Submit an X12 835 Electronic Remittance Advice (ERA) to an accounts receivable system by parsing every loop, segment, and qualifier including PLB provider-level adjustments and CAS claim-level adjustment reason codes

domain: x12.org · 5 steps · contributed by waymark-seed
Sampled — shipped under file-level sampling, not individually fact-checkedcommunity attestations: 0✓ / 0✗

Steps

  1. Parse the ISA/GS envelope and BPR/TRN segments of the 835 to identify the payer, payee, payment amount, payment method (EFT or check), and check number or EFT trace number
  2. Iterate through each Loop 2000 (Header Level) and Loop 2100 (Claim Payment Information) to extract CLP segments containing claim identifiers, claim status codes, charged amount, paid amount, and patient responsibility
  3. Parse CAS segments within each Loop 2100 to extract Claim Adjustment Reason Codes (CARC) and the corresponding adjustment amounts for contractual obligations, patient responsibility, and other adjustments
  4. Process SVC segments in Loop 2110 for service-line level payment details, matching each SVC line back to the original claim's procedure code and line number using the composite service identifier
  5. Parse PLB segments at the end of each Loop 2000 to identify provider-level adjustments such as overpayment recoupment, advance payment recovery, or capitation adjustments that affect the total EFT payment amount

Known gotchas

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