Unmatched & manual match

Outcome

Every line the matcher (and Review) couldn't place is either manually matched to the right claim or routed to Exceptions / write-off with a clean audit trail.

Prerequisites

Scope	What it lets you do
billing.receivable.read / .write	View and manually match
billing.receivable.override	Force-match a pair the matcher rejected

How a line gets here

Most unmatched lines fall into one of three buckets:

Bucket	Pattern
Off-system claim	Payer paid a claim we didn't build (paper, portal, partner glitch).
Wrong-tenant claim	Cross-tenant payment (another facility under the same group).
Reversed-and-rebuilt	Original claim was voided and re-billed; payer paid the original.

The Manual match dialog

Click Manual match on an unmatched row:

Search field	Behavior
Member ID	Exact match only.
Member name	Fuzzy on last + first.
Payer claim control #	Substring search.
Amount	Within $0.01 by default; widen with the slider.
DOS range	Within ±N days of the line's DOS.

The candidate list shows our claims with confidence indicators; the ranking is by combined match strength.

Steps

1. Open the Unmatched tab. Sort by amount descending (the dollars matter; small ones can wait).

2. Open a row. The side panel shows the 835 line + the global match attempt summary.

3. Search candidates in the Manual match dialog. Start narrow (payer claim control #) before widening.

4. Select a candidate, click Match. The platform:

   • Stamps the line MATCHED_MANUAL.
   • Records the actor and timestamp.
   • Updates confidence to 100 (manual = authoritative).

5. Repeat until Unmatched is empty or only contains rows you've decided to write off.

When there is no candidate

For genuinely off-system payments:

1. Click Create off-system claim (if your tenant has the feature on). The platform writes a stub claim with the line's amount + member + DOS and matches the line to it. Use only when the source EMR cannot provide the missing claim.

2. Otherwise click Move to Exceptions with a reason. Your supervisor reviews; sometimes the resolution is to refund or hold the payment.

Force match (override)

Occasionally the matcher's score is wrong (legitimate match scored below threshold). Use Force match sparingly:

When	Example
Numbers don't agree (off by a few cents)	Payer rounding edge case.
Member ID changed between submission and adjudication	Member ID changeover.
Payer split a multi-line claim into multiple 835 rows	Each line matches; the payer-control # comes back partial.

Force match requires billing.receivable.override and writes a prominent MATCHED_FORCED row in the audit log.

Validation

Check	Expected
Manual match removes the row from Unmatched	Yes.
Manual match stamps your name	Yes; visible on the row.
Force match writes MATCHED_FORCED audit row	Yes.
Off-system claim flow gates by billing.payment.write	Yes.

Troubleshooting

Symptom	Cause	Fix
Search returns nothing	Filters too narrow, or claim is archived	Widen amount tolerance; toggle Include archived.
Match button greyed	Selected candidate has zero balance	Pick a different candidate or create off-system.
MATCHED_MANUAL reverts to Unmatched	Server transaction failed	Re-match; ping support if persistent.
Force match disabled despite scope	Tenant disabled overrides for this payer	Ask admin; some tenants whitelist payers for force-match.

Where to next

• 4.5 — Exceptions for variances that emerge after matching.
• 4.6 — Adjustments & variances for the post-match review.