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835 — Remittance Advice
The 835 (Health Care Claim Payment/Advice) transaction is the payer's explanation of how they processed your claims. It details what was paid, what was adjusted, and why — the electronic equivalent of an Explanation of Benefits (EOB).
Purpose
The 835 communicates:
- Payment amounts and method (check, EFT)
- Adjustments with reason codes (CARC/RARC)
- Denial explanations
- Service-line level payment details
- Patient responsibility amounts
It flows from payer → clearinghouse → provider after claims are adjudicated.
Loop Structure
Loop 1000A — Payer Identification
Loop 1000B — Payee Identification
Loop 2000 — Header (TRN - Check/EFT info)
Loop 2100 — Claim Payment Information (CLP)
Loop 2110 — Service Payment Information (SVC)The 835 is flatter than the 837 — there's no HL hierarchy. Each check/EFT can contain multiple claim payments, and each claim can have multiple service lines.
Key Segments
TRN — Trace Number
Identifies the payment:
TRN*1*123456789*1512345678~| Element | Position | Description | Example |
|---|---|---|---|
| Trace Type | 01 | 1=Current Transaction Trace | 1 |
| Reference ID | 02 | Check number or EFT trace | 123456789 |
| Originator ID | 03 | Payer's routing/ID | 1512345678 |
CLP — Claim Payment
One per claim that was processed:
CLP*CLAIM001*1*1500*1200*150**1*PAYERCLAIMID~| Element | Position | Description | Example |
|---|---|---|---|
| Claim ID | 01 | Provider's claim number | CLAIM001 |
| Status Code | 02 | 1=Processed Primary, 2=Processed Secondary, 4=Denied | 1 |
| Billed Amount | 03 | Total charges submitted | 1500 |
| Paid Amount | 04 | Amount being paid | 1200 |
| Patient Responsibility | 05 | Patient owes | 150 |
| Payer Claim Control # | 07 | Payer's internal claim ID | PAYERCLAIMID |
Claim Status Codes
| Code | Meaning |
|---|---|
| 1 | Processed as Primary |
| 2 | Processed as Secondary |
| 3 | Processed as Tertiary |
| 4 | Denied |
| 19 | Processed as Primary, Forwarded to Additional Payer |
| 20 | Processed as Secondary, Forwarded to Additional Payer |
| 21 | Processed as Tertiary, Forwarded to Additional Payer |
| 22 | Reversal of Previous Payment |
| 23 | Not Our Claim, Forwarded to Another Payer |
CAS — Claim Adjustment
Explains why amounts differ:
CAS*CO*45*150~
CAS*PR*1*50~| Element | Position | Description | Example |
|---|---|---|---|
| Group Code | 01 | Adjustment category | CO, PR, PI, OA |
| Reason Code | 02 | CARC code | 45 |
| Amount | 03 | Adjustment amount | 150 |
Additional reason/amount pairs can follow (positions 04-05, 06-07, etc.)
Adjustment Group Codes
| Code | Meaning | Who's Responsible |
|---|---|---|
| CO | Contractual Obligation | Provider write-off |
| PR | Patient Responsibility | Bill to patient |
| PI | Payer Initiated Reduction | Payer adjustment |
| OA | Other Adjustment | Various reasons |
| CR | Correction/Reversal | Fixes prior error |
SVC — Service Payment
Payment detail for each service line:
SVC*HC:99213:25*125*100**1~| Element | Position | Description | Example |
|---|---|---|---|
| Procedure Code | 01 | Composite with modifiers | HC:99213:25 |
| Billed Amount | 02 | Charged for this line | 125 |
| Paid Amount | 03 | Paid for this line | 100 |
| Units Paid | 05 | Quantity paid | 1 |
LQ — Remark Code
RARC codes providing additional explanation:
LQ*HE*N130~| Element | Position | Description |
|---|---|---|
| Qualifier | 01 | HE = Remittance Advice Remark Code |
| Code | 02 | RARC code (e.g., N130) |
EDI Paisan Features
Viewing
- Payment summary — Total paid, denied, adjusted at a glance
- Claim-by-claim breakdown — Status, amounts, adjustments for each claim
- Adjustment code translation — Human-readable CARC/RARC descriptions
- Service line details — Drill into line-level payments
- Search — Find claims by ID, check number, or adjustment code
Splitting (Pro)
| Split Mode | What It Does |
|---|---|
| By Check | One file per ST envelope (each check/EFT) |
| By Payment | One file per CLP segment (individual claims) |
| By Payer | Group all payments from the same payer |
| By Provider | Group all payments to the same payee |
| By Transaction | One file per ST...SE envelope |
Each split file includes proper envelopes and header information (BPR, TRN, payer/payee loops).
