Setup
Posting rules and reason codes
Decide what happens to each adjustment code on a remittance, and keep your clinic's own reasons for manual adjustments.
A remittance (ERA) explains every amount a payer did not pay with an adjustment: a group code that says who owns the amount and a reason code (CARC) that says why, sometimes with a remark code (RARC) that adds detail. Posting rules tell NeatPractice what to do with each one when it posts the remittance.
Open Setup > Billing setup > Posting Rules.
Group codes#
| Group | Meaning |
|---|---|
CO | Contractual obligation: the clinic agreed not to bill this amount to the patient |
PR | Patient responsibility: deductible, coinsurance, copay and similar amounts |
OA | Other adjustment, often an amount another payer already covered |
PI | Payer initiated reduction |
CR | Correction and reversal of an earlier claim |
What a rule can do#
- Write off: take the amount off the balance with an adjustment type. Leave the type empty to use the built-in Contractual adjustment type.
- Move to next payer or patient: pass the amount to the claim's next payer, or to the patient when there is none.
- Move to patient: pass the amount straight to the patient.
- Send to review: hold the claim so a biller looks at it before anything posts.
How NeatPractice picks a rule#
For each adjustment, NeatPractice uses the first rule that matches, in this order:
- A rule for the remittance's payer, with the same group and reason code.
- A rule for all payers, with the same group and reason code.
- The group's default rule (a rule with no reason code).
Within a step, a rule that names a remark code on the adjustment wins over one that names no remark code. Inactive rules are skipped. When no rule matches, the claim goes to review, so a new or unusual code is never posted blind.
The starter rules#
A new clinic starts with these rules for all payers. Change them to suit your contracts.
| Adjustment | Rule |
|---|---|
CO-45, CO-59, CO-253 | Write off as contractual |
PR-1, PR-2, PR-3 | Move to next payer or patient |
| Any other code in each group | Send to review |
Add a rule#
- Click New Posting Rule.
- Choose the Group code.
- Type a Reason code (CARC) and pick it from the list. Leave it empty to set the group's default rule.
- Optionally pick a Remark code (RARC) so the rule applies only when that remark is on the adjustment, and a Payer so the rule applies only to that payer's remittances. Both need a reason code; clearing the reason code makes the rule the group default and drops them when you save.
- Choose what Posting does and, for a write-off, the Adjustment type.
- Click Create Rule.
Each combination of group, reason code, remark code and payer can have one rule. Changing a rule affects remittances posted afterwards; amounts already posted keep the rule they used. A payer that a rule names cannot be deleted; remove or change the rule first, or deactivate the payer.
Reason codes for manual adjustments#
Reason codes on a remittance come from the payer. When your staff adjust a balance by hand, they pick one of your clinic's own reason codes instead. Open Setup > Billing setup > Reason Codes to manage them.
- Click New Reason Code.
- Enter a Code of 2 to 10 letters, digits or hyphens, such as
HARDSHIP. NeatPractice stores it in capitals, and each code is used once. - Enter a Description staff will recognize, such as
Financial hardship. - Click Create Code.
A new clinic starts with a few codes, such as HARDSHIP, PROMPTPAY and POSTERR. Turn off Active to stop
offering a code without removing it from past adjustments.
Export and print#
Click Export CSV to download the list as a spreadsheet file, or Print for a PDF of the list. See Import, export and print.