Before you start
Sometimes a payer takes back money it already paid you on a claim. You may see this on the EOB/ERA as a reversal, a recoupment, a take-back, or an overpayment recovery.
In NikoHealth, you record a take-back in two parts:
Part | What it does | Where you enter it |
1. Negative line-level posting | Takes the money back off the invoice that was originally paid | Add Invoice on the payment |
2. Provider-level adjustment (PLB) | Balances the payment so that Unapplied = $0 | Edit Payment Details › Adjust |
Rule to remember: In a take-back, every value you enter on the invoice is a negative number — the charge, the allowed amount, the payment, and the adjustments.
You need:
The EOB/ERA that shows the take-back
The invoice number, or the claim control number shown on the remit (see Finding the invoice by claim control number)
Key terms
Term | Meaning |
Reversal / recoupment / take-back | The payer takes back some or all of an earlier payment on a claim. |
PLB (provider-level adjustment) | An adjustment on the whole payment, not on a single claim. Payers use PLBs to report take-backs, forwarding balances, and interest. |
WO – Overpayment Recovery | The PLB adjustment type for a payer take-back. |
Unapplied | Money on the payment that is not yet applied to an invoice or a PLB. A finished payment shows Unapplied = $0. |
Balancing equation | For every service line: Charge − Payments − Adjustments = 0 |
Step 1: Create the payment
If the take-back is on a payment that is already in NikoHealth (for example, an ERA that posted automatically), open that payment from: Billing › Payments and go to Step 2.
If you are posting the take-back manually
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
Method: Other
Total payment amount: the check/EFT amount on the EOB. If the EOB is only a take-back with no check, enter 0.
Reference number: the check or EFT number from the EOB
Billing provider
Click Save. The payment status is New.
Step 2: Add the invoice and enter negative amounts
On the payment, click Add Invoice.
Search for the invoice by invoice number or claim control number.
Can't find the invoice? The invoice may now be billed to the patient. If the payer filter is set, the invoice will not appear. Clear the payer filter and search again.
Select the invoice from the list.
At the top (invoice) level:
Charge: enter the charge as a negative number.
Payment: enter the amount being taken back as a negative number.
If the invoice is billed to the patient, the system asks which payer this is for. Select the payer (for example, Primary).
On each service line being taken back:
Charge: negative
Payer Allowable: negative
Payment: negative (the amount taken back for that line)
Adjustments: negative, with the same reason codes as the original posting (for example, CO-45, PR-2). If the system adds an adjustment for you, change it to match the EOB.
Post only what the take-back EOB shows.
If a service line isn't on the take-back EOB, remove it from this posting. Then check the invoice-level Charge and update it if needed.
If the EOB lists a line with $0 taken back but a reversal adjustment (for example, OA-18), post the line as the EOB shows it: negative charge, $0 payment, negative adjustment.
Click Save.
Tip: Don't use the Balance field to check a take-back. On a take-back line, the Balance field may not show $0, even when every entry is correct. In the example below, line 2 still shows a Balance of $3.14 after all the negative amounts are entered. To check a line, do the math yourself: Charge − Payment − Adjustments = 0.
What you'll see: The payment status changes to Unapplied, and the Unapplied amount equals the amount taken back. This is expected. Step 3 fixes it.
Step 3: Add the PLB adjustment (WO – Overpayment Recovery)
On the payment, click the blue + and select Edit Payment Details. Click Adjust.
Fill in the adjustment:
Date: the same date as the remit
Amount: the amount taken back. A negative number lowers the total payment amount. A positive number raises it. For a take-back, enter a negative number (for example, −12.57).
Patient name / claim control number: enter this if the EOB shows it. It helps you trace the take-back later.
Adjustment type: WO – Overpayment Recovery
If the EOB has more than one PLB, click Add Adjustment again for each one.
Click Save, then click Save again on the payment.
What you'll see: Unapplied = $0 and the payment status is Applied.
Tip: You can add the PLB before or after you add the invoice. What matters is that, when you're done, Unapplied = $0.
