Exceptions

Outcome

Every variance flagged by the platform is either resolved by your action (correcting upstream and posting again) or accepted with a reason note, and the Exceptions tab clears.

Prerequisites

Scope	What it lets you do
billing.receivable.read	View the tab
billing.receivable.write	Resolve, accept
billing.receivable.override	Override an exception

What lands here

The Exceptions tab catches anything the platform couldn't reconcile during matching:

Exception	Trigger
Footer mismatch	BPR02 ≠ sum of CLP04 + global CAS.
Per-claim mismatch	CLP03 ≠ CLP04 + per-claim CAS.
Negative payment with no PLB	Payer reversed a claim but no PLB-level note.
Duplicate of prior receivable's line	Same payer + payer claim control # + DOS already posted elsewhere.
Posted amount above expected	Payer overpaid relative to contract — see 4.6.
Posted amount below expected	Payer underpaid — same chapter.
Patient liability shift mid-month	PR-1/2/3 doesn't reconcile to expected deductible status.
COB chain mismatch	Secondary's primary CAS doesn't reconcile to our cached primary 835.

The decision

Working a footer or per-claim mismatch

1. Open the Trace tab to confirm the math. Sometimes a PLB (provider-level adjustment) explains the gap — that lives at the file footer, not per-claim.

2. If PLB explains it, switch to the Adjustments tab and ensure the PLB is tagged with the right reason code; the receivable will post the PLB to the global adjustment ledger.

3. If the math truly doesn't add up, mark the exception payer-error with a reason note, accept the variance, and post. Open a Discrepancy in the receivables tracker for follow-up.

Working a duplicate exception

A line that duplicates a previously-posted line is dangerous: posting again would double-pay.

1. Open the original posting via the duplicate's link.

2. Confirm it's the same dollars + same claim.

3. Either:

   • Reject the duplicate with reason dup-prior-post if you're certain the prior was right. The line stays unposted; the receivable closes.
   • Reverse the prior if the prior was wrong (rare).

Working an over/underpayment

Pattern	Likely cause	Move
Underpaid by < 1%	Rounding	Accept with reason.
Underpaid by 1-10%	Contract drift	Compare to contracted fee schedule; ask admin to re-confirm contract; appeal if wrong.
Underpaid by > 10%	Likely a denial wearing partial-pay clothing	Open the line; check CAS rows; treat as a denial.
Overpaid	Patient deductible already met, payer paid in full	Accept and expect a 271 reversal next month — many payers correct overpayments via PLB later.

Accepting a variance

When the variance is real but small or expected, click Accept on the exception with a reason. Required fields:

Field	Required
Reason category	Yes — picklist (rounding, contract-drift, payer-error, duplicate-rejected, other).
Reason note	Yes — free text for other.
Follow-up flag	Optional — sets a follow-up date for the supervisor.

The audit row carries everything.

Validation

Check	Expected
Resolving / accepting an exception decrements the count	Yes.
Receivable advances out of EXCEPTIONS once the tab is clear	Yes (provided tabs upstream are also clear).
Audit log captures reason + actor	Yes.
Discrepancy ticket creates if you click Open discrepancy	Yes; appears on the receivables-tracker view.

Troubleshooting

Symptom	Cause	Fix
Exception count stays at >0 after accept	Background variance check is still running	Wait 30 seconds; refresh.
Accept greyed	You lack billing.receivable.write	Ask admin.
Duplicate exception flag is wrong (claims are different)	The dedupe key is too loose for this payer	Note the false positive; accept with reason; admin can tune the dedupe rule.
PLB not surfaced	Some payers send PLB outside the 2110 loops	Check the Trace tab; PLB sits at the file footer.

Where to next

• 4.6 — Adjustments & variances — full adjustment taxonomy.
• 4.7 — Export & trace — when you need to leave the app to defend a variance.