The thirty-second habit
Most offices already have a system for posting adjustments: find the claim, match the EOB, write off the difference. Thirty seconds, done.
But do that a few thousand times and you end up with a problem you can't see until year end. Your reports can't tell you which insurance company took the most money from you, and your patient balances rest on EOBs nobody ever checked.
This guide shows how to post an insurance adjustment the right way, in eight steps, following one D2740 crown claim from EOB to closed. The careful way costs about two extra minutes per claim. Those two minutes are what make your reports worth reading.
What is an insurance adjustment?
An insurance adjustment is the part of your full fee that you write off because of your PPO contract. Here's a simple example we'll use through this whole guide:
- Your office fee for a crown is $1,200.
- The PPO contracted fee is $800.
- The plan covers crowns at 50%, so insurance pays $400.
- The patient owes $400.
- The adjustment is $400: the difference between your $1,200 fee and the $800 contracted fee.
That $400 is not a courtesy, and it's not a random write-off. It's the discount you agreed to when you signed the contract. Every adjustment you post is a record of what that contract costs you. Post them carefully and you can see, at the end of the year, exactly how much each plan is taking. Post them carelessly and that information is gone.
Check the EOB before you post
If you were trained to look at the EOB, find the claim, and post whatever it says, stop. The EOB is the insurance company's version of why they paid what they paid. It is not always right.
Before you post, compare the EOB to the breakdown of benefits you collected when you verified the patient:
- Does the math work? If the breakdown said crowns are covered at 50% and the EOB paid 40%, that's not a posting task. That's a phone call.
- Is it the right fee schedule? With leased networks, a patient with Cigna PPO can be paid on an Aetna fee schedule. If the EOB shows an allowed fee of $720 instead of the $800 you expected, find out which network they used before you write off the extra $80.
- Was a downgrade applied that shouldn't be? If you were told no downgrades on posterior composites and the EOB paid at the amalgam rate, that goes in the dispute pile, not the write-off pile.
Posting a wrong EOB hurts twice. The practice writes off money it's owed, and the patient's balance comes out wrong. If the EOB doesn't check out, don't post an adjustment. Work the claim instead. Here's how to appeal a dental insurance claim denial when it comes to that.
Steps 1 and 2: pull both documents and verify the math
Start every posting session by pulling the EOB and the breakdown of benefits together. You're comparing two documents, not copying one. The breakdown tells you what should have happened. The EOB tells you what the payer says happened.
Then run the checks above: the math, the fee schedule, the network status. If everything matches, keep going. If not, stop and work the claim.
Step 3: individual payment or bulk payment?
This one habit causes more bookkeeping headaches than any other. If one check covers ten claims, that's a bulk payment, and it needs to be batched in your software so all ten postings tie to one check number.
Here's what happens when you don't. You post the ten claims one by one, and somewhere along the way one gets posted for $85 instead of $58. Your software shows ten payments. The bank shows one deposit, and it's $27 off. A week later your bookkeeper is trying to figure out why, and now someone is spending an afternoon re-checking ten claims to find one typo. Batching prevents that, because the batch has to equal the check before you can finish.
If you don't know how to batch payments in your software, call your software support line and ask. Every major system can do it.
Steps 4 and 5: post line by line, then label the adjustment
Post what the payer paid on each procedure, not one lump sum spread across the claim. Line-by-line posting keeps each procedure's patient portion correct, and it makes the adjustment on each line mean something.
Then comes the step most offices skip, and it's the one that makes the reports useful. Don't use a generic insurance adjustment label. Set up a label for each plan you're contracted with: Delta Dental PPO Adjustment, Cigna PPO Adjustment, MetLife PPO Adjustment.
It's a five-minute setup in your software. Twelve months later, you can run one report and see that you gave Delta $84,000 last year and Cigna $31,000. That's the number you need when you're deciding which contracts to renegotiate and which networks to drop. With one generic label, you'll never see it.
Steps 6, 7, and 8: split, close, and attach
Say you billed a crown and a buildup together. The crown paid, the buildup was denied, and you're appealing it. Post the crown payment and split the claim so the buildup stays open. The paid part is closed, the appealed part is still outstanding, and your AR report stays honest.
Next, close the claim, not just the payment. In some systems, Curve is a well-known example, posting a payment and closing a claim are two separate steps. Offices skip the second one without realizing it, and the outstanding claims report fills up with claims that were actually paid months ago. If your AR report looks worse than it should, check for this first.
Finally, attach the EOB to the payment. Most systems let you do this, Open Dental included. When a question comes up six months from now, the answer is attached to the payment instead of buried in the imaging center. Then add a short note saying what the payment was for, so the next person doesn't have to guess.
The three posting mistakes that cause the most damage
- Bulk payments posted one by one. The deposit doesn't match the bank, and finding out why takes hours.
- Payments posted, claims left open. Your outstanding claims report fills up with money you already have.
- One generic adjustment label. At the end of the year, you can't tell which plan is costing you the most.
None of these look like a problem on the day they happen. They add up quietly, and they show up later as reports nobody trusts.
Frequently asked questions
What's the difference between an adjustment and a write-off?
People use the words interchangeably, but it helps to keep them separate. An adjustment is contractual: the PPO discount you agreed to, tied to a fee schedule. A write-off is a choice: a courtesy discount, or a balance you've decided not to collect. Give them separate labels. If they share one bucket, both numbers are useless.
Should I post the adjustment before insurance pays?
No. Until the EOB arrives and checks out, you don't know for certain which fee schedule the payer will use. Post the adjustment when you post the payment.
What if the EOB is wrong?
Don't post it. Call the payer with the breakdown of benefits in front of you, or appeal. Once you post a wrong EOB, the payer's mistake becomes your permanent record, and someone has to find it and unwind it later.
