Posting insurance payments in RXNT ensures accurate financial records, proper claim resolution, compliance with payer requirements, and clear billing for both insurance companies and patients. This article walks you step by step through creating, reviewing, and posting insurance payments, including ERA payments, while explaining common scenarios, errors, and best practices.

Insurance payments tab

Click on the Insurance Payment tab in the top Navigation Bar. You will be taken to the Insurance Payment screen, which displays all insurance payments in the system.

• Unposted – Payments ready to be reviewed and posted (ERAs and saved manual payments)
• In Progress – Payments currently being posted
• Posted – Successfully posted payments
• All – All insurance payments, regardless of status

Insurance payment queue

The queue streamlines your workflow by letting you process payments sequentially while keeping the entire batch organized. This approach helps reduce errors, saves time, and ensures each payment is reviewed thoroughly before posting. It also makes managing large volumes of payments easier, improving accuracy and overall efficiency in payment processing.

In the Unposted Tab, you can select multiple payments and review them one by one using a queue. To do this, check the box next to each payment you want to include, then click Open Queue. 

 

A queue containing the selected insurance payments will open automatically, displaying the first payment on the screen along with the total number of payments selected. From this view, you can review, edit, and post each payment individually. Click Next Payment to move through the remaining payments in the order they were selected, or click Previous Payment to return to a payment you’ve already reviewed.

Click the Errors tab to verify if any corrections are required before the payment can be posted. Clicking on the error will navigate you to the exact error. Once resolved, the error will move to the Resolved tab. 

Both Unresolved and Resolved tabs include Error Types that allow you to filter errors by Blockers, Warnings, or Both. The blocker and warning levels are shown across three different levels: Patient, Payment, and Encounter. 

The fields highlighted in red are blockers, indicating that these need to be corrected before saving or posting the payment. Those highlighted in yellow are warnings, suggesting that information may need to be entered into the field.

After reviewing or editing the payment, click Save to apply your changes, then select Next Payment to continue. 

Or, click Save & Post to post the payment. You’ll be automatically taken to the next payment in the queue. 

The previous payment will display In Progress while posting and will update to Posted once complete.

You can exit the queue at any time by clicking Exit Queue.

A confirmation message will appear, informing you that once you exit, the queue will no longer be accessible. If you choose to continue, click Exit to confirm. You will then be redirected back to the Unposted tab, where you can return to the remaining payments at a later time if needed.

Once the payments have been posted, they will be displayed under the Posted tab. 

To search for payments within a specific date range, adjust the Date From and Date To fields, then click Search. Expanding the date range is helpful when you need to locate older payments, review transactions from a particular billing period, reconcile monthly or quarterly records, or investigate a payment that was received outside the default date range.

Creating and posting insurance payments

Manually creating and posting insurance payments may be necessary when an Explanation of Benefits (EOB) is received and Electronic Remittance Advices (ERAs) are not available or not being received. In these situations, you can use the information provided on the EOB to apply payments, adjustments, and denials accurately.

Click New Payment. 

Select the Payment Method from the dropdown menu. If the method selected is Check or Electronic Fund Transfer, enter a check or electronic fund transfer number in the Check Number field.  If you enter a check or EFT number that has already been used, you will receive an error message indicating that it’s already in the system. Enter the Payment Amount and Payment Date

Adding a Payer and Penalty amount is optional and is usually done when you need to document reductions such as late filing penalties, authorization-related penalties, or other payer-imposed deductions. The Payer selected here is used for reporting and display purposes. Users can select a payer for each encounter on the next screen. 

The payment Unapplied amount will be equivalent to the payment amount until payments are assigned to the line items. As soon as payments are assigned to line items, the Payment Unapplied decreases by the assigned amount, and the Payment Applied amount increases by the assigned amount. The Payment Number remains blank until the payment record is created. 

Click Create Payment. 

Payment details

The payment details you entered are displayed at the top of the screen. This includes key information such as the payment amount, payer, date, and any associated penalties or adjustments. If needed, you can edit this information before posting the payment to ensure accuracy. 

Link patients

Patients need to be linked to insurance payments to ensure that payments, adjustments, and balances are applied to the correct accounts and claims. Linking patients allows the system to accurately distribute payments across services, update account balances, and calculate any remaining patient responsibility.

To begin, search for the patient using Last Name, First Name, Account Number, Chart Number, or Claim Number.

Enter the search criteria in the Search Patient field, then select the appropriate patient to link the payment. The Patient Name and Chart Number, if applicable, will be displayed in the Patients Linked section.

To add new patients into the system, click the (+) Sign. This will automatically open the Patient Profile screen. Once you enter and save the patient information, the patient will be linked to the payment automatically. 

Unlink patients

If a patient was linked in error, they can be unlinked. This ensures that payments are applied accurately and prevents incorrect account balances or misapplied funds.

