Virtual Card Reimbursements: Where Posting Breaks Down (And How STP Fixes It)

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Key Takeaways

  • Virtual card payments often look digital but still rely on mail, manual keying and spreadsheet-driven posting—which slows cash and increases risk.
  • Straight Through Processing (STP) automates Optum virtual card payments end-to-end, unifying funds and remittance to support auto-posting and cleaner reconciliation.
  • Physician groups can pilot STP in 90 days, targeting high-volume, high-friction reimbursement streams without changing payer adjudication or core clinical systems.

If you look only at payer portals and remittance advice, virtual card payments seem like progress. Funds are “digital,” checks are disappearing, and payers can route reimbursements over card rails instead of the mail.

But if you sit in a physician group finance or admin role, the view is different. Every “payment available” notice can trigger a familiar chain: someone logs into a portal or opens mail, retrieves card details, runs the card, hunts down the remit, then works the posting and reconciliation by hand—often across multiple systems and spreadsheets.

On paper, those dollars are “paid.” In practice, they’re not truly closed out in your ledger for days or weeks. That’s where posting breaks down—and where Straight Through Processing (STP) is designed to help.

This blog unpacks why virtual card reimbursements create so much posting friction for physician groups and how STP changes the flow from “approved” to “deposited and reconciled,” without forcing a rip-and-replace of your revenue systems.

 

Why “digital” virtual card payments still behave like paper

Most posting problems with virtual card payments aren’t about a single big failure. They’re the result of how information moves—piecemeal—between payers, portals, lockboxes, and your internal teams.

For many physician groups today, an Optum or other payer virtual card reimbursement looks like this:

  1. Payment available: The payer and/or Optum issues a virtual card for an adjudicated claim. A notice arrives by mail or via a payer portal.
  2. Retrieval: Staff open envelopes or log into portals to retrieve the card number, amount and basic remittance.
  3. Processing: Card details are keyed into a POS or virtual terminal as if they were a standard retail card transaction.
  4. Remittance match: Deposits are manually matched to 835s, PDFs, or portal remits. Teams rely on spreadsheets and workarounds when something doesn’t line up.
  5. Posting: Payments and adjustments are re-keyed into practice management (PM), EHR, or central business office systems.
  6. Reconciliation
    Finance reconciles bank activity to the GL by payer, location and specialty, dealing with gaps, delays, and unapplied cash.

That workflow “works,” but it’s slow, expensive, and hard to standardize—especially in multi-location physician groups with a complex payer mix.

 

Where posting breaks down in virtual card workflows

From a CFO’s perspective, there are four recurring break points that turn virtual card payments into posting headaches.

1. Card credentials are not a postable transaction

A mailed virtual card letter or portal credential is really just a set of instructions. Your staff have to turn it into cash and accounting entries: retrieve, run, post, reconcile.

Every step adds delay and introduces the risk of:

  • Wrong amounts keyed
  • Missed timing (expired cards, missed redemption windows)
  • Payments run but never fully reconciled back to the remit

At scale, this becomes thousands of low-value touches per month for centralized cash posting teams.

2. Funds and remittances don’t travel together

In many card-by-mail models, you see the deposit on the bank side well before a complete, standardized remit is available in your revenue system. Staff are left to answer: “What does this deposit belong to?”

That separation creates:

  • Unapplied cash and backlog at month-end
  • Misapplied payments when line items are matched incorrectly
  • Extra research work to satisfy auditors and internal controls

3. One virtual card often covers many claims

Virtual cards frequently bundle multiple encounters, patients, or service lines. If your tools don’t receive a clean, machine-readable remittance alongside the deposit, your team performs manual “unbundling” in spreadsheets before they can post by claim or encounter.

The more specialties, locations, and TINs you have, the more complex this gets.

4. Manual keying expands your risk and compliance footprint

When staff handle card data directly—opening mail, reading card numbers, and entering them into terminals—you extend PCI scope and increase the number of people and locations exposed to sensitive information.

You also distribute control over a high-value revenue stream across improvised, local workflows instead of a governed, central process.

