EDI 835 — Payment/Remittance Advice
The 835 transaction, also known as the Electronic Remittance Advice (ERA), is sent from payers to providers detailing how claims were adjudicated and paid. It is the electronic equivalent of a paper Explanation of Payment (EOP).
What the 835 Contains
For each claim in a payment batch, the 835 includes:
- Claim identification — Patient name, claim number, dates of service
- Billed amount — What the provider originally charged
- Allowed amount — The maximum amount the payer recognizes based on contract
- Paid amount — What the payer is actually paying the provider
- Patient responsibility — Copay, coinsurance, and deductible amounts shifted to the member
- Adjustment codes — Specific reasons for any payment adjustments
Adjustment Reason Codes
CARCs (Claim Adjustment Reason Codes)
Explain why a payment was adjusted from the billed amount:
- CO (Contractual Obligation) — Contract-based adjustment (provider write-off)
- PR (Patient Responsibility) — Amount the patient must pay
- OA (Other Adjustment) — Adjustments not covered by other categories
- PI (Payer Initiated) — Payer-specific reduction
RARCs (Remittance Advice Remark Codes)
Provide additional explanatory information supplementing CARCs:
- N382 — "Missing/incomplete/invalid patient identifier"
- MA18 — "Alert: This claim may be subject to coordination of benefits"
835 and EFT
The 835 (remittance detail) is typically paired with an EFT (Electronic Funds Transfer) that deposits the payment directly into the provider's bank account. The CAQH CORE EFT/ERA Operating Rules standardize how these two components are linked using a TRN (Trace Number) that matches the 835 to the corresponding EFT deposit.
Provider Reconciliation
Providers use the 835 to post payments in their practice management system:
- Match ERA to submitted claims
- Apply payments and adjustments to patient accounts
- Identify underpayments (allowed amount less than expected)
- Flag denied claims for appeal or corrected claim submission
- Transfer patient responsibility to the patient billing module
- Write off contractual adjustments
FHIR Equivalent
The FHIR ExplanationOfBenefit resource serves a similar function to the 835 ERA, providing detailed payment and adjudication information in a structured, API-accessible format.