Click the Chain icon to unlink a patient from the payment.

A confirmation popup will appear, click Unlink.

Link encounters

Once you’ve linked your patients, you must also link the corresponding encounter before applying the payment. Linking the encounter ensures that the payment is applied to the correct services or procedures on the patient’s account.

The Encounters section includes three tabs: 

• Linked – The Linked tab displays all encounters that have already been linked to the payment.
• Unlinked – The Unlinked tab is selected by default when linking a new patient. It shows all encounters associated with the patient that have not yet been linked to the payment.
• Unlinked & Settled – The Unlinked & Settled tab displays all unlinked encounters, including those with a zero balance. Settled encounters are typically linked when a changeback or recoupment has been received.

Click the link Chain icon to link the appropriate encounter.  

The encounter will be placed in the Linked tab.

Please note that the system will automatically save your work when you perform any of the following actions:

• Linking a patient
• Linking an encounter
• Switching between patients
• Switching between encounters
• Adding a new encounter
• Adding a new patient

The last saved time will be displayed at the top of the screen to confirm the auto-save before you proceed further.

Important: Auto-save does not create a version in the history. A record of changes is only saved when you click the Save button. This ensures that only finalized updates are stored in the change history.

When you click the Link Chain icon under the Linked tab, you can unlink encounters and move them back to the Unlinked tab. This allows you to correct mistakes and reassign payments if needed.

A confirmation popup will appear to ensure that you want to proceed. Click Unlink to confirm the action. Once unlinked, the encounter will no longer be associated with the payment and will be available in the Unlinked or Unlinked & Settles tabs for future linking. 

Line items

The line items section provides a detailed view of all individual charges associated with a claim. Each line item displays the specific CPT codes linked to the corresponding charges, allowing for accurate documentation, billing, and verification of services rendered.

In the encounter line item section, enter the payment details.

Select the Payer. This payer drop-down is populated from the selected encounter’s case. The line item balances and Requeue payer are assigned correctly based on the chosen payer.

The date of service or date range is also accessible by hovering over the (i) information icon beside each CPT code line item.   

Select the Payment Type. This is populated from the payment transactions saved in the system.

Line item statuses should be selected based on the current state of a claim, such as when it has been denied, needs resubmission, is awaiting payment, or if a line item should be ignored. Each status determines how the line item is handled and whether fields are editable.

1. Rework Denial

• Use this status when a payer denies the claim, but the claim is resubmittable.
• Line item fields cannot be edited in this status.
• Line items remain under the current payer’s responsibility and the claim is moved to the Denied / Left Open tab.

2. Accept & Rework Denial

• Use this status when a payer denies the claim, but you wish to accept any payment received and then rework the denial.
• Line item fields remain editable.
• Line items stay under the current payer’s responsibility, and the claim moves to the Denied / Left Open tab.

3. Awaiting Payment

• Select this status for line items that have not yet received payment from the payer.
• If a payer partially pays for an encounter, leaving some CPT codes unpaid, use this status for the unpaid line items.
• Line item fields cannot be edited, keeping responsibility with the current payer and moving the claim to the Denied / Left Open tab.

4. Ignore Line Item

• Use this status when no data entry is required for a line item in the payment.
• Line item fields cannot be edited.
• The line item remains under the current payer’s responsibility and the claim is moved to the Denied / Left Open tab.

5. No Requeue

• Select this option if the line item should not be requeued.
• Line item fields remain editable.
• The line item moves to the next payer’s responsibility without placing the claim in the Denied / Left Open tab.

In the Requeue section, the information regarding the next responsible payer will be displayed. If the next payer in responsibility is the patient, the Requeue field will display "No Payer.” Additionally, when any one of the line item statuses is chosen, the Requeue field will display "No Payer.” Based on this logic, the Patient Balance and Insurance Balance will be displayed. Hovering over the information (i) icon will show the total of all past patient and insurance payments.

Enter the Allowed amount. Once you’ve entered the Allowed amount, the Disallowed amount will auto-populate for payers. However, both these fields can be edited. 

If applicable enter a Co-Insurance (PR-2), Co-Payment (PR-3), Deductible (PR-1), or Other Patient Responsibility (OPR) in the respective fields.  

Enter the Payment amount. 

If applicable, enter a Write-Off amount.

The Adjustment Total amount will automatically populate based on the Disallowed amount and any other adjusted amounts.

Choose the Adjustment Type from the dropdown menu, which includes Insurance or Patient.  

Select the Adjustment Code from the dropdown menu. 

If applicable, enter any additional adjustment amount in the Adj column.  

When Insurance Only is selected in a patient’s case, the system automatically writes off the patient balance once responsibility transfers to the patient. Click here to Learn more about patient cases! This write-off is reflected in the Adj. Code column. However, if the line item status is set to Accept & Rework Denial or No Requeue, the insurance-only adjustment can be edited or removed without requiring an update to the patient case.