Payment Export (Pro)
Extract payment data in structured format:
| Field | Source |
|---|---|
| Check Number | TRN02 |
| Claim ID | CLP01 |
| Billed Amount | CLP03 |
| Paid Amount | CLP04 |
| Patient Responsibility | CLP05 |
| Adjustments | CAS segments |
| Service Lines | SVC segments |
Understanding Adjustment Codes
Common CARC Codes
| Code | Description |
|---|---|
| 1 | Deductible amount |
| 2 | Coinsurance amount |
| 3 | Copay amount |
| 4 | The procedure code is inconsistent with the modifier |
| 16 | Claim lacks information needed for adjudication |
| 18 | Exact duplicate claim |
| 29 | Time limit for filing has expired |
| 45 | Charges exceed fee schedule/maximum allowable |
| 96 | Non-covered charge(s) |
| 97 | Benefit maximum has been reached |
Common RARC Codes
| Code | Description |
|---|---|
| N130 | Consult the payer's website for additional information |
| N362 | Missing/Incomplete/Invalid diagnosis code(s) |
| N382 | Missing/Incomplete/Invalid patient identifier |
| N657 | This should be billed to another payer first |
| MA04 | Secondary payment cannot be made |
| MA130 | Your claim contains incomplete/invalid information |
Example 835 Structure
ISA*00* *00* *ZZ*BCBS *ZZ*PROVIDER *240120*0800*^*00501*000000001*0*P*:~
GS*HP*BCBS*PROVIDER*20240120*0800*1*X*005010X221A1~
ST*835*0001~
BPR*I*1200*C*ACH*CCP*01*999999999*DA*123456789**01*999999998*DA*987654321*20240120~
TRN*1*CHECK123*1999999999~
DTM*405*20240120~
N1*PR*BLUE CROSS BLUE SHIELD~
N3*PO BOX 12345~
N4*CHICAGO*IL*60601~
REF*2U*PAYERID123~
N1*PE*ABC MEDICAL GROUP*XX*1234567890~
N3*100 MAIN STREET~
N4*ANYTOWN*NY*12345~
REF*TJ*111111111~
CLP*CLAIM001*1*1500*1200*150**1*PAYERCN001~
NM1*QC*1*SMITH*JOHN****MI*MEM123456~
NM1*82*1*JONES*MARY****XX*9876543210~
DTM*232*20240110~
DTM*233*20240110~
CAS*CO*45*150~
CAS*PR*1*150~
SVC*HC:99213:25*125*100**1~
DTM*472*20240110~
CAS*CO*45*25~
SVC*HC:85025*125*100**1~
DTM*472*20240110~
CAS*CO*45*25~
AMT*B6*150~
SE*26*0001~
GE*1*1~
IEA*1*000000001~Common Issues
Missing Payment Information
If TRN or BPR segments are missing, EDI Paisan will:
- Display a warning
- Still render available claim data
Unrecognized Adjustment Codes
CARC and RARC codes are updated periodically. EDI Paisan maintains current lookups but will display the raw code if a description isn't available.
Coordination of Benefits
For secondary payments (CLP02=2), adjustments may reference amounts paid by the primary payer. EDI Paisan displays these but cannot validate against the primary 835.
Related Documentation
- 835 Splitting Guide — Splitting remittance files
- Adjustment Code Reference — Full CARC/RARC lookups
- Payment Reconciliation — Working with multiple 835s