Settlements & EOB
You cannot approve a payment you prepared.
One payment out, against one adjudicated claim, released by somebody other than the person who assembled it. Then the statement that closes the file.
- Reference
- EOB-2026-000094
- Payment states
- Pending → Approved → Sent → Confirmed
- Self-approval
- Refused, with the reason named
- EOB edits
- None. Issue another
The problem
Two permissions is not a control. Every administrator holds both, so one person could prepare a payment and release it in the very next request with nothing anywhere to notice.
What it does
Settlements & EOB, in practice.
Four eyes, enforced
The preparer is written from the authenticated actor, never from the request. Approval from that same person is refused outright, and the refusal names the control and says to ask a colleague. Both halves are on the record by name — a separation nobody can see is a separation nobody audits.
Exactly one payee, matching the type
A cashless settlement pays the provider who treated the patient; a reimbursement pays the traveller back. The provider has to exist in your company and the patient has to be the traveller on the claim's case — a reimbursement to somebody else is a valid row and a wire transfer to a stranger.
Sent is not paid
An instruction to a bank can still fail. The status machine keeps sent, confirmed and failed apart, a failed payment can be re-prepared with corrected details, and only a confirmation settles the claim.
An explanation of benefits with frozen totals
Billed, guaranteed, allowed, paid, and patient liability — computed once at issue and never recomputed on read. Paid counts confirmed settlements only. Where no guarantee was issued, the total guaranteed prints in words rather than as a zero, because a guarantee of nothing and no guarantee at all are different facts.
A reason on every reduction
Any line where the allowed amount differs from the billed amount needs a reason, including a denial in full. Every offending line is named in one refusal rather than one at a time.
Rules that are not obvious
Why it behaves this way.
Each of these is a decision with a cost behind it. They are the difference between software that records what happened and software you can defend in an audit.
Patient liability is measured against what was allowed, not what was billed.
The gap between them is a reduction a reviewer decided and is settled between the payer and the provider. Charging it to the traveller would turn every successful bill review into a bill for the patient. The document says so in words.
An issued statement has no edit path.
Three parties reconcile against it. A wrong statement is corrected by issuing another.
A confirmed payment is terminal.
A claim has been settled on the strength of it. Rewriting the row would restate a fact the bank already recorded differently. Corrections are a second, recovering settlement.
No bank details are stored, at all.
An account number here would make the table a payment-credential store with none of the controls that implies. A reference points at the finance system that legitimately holds them.
Stopping a payment never needs more authority than making one.
Cancelling runs on the same grant as preparing.
Works with
The modules next to this one.
Claims
The financial file for a case: collection, scrubbing, audit, adjudication — with an appeal path that keeps the history attached.
ExploreReimbursements
The traveller already paid. Receipts as lines, adjudication line by line, and a reason required on every reduction.
ExploreGuarantees of payment
The letter the assistance business turns on — drafted, issued, sent to the hospital and measured against what actually gets billed.
Explore
See it against one of your own files.
The fastest way to judge CareTrack is to walk a real case through it — intake, guarantee, charges, adjudication, settlement, statement. Bring one and we will do exactly that.
Or email contact@sthiramtechnologies.com