Description
Summary Project scope Develop a healthcare payment-posting platform that connects the practice management system, clearinghouse, and bank data into one workflow for insurance reimbursement posting and reconciliation. The system should automate ERA/EOB intake, claim matching, payment posting, contractual adjustments, denial and exception routing, deposit reconciliation, and A/R reporting. Build software that automates ERA/EOB intake, insurance payment posting, adjustments, denial routing, and deposit reconciliation for a dental practice. Separate roles such as Administrator, Billing Manager, Payment Poster, Reviewer, and Read-Only Auditor. • Require a review queue for unmatched ERAs/EOBs, denials, zero-pay claims, unusual write-offs, duplicate payments, and manual adjustments. • Lock finalized payment batches after reconciliation; corrections should be entered as reversing or adjusting transactions rather than overwriting original data. • Reconcile every payment batch to the EFT/check and bank deposit, with a documented exception trail. • Mask sensitive identifiers in default views, exports, notifications, error messages, and support screenshots. • Prevent PHI in ordinary email, SMS, application logs, analytics tools, and third-party error tracking unless those services are approved, secured, and under a BAA where required. The Security Rule requires controls to protect confidentiality, integrity, and availability of ePHI. For an ERA/EOB payment-posting system, HIPAA applies because the software will create, receive, maintain, or transmit electronic protected health information (ePHI), such as patient identifiers, insurance data, claim details, and payment information. The goal is not a “HIPAA-certified” app—HHS does not certify software—but a system and vendor operation designed to support the practice’s HIPAA obligations.