When Insurance Pays But the Ledger Doesn't Match

The bank shows a $12,847 deposit from Delta Dental. Your ledger shows $11,392 posted. Where is the other $1,455?

The Mismatch Problem

Insurance payment mismatches are among the most common and frustrating reconciliation issues in dental practices. You know money came in, but the numbers do not line up.

These mismatches matter. The gap could represent:

• Revenue you earned but did not record
• Posting errors that affect patient balances
• Missing claims that need attention
• Potential fraud indicators

This guide helps you systematically identify and resolve insurance payment mismatches.

Types of Mismatches

Bank Higher Than Ledger

More was deposited than posted.

Possible causes:

• Payments not posted yet
• Payments posted to wrong date
• ERA not fully processed
• Payment for claims you did not recognize

Impact if not resolved:

• Unidentified deposit on books
• Patient accounts understated
• AR overstated
• Revenue potentially missed

Ledger Higher Than Bank

More is posted than was deposited.

Possible causes:

• Payment posted but not yet received
• Check not deposited
• EFT enrollment issue
• Posting error

Impact if not resolved:

• Cash overstated
• May have recorded revenue not received
• Patient accounts may be wrong

Different Distribution

Totals match but claim-level amounts differ.

Possible causes:

• Posting errors on individual claims
• Adjustments applied incorrectly
• Patient portions calculated wrong

Impact if not resolved:

• Patient balances wrong
• Insurance AR incorrect
• Follow-up confusion

Systematic Troubleshooting

Step 1: Verify the Deposit

Start with the bank side.

Confirm:

• Exact deposit amount
• Deposit date
• Payer identification
• Trace number if available

Document: Write down these details for reference throughout investigation.

Step 2: Locate the ERA

Find the remittance documentation.

Sources:

• Clearinghouse portal
• Payer portal (e.g., Delta Dental, Cigna)
• Paper EOB if not electronic
• Auto-posted ERA in PMS

Verify:

• ERA total matches deposit amount
• ERA date aligns with deposit timing
• Trace numbers match if available

Step 3: Compare ERA to Postings

Claim by claim verification.

Process:

1. List all claims on ERA with amounts
2. Verify each claim is posted in PMS
3. Verify each posting amount matches ERA
4. Note any discrepancies

Common findings:

• Claims on ERA not posted
• Claims posted with wrong amounts
• Claims posted to wrong patients
• Adjustments not applied

Step 4: Investigate Discrepancies

For each discrepancy found:

If claim not posted:

• Was it overlooked?
• Was it rejected by auto-posting?
• Is it for a patient not in your system?

If amount wrong:

• Typo during manual entry?
• Auto-posting misread ERA?
• Adjustment calculated incorrectly?

If patient wrong:

• Similar names confused?
• Subscriber vs dependent?
• Wrong family member selected?

Step 5: Make Corrections

Fix what you find.

For unposted claims:

• Post payment to correct patient/claim
• Apply adjustments per ERA
• Update patient balance

For incorrect amounts:

• Adjust the payment
• Correct adjustment amounts
• Recalculate patient balance

For wrong patient:

• Reverse from wrong patient
• Post to correct patient
• Verify both accounts

Step 6: Verify Resolution

Confirm the mismatch is resolved.

Check:

• Total posted now matches deposit
• Individual claim postings are correct
• Patient balances are accurate
• Documentation supports changes

Common Mismatch Scenarios

Scenario 1: Multiple ERAs in One Deposit

Situation: Deposit is $15,000 but your ERA shows $8,500.

Cause: Insurance company combined multiple ERAs into single EFT.

Resolution:

1. Search for additional ERAs from same date
2. Add ERA totals to verify they sum to deposit
3. Ensure all ERAs are posted

Prevention: When deposit does not match ERA, always search for additional ERAs before investigating further.

Scenario 2: Take-Back Included

Situation: ERA shows $10,000 but deposit is $9,200.

Cause: $800 take-back for prior overpayment deducted from current payment.

Resolution:

1. Find the take-back on ERA (shown as negative)
2. Locate original claim being reversed
3. Reverse original payment posting
4. Bill patient if they now owe

Prevention: Review ERAs for negative amounts before posting.

Scenario 3: Auto-Post Rejection

Situation: ERA received but claims did not post automatically.

Cause: Auto-posting failed due to matching issues.

Resolution:

1. Check auto-post error queue
2. Identify why matching failed
3. Manually post or fix matching issues
4. Reprocess ERA

Prevention: Monitor auto-post completion daily.

Scenario 4: Wrong Practice

Situation: Deposit received but no matching ERA or claims.

Cause: Payment is for a different practice (common with group NPIs or shared Tax IDs).

Resolution:

1. Verify payer intended payment for you
2. If wrong practice, contact payer
3. May need to return and redirect payment

Prevention: Verify EFT enrollment is correct for your specific practice.

Scenario 5: Old Claims Paid

Situation: ERA includes claims you do not recognize.

Cause: Claims from long ago finally processed, or claims you did not submit.

Resolution:

1. Research claim dates and patients
2. Verify claims were actually submitted by you
3. Post if legitimate, investigate if not
4. Contact payer if claims are not yours

Scenario 6: Fee Schedule Differences

Situation: Payments per claim are less than expected.

Cause: Payer paid per their fee schedule, not your billed amount.

Resolution:

1. Verify you are posting per ERA (not per expectation)
2. Apply contractual adjustments correctly
3. Verify fee schedule with payer if payments seem wrong

Prevention: Regularly verify contracted fee schedules.

Prevention Strategies

Daily Matching

Match deposits to ERAs daily.

Process:

1. Identify all insurance deposits
2. Match each to ERA(s)
3. Flag any unmatched deposits
4. Investigate before next day

ERA Review Before Posting

Review ERAs before posting.

Check for:

• Negative amounts (take-backs)
• Unusual adjustments
• Claims you do not recognize
• Total matches expected deposit

Auto-Post Monitoring

Monitor auto-posting completion.

Daily checks:

• Auto-post queue cleared?
• Any rejections to address?
• Totals match deposits?

Monthly Reconciliation

Catch anything that slipped through.

Process:

1. Sum all insurance deposits for month
2. Sum all insurance payments posted
3. Investigate any variance
4. Resolve before closing month

When to Escalate

Contact the Insurance Company

When you need help from the payer:

Situations:

• Cannot locate ERA for deposit
• ERA and deposit do not match after investigation
• Payment appears to be for wrong practice
• Take-back seems incorrect

Have ready:

• Deposit details (amount, date, trace)
• ERA information if available
• Specific questions

Contact Your Clearinghouse

When ERA delivery is the issue:

Situations:

• ERAs not arriving
• ERAs arriving incomplete
• Auto-posting failures
• Integration issues

Involve Your Accountant

When the issue affects financials:

Situations:

• Large unexplained variances
• Pattern of mismatches
• Potential fraud concerns
• Month-end close implications

Documentation Requirements

For Each Investigation

Document what you found and did.

Record:

• Original mismatch identified
• Investigation steps taken
• Root cause determined
• Corrections made
• Verification that resolved

For Recurring Issues

Track patterns.

Analyze:

• Which payers have most issues?
• What types of mismatches recur?
• Are there staff training needs?
• Are there system issues to address?

Tired of chasing insurance payment mismatches? Zeldent automatically matches insurance deposits to your posted payments, flagging discrepancies the same day they occur. Stop the detective work and let automation identify exactly what does not match. Schedule a demo to see insurance reconciliation simplified.