Step 4: Check the invoice and decide next steps
On the payment, click the invoice number to open it. Expand the top section to see all transactions on the invoice.
The original payment and the negative take-back both show here.
Check the invoice's status and bill-to. After a take-back, the invoice may still be open to the patient. Update it so the balance goes to the right place.
Decide what happens next with the balance. For example:
Correct and rebill the claim
Appeal the take-back
Bill the balance to the next payer or to the patient
Don't skip this step. If you don't follow up on the invoice, you may miss revenue you can still collect.
Worked example
The payer originally paid an invoice with two service lines. Total paid: $82.97.
Original posting | Line 1 (E1390) | Line 2 (E0431) |
Charge | $251.22 | $48.62 |
Payer Allowable | $88.00 | $15.71 |
Payment | $70.40 | $12.57 |
CO-45 | $163.22 | $32.91 |
PR-2 | $17.60 | $3.14 |
A new EOB shows the payer is taking back the $12.57 paid on line 2.
Step 1: Create the payment
Payer payment, Method Other, Total $0. Status: New.
Step 2: Add the invoice and enter the take-back as negatives
Line 1 isn't being taken back, but the take-back EOB lists it with a reversal adjustment. Post it as the EOB shows: Charge −$251.22, Payer Allowable blank, Payment $0, Adjustment −$251.22 OA-18 (Exact duplicate claim/service). The line balances: −251.22 − 0 − (−251.22) = $0 ✅
Line 2: enter every value as a negative:
Field | Take-back entry (line 2) |
Charge | −$48.62 |
Payer Allowable | −$12.57 |
Payment | −$12.57 |
CO-45 | The system calculates −$36.05. Change it to match the EOB: −$32.91 |
PR-2 | Add −$3.14 |
Check: Charge − Payment − Adjustments | −48.62 − (−12.57) − (−32.91 + −3.14) = $0 ✅ |
Why change CO-45? The system calculates CO-45 as Charge − Payer Allowable. On a take-back that may not match how the EOB splits the adjustments. Always change the adjustments so they match the EOB.
Click Save. Status: Unapplied, Unapplied = $12.57. This is expected.
Step 3: Add the PLB
Edit Payment Details › Adjust: Amount −$12.57, type WO – Overpayment Recovery.
Status: Applied, Unapplied = $0.
Step 4: Review the invoice
Open the invoice. Check its status and bill-to, and decide what to do with line 2's balance (re-bill, appeal or move it).
Finding the invoice by claim control number
The account number on a remittance can look unusual. Often it is the claim control number that NikoHealth sent with the claim.
Open the invoice search. Search using the Claim Control # field. Payers sometimes add extra digits to the front of the number. If you get no match, try again without the first digits.
You can see an invoice's claim control number on the invoice's Audit tab.
Tip: Copy the claim control number into the PLB's Provider Reference ID field. This keeps the link between the take-back and the invoice.
Troubleshooting
Problem | What to check |
The invoice doesn't appear when I search | The invoice may be billed to the patient. Clear the payer filter and search again. |
The payment won't save or won't balance | Every value on the invoice must be negative. Check that Charge − Payments − Adjustments = 0 on each line. |
Status is Unapplied after I added the invoice | This is expected. Add the PLB adjustment (Step 3). |
Unapplied isn't $0 after I added the PLB | Check the PLB sign (it should be negative for a take-back) and that the amount matches the take-back. Check for a second PLB on the EOB. |
The Balance field doesn't show $0 on a take-back line | This is expected. Check the line with Charge − Payment − Adjustments = 0 instead. |
Some lines on the invoice weren't taken back | If the take-back EOB doesn't list the line, remove it and update the invoice-level charge. If the EOB lists it with a reversal adjustment (for example, OA-18), post it as shown. |
Reporting
Negative payments (reversals) show on the Payment Detail report.
PLB adjustments (including WO – Overpayment Recovery) show on the PLB Adjustment report.