 

What STP is and how it changes the last mile

STP is CSG Forte and Optum Financial’s answer to these breakdowns. Internally, it’s defined as a payment automation process that lets healthcare providers receive payments from insurance companies and from patients (via their payers) in about one day, directly into their bank accounts.

The key is that STP doesn’t ask payers to stop using virtual card payments. It changes what happens next:

  • The payer and Optum continue to originate virtual cards for adjudicated claims, just as they do today.
  • Instead of printing and mailing card details or relying on manual portal retrieval, Optum sends virtual card credentials and remittance data electronically to CSG Forte over secure, encrypted channels.
  • CSG Forte processes those virtual cards automatically and deposits funds into your designated bank account—typically the next business day after approval, rather than weeks later.
  • Payment and remittance data are delivered together through Forte’s platform (Dex) and into your revenue tools where integrated, supporting auto-posting and faster reconciliation.

For your team, the experience shifts from “we finish the last mile by hand” to “reimbursements show up as electronic deposits with usable remittance data.”

 

How STP fixes the posting problem

From a physician group admin/CFO lens, STP addresses the root causes of posting friction.

1. Eliminating “retrieve and key” work

For Optum virtual card streams enrolled in STP, your staff no longer:

  • Open envelopes or log into portals to pull card numbers.
  • Key 16-digit card details into a terminal.
  • Re-key the same amounts and adjustments into billing systems.

Those steps are handled electronically. Your revenue cycle team can move from touching every payment to managing defined exception queues.

2. Unifying funds and remittance

Because STP carries both the virtual card transaction and associated remittance data, deposits arrive with the context needed to post them correctly.

That supports:

  • Auto-posting of payments and adjustments where your PM/EHR or RCM is integrated
  • Cleaner reconciliation in Dex and core finance systems
  • Less unapplied cash and fewer “mystery” deposits at month-end

3. Standardizing workflows across clinics and specialties

STP gives finance and revenue leaders a way to centralize how virtual card reimbursements are handled—even if front-end systems and payer mixes vary by location or specialty.

You can:

  • Define routing rules by payer, specialty, entity, and bank account.
  • Apply consistent controls and exception handling across the footprint.
  • Reduce reliance on local spreadsheets and “shadow systems” to close gaps.

4. Reducing risk and tightening controls

STP is designed to operate within PCI DSS, HIPAA and HITRUST-aligned security frameworks.

Card data and remittance information flow through encrypted, access-controlled systems instead of mailrooms, desktops and ad-hoc terminals.

That enables:

  • A smaller group of staff with direct access to payment data
  • End-to-end audit trails from Optum transaction ID to bank deposit to GL entry
  • Clear segregation of duties between configuration, exception resolution, and financial approval

 

Two flows to focus on: insurer and patient-via-payer

For physician groups, STP impacts two main sets of virtual card payments.

1. Insurer (B2B) reimbursements

  1. A patient visit is coded and billed.
  2. The payer adjudicates and approves a portion of the claim.
  3. Optum generates a virtual card for the allowed amount and routes credentials + remittance data to CSG Forte under the STP model.
  4. Forte processes the virtual card and deposits funds to your bank account, typically within one business day of approval.
  5. Payment and remittance data are surfaced in Dex and, where integrated, flow into your revenue and finance systems for posting and reconciliation.

2. Patient (C2B) payments via payer portals

  1. After insurance, the patient owes a remaining balance (copay, deductible, coinsurance).
  2. The patient pays that balance through a payer-linked portal using an HSA/FSA or other card.
  3. That payment hits the payer’s engine, which creates a virtual card for the patient-owed amount and sends it via STP to CSG Forte.
  4. Forte processes the virtual card and deposits funds into your account, aligning the payment with the same claim and patient.

By centralizing both flows, STP gives your finance team a clearer, more predictable picture of cash from insurer contracts and payer-portal patient payments.

 

Evaluating STP as a physician group finance leader

You don’t need to treat STP as a major IT overhaul. Internal playbooks position it as something you can pilot in 90 days with a focused, data-driven approach.

Here’s a practical way to frame the decision.

