovered weeks later.
- Payments reconciled cleanly to the general ledger, reducing the after-hours catch-up.
Why it worked
The module followed the money the way the team already thought about it — claim to remittance to ledger — and automated the highest-friction step, reconciliation, while keeping people in control of review. Built and refined as an ongoing partnership, shaped by the accounting team using it every day.