Enroll for electronic ERA (835) and EFT delivery with a payer and validate the first live remittance file

Verified steps

1. Locate the payer's ERA/EFT enrollment form or online portal — most payers require a separate enrollment distinct from EDI claim submission enrollment; some route through clearinghouses like Availity or Optum/Change Healthcare.
2. Submit enrollment with your provider NPI, tax ID, bank account details (for EFT), and clearinghouse routing information; confirm whether the payer delivers 835s directly or routes through a clearinghouse before specifying the delivery destination.
3. Once enrollment confirmation is received, request or await a test 835 file; validate it against the X12 005010X221A1 implementation guide — check the BPR (financial information) segment for payment method (ACH, CHK), amount, and effective date.
4. Write a parser that walks the CLP (claim payment) loop hierarchy: CLP01 (payer claim control number), CLP04 (paid amount), CLP05 (patient responsibility), CAS (claim adjustment with CARC code and adjustment amount), NM1*QC (patient) and NM1*82 (rendering provider).
5. Parse PLB (provider-level adjustment) segments at the end of the file; PLB carries recoupments, withholdings, interest, and capitation payments that do not belong to a specific claim — post these separately to a GL suspense account.
6. Reconcile the sum of all CLP04 claim payments minus PLB adjustments against BPR02 (total payment amount) to confirm file balance before posting to accounts receivable.