Step 1: Quantify the current burden

With revenue cycle and operations leaders, gather:

  • Monthly volume of Optum virtual card payments, by payer and specialty
  • Minutes of staff time per payment from “payment available” to posted and reconciled
  • Effective fee rate on those virtual card payments, including any value-add services
  • Exception rate: percentage of payments requiring rework or escalation

This gives you a directional view of how much FTE capacity and margin these workflows consume today.

Step 2: Identify high-impact cohorts for a pilot

Look for combinations of:

  • High virtual card volume
  • Long lag between approval and posting
  • Heavy manual work and backlog

These payer/specialty/location cohorts are strong candidates for a first STP rollout.

Step 3: Design a 90-day straight-through reimbursement pilot

Internal guidance outlines a 0–90-day path:

  • Days 0–30: discover and map current steps, touch points and systems
  • Days 31–60: configure STP enrollment and bank routing with Optum and CSG Forte; connect to Dex and test with a limited scope
  • Days 61–90: expand to more sites/specialties, monitor auto-posting and exception metrics, and refine rules and training

The objective is not perfect automation on day one. It’s a governed, measurable improvement in:

  • Time from approval to deposit
  • Hours per 1,000 payments
  • Exceptions per 1,000 payments
  • Unapplied cash and reconciliation noise

 

Where STP fits alongside ACH and other rails

It’s important to note that STP isn’t an all-or-nothing choice. Providers can request standard EFT/ERA via ACH from payers where it’s available and continue to use ACH wherever it makes sense.

Today’s STP offering is intentionally focused on virtual card reimbursements—both insurer payments and patient payments via payer portals.

Many groups pursue ACH and STP together:

  • Use ACH where it’s available and well supported.
  • Apply STP to the large and growing slice of virtual card payments that aren’t going away in the near term.

That combined approach lets you reduce paper and posting friction now, instead of waiting for every payer to standardize on EFT.

 

Bringing it back to your physician group

Margins for physician groups are under pressure from rising costs, staffing constraints and shifting payer mix. When your most predictable revenue streams are slowed down by envelopes, portals and manual posting, you’re effectively paying a “time and labor tax” on dollars you’ve already earned.

Virtual card payments aren’t going away—but the paper-era processes around them can.

Straight Through Processing with CSG Forte and Optum Financial is designed to:

  • Replace mailed virtual cards with automated, next-day deposits for enrolled reimbursements.
  • Deliver payment and remittance together so posting and reconciliation run cleaner.
  • Standardize workflows across clinics and specialties without forcing a new EHR or PM system.
  • Strengthen control, audit and security posture around a high-value revenue stream.

If you’re seeing backlogs, inconsistent workflows and too many spreadsheets in your virtual card reimbursement process, STP is worth a closer look.

Sign up today for a focused pilot, which can quickly show whether “approved” can reliably become “deposited and reconciled” in days instead of weeks.

 

FAQs

What are virtual card payments in healthcare?

Virtual card payments are payer-funded card transactions generated for approved claims or patient balances. Instead of sending a paper check, the payer (or an intermediary such as Optum) issues a card credential that the provider processes like a card transaction.

Why do virtual card payments create posting challenges for physician groups?

Because card credentials and remittance often arrive separately, staff must retrieve card numbers, run them through terminals, then manually match deposits to remittance files across systems. This adds delay, increases error risk and makes it harder to reconcile cash by payer, specialty and location.

What is Straight Through Processing (STP) for virtual card payments?

STP is a payment automation process from CSG Forte and Optum Financial that keeps the virtual card funding model but automates acceptance, settlement and reconciliation. Payers still generate virtual cards, but send card and remittance data electronically to CSG Forte for automatic processing, deposit, and delivery of postable remittance data.

Does STP replace ACH EFT or checks?

STP focuses on virtual card reimbursements, including payer and payer-portal patient payments. Providers can still request EFT/ERA via ACH where available, and many use ACH and STP together—using ACH for traditional electronic payments and STP to automate the remaining virtual card volume.

How does STP support compliance and security requirements?

STP is designed to operate within HIPAA, PCI DSS and HITRUST-aligned frameworks, keeping card and remittance data within encrypted, access-controlled systems and reducing the number of staff who handle card credentials directly. That helps narrow PCI scope and strengthens audit trails for payer remittances.