Miscellaneous payments

Miscellaneous Payments are used to record payments that are not directly tied to a specific claim or line item, such as refunds, interest payments, overpayment recoveries, or other non-standard transactions. 

To add a miscellaneous payment, click the “+” icon.

Select the Insurance, Payment Code, and Reason Code from their respective dropdown menus, then enter the Payment Amount. 

Errors

Click the Errors tab to verify if any corrections are required before the payment can be posted. Clicking on the error will navigate you to the exact error. Once resolved, the error will move to the Resolved tab. 

Both Unresolved and Resolved tabs include Error Types that allow you to filter errors by Blockers, Warnings, or Both. The blocker and warning levels are shown across three different levels: Patient, Payment, and Encounter. 

The fields highlighted in red are blockers, indicating that these need to be corrected before saving or posting the payment. Those highlighted in yellow are warnings, suggesting that information may need to be entered into the field.

Miscellaneous actions

Additionally, by clicking the three dots, you can access options such as:

• Attach Documents – Allows you to upload supporting files or documents directly to the payment for reference or record-keeping.
• View History – Displays a log of all changes, saves, and actions taken on the payment, so you can track updates over time. 
• Audit Log – Provides a detailed record of who accessed or modified the payment, including timestamps, for compliance and tracking purposes. 
• Delete – Removes the payment from the system. Use with caution, as deleted payments may not be recoverable. 
• Reprocess ERA – Use this option to restore the original ERA allocation for a payment. If any changes were saved or draft-saved after the initial allocation, clicking Reprocess ERA will revert the payment back to its original ERA data. After entering CONFIRM and selecting Continue, the current payment will be deleted, and a new payment with the same check number will be recreated in the Unposted tab within a few minutes.
• Custom Fields – Allows you to view any additional fields that have been added to the screen. Optional fields can be left blank and the payment can still be saved. Required fields, however, must be completed before the payment can be saved.

To add a note, click Notes. This allows you to enter additional information, comments, or reminders related to the record, helping provide context or clarification for future reference. 

Enter the note details in the Notes field. If the note requires special attention, select the Alert checkbox. Once complete, click Add Note to save it. The note will then appear in the list below. Click Close to exit the notes window.

Save or save & post

To save the payment without posting it, click Save. This creates a saved version that can be viewed in View History. To save and post the payment, click Save & Post.

• Unposted payments that are saved or draft-saved will not appear in reports as posted payments, and their posted dates will not display in the grids.
• If a user backdates the posted date on an unposted payment and then saves or draft-saves it, the backdated date will not be retained when the payment is reopened. Instead, the posted date will default to the date the payment is accessed. This behavior is explained when hovering over the information (i) icon.

To cancel the payment, click Exit. This will close the payment screen without saving or posting any changes. If you have made changes that you want to keep, make sure to Save or Draft Save before exiting. 

Post ERA payments

ERA (Electronic Remittance Advice) payments can be reviewed and posted from the unposted insurance payments, but they can also be posted directly from the pending ERAs. These electronic remittances help practices and billing teams process payments more efficiently, reduce errors compared to paper explanations of benefits, and provide a clear, auditable record of all insurance transactions.

From the Application Dashboard, click the Pending ERAs alert to navigate to the ERA tab. From there, you can view and manage both Pending and Resolved ERAs.

In the Pending tab, you will see a list of ERAs that have been successfully processed as well as those that contain errors. 

Errored ERAs will have an explanation of the error and associated next steps in the Processed Status Message column. Hover over the error message to view the entire message. If you need further details, click on the Icon in the first column. Follow the instructions provided in the message. 

When an ERA comes in with missing payer information, an Edit Icon will appear next to the Process Status column. 

Click the Edit Icon to link the payer. 

Enter the payer's name in the Payer Name field, then select the correct payer from the dropdown menu to include their information in the EDI.

Click Link Payer & Continue Processing. 

Reprocessing the ERA will create a new payment with the payer's name and delete the previous payment associated with that check number. 

Click the Payment Number under the Posted tab for a successfully processed ERA.

The insurance payment pop-up opens with all details automatically populated from the ERA. The payment details are located at the top of the screen. Below the payment details, you will see the encounter and line item details section.  

The ERA is processed with all validations automatically populated within the payment. In the Errors tab, there are two views: Unresolved and Resolved. By default, the Unresolved view is displayed and shows errors that still require action. The Resolved view lists errors that have already been addressed. To quickly post ERA payments, navigate directly to the Errors tab, resolve any blockers, and then proceed with posting the payment.

You can click an error message to navigate directly to the corresponding field or location in the payment. Once an error is corrected, it is moved to the Resolved view. After all blocker errors have been resolved, the payment can be saved or posted.

