←Insights

The Ins and Outs of 835s

November 30, 2021

An 835 file is another name for an Electronic Remittance Advice (“ERA”) file. It is a way for the payer to send claim and payment information to the healthcare provider or biller. These files are used to assist in posting claim level payments into the healthcare provider’s billing system. Each 835 contains information regarding any adjustments that have been made to the payments so that everything balances at the claim level, the service line level, and the transaction level. If everything is balanced, the remittances contained in the 835 file will match the corresponding payments in the healthcare provider’s billing system. 

Some key components of an 835 file include:

  • Sender information

  • Receiver information

  • Financial information associated with the payment (i.e. payment type, check number)

  • Production date

  • Any provider level balance (“PLB”) adjustments that have been made

Fawkes Health’s CAMS application efficiently works with 835 files using the remittance workflow. CAMS can decipher the text in an ERA and parse the information into a human readable format, allowing users of the application to work with these remittances with ease. Once the 835 files are loaded into the application, CAMS will recognize when a remittance corresponds to a payment and will automatically match them together. CAMS also has Create Remittance functionality. When a payer sends a paper Explanation of Benefits (“EOB”) or RA, a user can create a remittance from that information, process it through our automation logic to match to the corresponding payments, and export the remittance to post to the corresponding patient accounting system. 

The table below shows examples of segments that would appear in an 835 file and a brief description. While these are some of the most common examples, this is not an exhaustive list of segments that one might find on an ERA.

835 Segment Segment Description Example 835 Text
ST - Transaction Set Header Indicates the start of a transaction set and assigns a control number ST✽835✽1234~
BPR - Financial Information Beginning of an RA transaction set and total payment amount BPR✽C✽150000✽C✽ACH✽CTX
✽01✽999999992✽DA✽123456✽
1512345678✽999999999✽01✽
999988880✽DA✽98765✽20030901~
TRN - Reassociation Trace Number Identifies a transaction to an application TRN✽1✽12345✽1512345678✽
999999999~
DTM - Production Date
 Specifies important dates and times DTM✽405✽20020317~
REF - Additional Payer/Payee Information Specifies identifying information for the payer or payee REF✽PQ✽12345678~
N1 - Payer/Payee Identification Identifies a party by type of organization, name and code N1✽PE✽MID-STATEHOSPITAL✽
XX✽12345678~
N3 - Payer/Payee Address
 Specifies the location of the party N3✽SUITE200✽
1000MAINSTREET~
N4 - Payer/Payee City, State, Zip Code
 Specifies geographic place of the party N4✽KANSASCITY
✽MO✽64108~
TS3 - Provider Summary Information Supplies provider level control information TS3✽123456✽11✽
20021031✽10✽130957.66~
CLP - Claim Payment Information Supplies information common to all services of a claim CLP✽7722337✽1
✽211366.97✽138018.4✽✽12✽
119932404007801~
CAS - Claim Adjustment
 Supplies adjustment reason codes and amounts as needed for an entire claim or a partial service within the claim being paid CAS✽PR✽1✽793✽✽
3✽25~ CAS✽CO✽131✽250~
SVC - Service Payment Information
 Supplies payment and control information to a provider for a particular service SVC✽HC:99214✽100✽80~
PLB - Provider Adjustment
 Conveys provider level adjustment information for debit or credit transactions such as accelerated payments, cost report settlements for a fiscal year and timeliness report penalties unrelated to a specific claim or service PLB✽1234567890✽20000930
✽CV:9876514✽-1.27~
 
 

The XYZs of PLB Codes→

October 21, 2021