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Reconciling EFTs from Insurance Companies

Question asked by suzanne on Mar 22, 2018
Latest reply on Apr 17, 2018 by suzanne

Does anyone have an efficient method of tracking, matching, and reconciling their Insurance EFT payments?  Since most of our Insurance payments are through EFT now, this process is becoming a monster and taking way too much time to get payments posted. 

I need to ensure that what is posted in Softdent is what is deposited into our bank account, since we had a fiasco in 2016 when suddenly United Healthcare started sending our payments to a different bank account who was a private citizen unrelated to the office.  On Saturdays, I post all payments that were deposited into our bank account for the week.  However not all companies fax/email an EOB, so I have to check the bank account first and then go to each company's website to download a copy of the EOBs.  On top of that, some companies do not have EOB information on their website if we are not contracted or an out-of-state provider.  For those companies I actually have to call and have a representative email me the EOBs. 

And with the upsurge in network leasing and changing TPAs, some of the names on our bank statement aren't the actual company that made the payment.  So it becomes a cat and mouse game.  For example, our bank statement shows an EFT from BCBS Georgia.  I called BCBS Georgia which has no record of payment to us.  They said it could be from one of the companies that they administer, but not actually underwrite.  Without having the patient name (since we didn't have an EOB), this took another 3 departments, multiple transfers, and 2 more weeks of research to find who the payment was for!  This creates a problem when the deposit was in a previous month and I have to backdate the system to post the payment, then re-run all Final Daysheets and Month-End reports.

Also, the Delta Dental Individual Plans don't have the EOBs available on the National website.  I asked if we could get paper checks and EOBs for those patients.  They said since we are signed up with Delta Dental's National EFT program, we can't pick and choose which companies to get paper checks from.  So the solution is that I have to call to get the EOBs emailed to me.  And for those of you who have had to call an insurance company for anything other than simple benefits, you already know it's about a 30-minute process to get through the menu system, wait on hold, and finally get to someone who has the information you need!