If no action is taken on warnings, they will remain in the Unresolved view but will not prevent saving or posting the payment.

Warning messages may appear when you hover over the warning icon at the top of the payment or within the Errors tab. Each warning message provides guidance on the recommended next steps. You can identify such warnings by their display location or behavior, when fields aren’t highlighted for that specific warning or when the message is displayed when hovering over the warning icon on top of the payment.

A special blocker error occurs when the ERA payment is received at the encounter level. Such an error is displayed within the error banner and will be resolved once the blocker has been addressed. 

Next to the Errors tab is the Patients & Encounters tab. Select this tab to view a list of all patients and encounters associated with the ERA. From this tab, you can link or unlink patients and encounters, add a new patient or encounter, and, if needed, access related areas such as the patient dashboard, patient profile, encounter details, cases, and the ledger.

To quickly navigate between patients, use the arrows in the top-right corner of the line item details. Clicking the Right Arrow moves to the next patient, while clicking the Left Arrow moves to the previous patient.

The date of service or date range for each CPT code line item can be viewed by hovering over the (i) information icon next to the line item. 

If there is a denial and denial management is turned on for your company, the line item status changes to “Accept and Rework Denial,” and the denial code gets populated. The adjusted amount will be 0, except for special cases.

If there is a cross-over claim, the line item status changes to “No Payer.”  

If there is a requeue payer, the Requeue Payer field displays the payer name. However, you can change the line item status based on your practice’s workflow.

Miscellaneous codes are usually populated from the ERA’s PLB. If not, click the “+” icon to add a miscellaneous payment. Select Insurance from the dropdown to see payers for the patient’s encounter, then choose a Payment Code and a Reason Code from the available options. Enter the payment amount in the Amount field.

To print the ERA or its summary, click on the icons Print ERA or Print ERA Summary located at the top right of the screen. 

To save the payment without posting, click Save. This will save a version in the View History.

• Unposted payments that are saved or draft-saved will not appear in reports as posted payments, and their posted dates will not display in the grids.
• If you backdates the posted date on an unposted payment and then saves or draft-saves it, that date will not be retained when the payment is reopened. Instead, the posted date will default to the date the payment is accessed. This is explained when hovering over the information (i) icon.

Alternatively, to save and post the payment, click Save & Post. It's important to resolve any blocker validations before proceeding with either action. 

Additionally, clicking the 3 dots you can access options such as:

• Attach Documents – Allows you to upload supporting files or documents directly to the payment for reference or record-keeping.
• View History – Displays a log of all changes, saves, and actions taken on the payment, so you can track updates over time. 
• Audit Log – Provides a detailed record of who accessed or modified the payment, including timestamps, for compliance and tracking purposes. 
• Delete – Removes the payment from the system. Use with caution, as deleted payments may not be recoverable. 
• Reprocess ERA – Use this option to restore the original ERA allocation for a payment. If any changes were saved or draft-saved after the initial allocation, clicking Reprocess ERA will revert the payment back to its original ERA data. After entering CONFIRM and selecting Continue, the current payment will be deleted, and a new payment with the same check number will be recreated in the Unposted tab within a few minutes.
• Custom Fields – Allows you to view any additional fields that have been added to the screen. Optional fields can be left blank and the payment can still be saved. Required fields, however, must be completed before the payment can be saved.

To exit the payment without resolving blockers, simply click the "X" button and select Draft Save to save your progress. 

Helpful tips and items to note: 

• Patient Payments and Insurance Balance:
  If a patient pays for a visit (e.g., a copay), the payment is not included in the insurance balance billed to the next payer in priority. Patient payments only affect the line item balance. This approach ensures that subsequent payers are billed the maximum allowable amount, helping to maximize reimbursement. Always ensure the insurance balance is correct so that the proper amount is billed to the next payer in priority.
  
• Requeue Payer Field:
  The Requeue Payer field shows the next payer responsible for each line item. The priority order is: Primary → Secondary → Tertiary. If a payer makes a payment out of order, the claim is automatically requeued to the higher-priority payer among the remaining payers.
  
• Crossover Claims:
  When claims are crossed over, the line item status is automatically set to No Requeue.
  

Errors and Warnings:

• Blockers (Red): Payments cannot be saved or posted until all blockers are resolved.
  
• Warnings (Yellow): Payments can be saved or posted even if warnings are active.
  
• Unresolvable Warnings: Some warnings cannot be resolved for ERA payments—for example, if the ERA cannot find certain encounter line items, a valid claim is missing, or an adjustment code cannot be found. These warnings are identifiable when fields are not highlighted or when the validation does not have a Resolve button.
  
• Encounter-Level Blocker: A special blocker occurs when an ERA payment is received at the encounter level. This error is displayed in the error banner and can be resolved by clicking the Resolve button.

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