Before you start
Most payer payments come in electronically (ERA) from the clearinghouse. NikoHealth creates them in Billing › Payments and matches them to invoices for you. Use this article when you need to post a payment manually, for example from a paper EOB.
You need:
The EOB (Explanation of Benefits) from the payer
The invoice number for each claim on the EOB
The balancing rule: For every service line, Charge − Payments − Adjustments = 0. If a line doesn't balance, you can't apply the payment.
The video walks through Steps 1–4 and the worked example below.
Key terms
Term | Meaning |
Payer Allowable | The amount the payer agrees to pay for the service under the contract (the "allowed amount" on the EOB). |
CO-45 | Contractual adjustment: the part of the charge above the allowed amount. You write it off. |
PR-2 (or PR-1, PR-3) | Patient responsibility. PR-2 = coinsurance, PR-1 = deductible, PR-3 = copay. |
Unapplied | Money on the payment that is not yet applied to an invoice. A finished payment shows Unapplied = $0. |
Payment status | New = nothing applied yet. Applied = all funds are applied. See [Payment Status]. |
Step 1: Create the payment
Go to Billing › Payments. Click the blue + and select Add Payment.
Fill in the payment details:
Type: Payer
Payer: the payer on the EOB
Date: the remit date on the EOB
Method: how the payer paid (for example, check or EFT)
Total payment amount: the total check or EFT amount on the EOB
Reference number: the check or EFT number
Billing provider
Click Save.
The payment is created with status New. That means no funds are applied to an invoice yet.
Step 2: Add the invoice
On the payment, click Add Invoice.
Enter the invoice number in the filter.
Select the invoice from the list.
The invoice opens in two sections:
The top section shows the totals for the invoice.
Each service line has its own fields that you fill in from the EOB.
Can't find the invoice? If the invoice is now billed to the patient or to another payer, it may not appear while the payer filter is set. Clear the payer filter and search again.
Step 3: Enter the amounts from the EOB
At the top (invoice) level:
Payment: the total the payer paid on this claim
On each service line:
Payer Allowable: enter the allowed amount from the EOB.
The system adds the CO-45 adjustment for you (Charge − Payer Allowable). Check that it matches the CO-45 on the EOB.
Payment: enter the amount paid for this line.
Patient responsibility: if there is still a balance on the line, click to add another adjustment and enter the PR amount and reason code from the EOB (for example, PR-2).
Check that the line balances: Charge − Payment − Adjustments = 0.
Repeat for every service line on the EOB.
When every line balances, click Save.
Step 4: Check the results
On the payment:
Status changes from New to Applied
Unapplied = $0
On the invoice:
The payment shows when you expand the top section.
If the patient owes a balance, the invoice stays Open and the bill-to changes to the patient.
If nothing is owed, the invoice status changes to Closed.
Worked example: payment with patient responsibility
The EOB shows a total payment of $82.97 on an invoice with two service lines. Both lines have a CO-45 contractual adjustment and a PR-2 coinsurance amount.
| Line 1 (E1390) | Line 2 (E0431) |
Charge | $251.22 | $48.62 |
Payer Allowable | $88.00 | $15.71 |
Payment | $70.40 | $12.57 |
CO-45 (added by the system: Charge − Payer Allowable) | $163.22 | $32.91 |
PR-2 (you add: Payer Allowable − Payment) | $17.60 | $3.14 |
Check: Charge − Payment − Adjustments | $0.00 ✅ | $0.00 ✅ |
Line 1: After you enter the Payer Allowable ($88.00), the system adds CO-45 for $163.22. After you enter the payment ($70.40), $17.60 is still unaccounted for. The EOB shows it as PR-2, so you add a PR-2 adjustment for $17.60. The line now balances.
Line 2: Same steps. CO-45 is added for $32.91, and you add PR-2 for $3.14.
Total paid: $70.40 + $12.57 = $82.97, which matches the EOB.
After you save, the payment is Applied, Unapplied is $0, and the invoice moves to the patient for the PR-2 balances ($20.74 total).
Posting a denial
A denial is posted the same way, using the same balancing rule. The payer pays $0, so the full charge goes to the adjustment.
Go to Billing › Payments, click the blue +, and select Add Payment.
Fill in the payment:
Type: Payer
Payer and Date (remit date)
Method: Other
Total payment amount: 0
Click Save.
Click Add Invoice and select the invoice.
At the top (invoice) level:
Payment: 0
Payer Level: check that it's correct (for example, Primary)
On each denied service line:
Leave Payer Allowable empty
Payment: 0
Adjustment amount: the full charge amount
Reason: type the denial code from the EOB (for example,
CO 183) and select it from the list
Click Save.
Example: The EOB denies a $151.86 charge with CO-183 (The referring provider is not eligible to refer the service billed).
Charge $151.86 − Payment $0 − Adjustment $151.86 = $0 ✅
Tip: Type part of the code in the Reason field to search the list. Make sure the group code (CO, PR, OA) matches the EOB, not just the number.
What you'll see:
The payment status is Applied.
The invoice status changes to Denied.
The denied service line gets a denial tag. You can click it to see the denial reason.
Next, work the denial: correct and resubmit, appeal, or move the balance. See [Denials].
When the payment includes a take-back or PLB
Not every EOB is a straight payment. Use these articles if the EOB shows any of the following:
What you see on the EOB | Article |
The payer takes back money on a claim it already paid (reversal, recoupment, take-back) | [Posting Payer Recoupments and Payment Reversals] |
The check amount doesn't match the claims paid (offset, forwarding balance, interest) | [Posting Offsets, Forwarding Balances, and Other PLB Adjustments] |
Troubleshooting
Problem | What to check |
The payment won't apply | A service line doesn't balance. Check Charge − Payment − Adjustments = 0 on each line. |
CO-45 doesn't match the EOB | Check the Payer Allowable amount. The system calculates CO-45 from it. |
The invoice doesn't appear in search | It may be billed to the patient or another payer. Clear the payer filter. |
Claims are posted but Unapplied isn't $0 | The EOB may have a PLB (offset, forwarding balance or interest). See [Posting Offsets, Forwarding Balances, and Other PLB Adjustments]. |
An ERA came in with status Failed | The system got the payment but couldn't match it. See [Failed Payments]. |
Reduce manual posting
The goal is to post as many payments electronically as possible. If a payer still sends paper EOBs, contact the NikoHealth payer enrollment team to ask whether ERA enrollment is available.