A Pennsylvania Psychiatry Group Had $218,000 in Unfollowed A/R. Payments Were Already Sitting in a Clearinghouse.
Table of Contents
THE SITUATION
This 5-psychiatrist group had been in operation for seven years. In Q2 2024, the billing coordinator went on extended leave. A temp was brought in to cover.
The temp flagged within two weeks that A/R was $218,000 higher than it should have been based on claim submission volume. The practice owner called us assuming payers were holding payments.
We ran the investigation.
The payers weren’t holding anything. Every dollar was sitting in their Change Healthcare clearing house because ERA (Electronic Remittance Advice) enrollment had never been completed for 2 of the 4 payers and the other 2 had ERAs routing to an inbox nobody was checking.
WHAT WAS ACTUALLY WRONG
ERA enrollment incomplete for Highmark and UPMC:
Highmark and UPMC had processed and paid claims but were routing ERAs to a generic clearing house mailbox that was never linked to DrChrono. Payments were sitting in the clearing house unposted not denied, not pending just waiting for someone to retrieve and apply them.
UHC and Aetna ERAs were routing to a former billing coordinator’s inbox:
UHC and Aetna ERA notifications were set up in 2019 under a billing coordinator who had left in 2021. Her inbox had been deactivated. ERA notifications were generating but disappearing. Claims appeared unpaid in DrChrono because ERA data wasn’t posted but the funds had actually been processed.
DrChrono’s auto-posting feature was disabled:
DrChrono has an auto-ERA posting feature that would have caught this. It had been disabled during a 2022 system configuration and never re-enabled. Every ERA required manual import, a step nobody was doing.
WHAT WE DID
Days 1–3: Logged into Change Healthcare clearing house. Pulled 18 months of unposted ERAs. Confirmed $218,000 in payments had been processed by payers and were sitting in the clearing house unposted.
Days 3–5: Updated ERA enrollment for Highmark and UPMC linked to active DrChrono integration. Updated UHC and Aetna ERA routing to current billing team email with DrChrono direct posting.
Days 5–10: Re-enabled DrChrono auto-posting. Imported all 18 months of clearing house ERAs. $203,000 posted within 14 days. $15,000 required manual matching due to patient account changes.
Week 3: Implemented monthly clearing house reconciliation all ERA batches confirmed posted within 48 hours of generation.
THE RESULTS
| Metric | Before | After |
|---|---|---|
| Unposted A/R | $218,000 | $0 |
| Revenue Posted | — | $203,000 in 14 days |
| ERA Enrollment | Broken for 2 payers | All 4 active |
| DrChrono Auto-Posting | Disabled | Active |
| Clearing House Reconciliation | Never | Monthly |
WHAT THIS MEANS FOR YOUR PRACTICE
Unposted ERA revenue is invisible in standard A/R aging reports; it appears as an unpaid claim, not a payment awaiting import. If your clearinghouse accounts tied to payer ERA enrollment aren’t reconciled monthly, payments may be sitting there that your A/R report doesn’t show.