The EDI 835 or Electronic Remittance Advice (ERA) 835 also known as Health Care Claim Payment and Remittance Advice is the electronic transaction that provides claim payment information. This translation set and format have been specified by HIPAA 5010 requirements for the electronic exchange of healthcare benefits and payment information. These EDI transaction 835 files are primarily used for healthcare insurance plans to make payments to healthcare providers and deliver Explanation of Benefits (EOB). it is used by facilities, practices, and billing companies to auto-post the claim payments into the systems. You can get your Electronic remittance advice 835 files through a clearinghouse or download them from an app.
Once a healthcare service provider submits the claim, the healthcare insurance plan uses the EDI 835 to get the details related to the payments of the claim. This includes:
- Charges that were paid, denied, and adjusted
- The presence of co-insurance, deductible, or co-pay.
- Bundling or splitting of claims or line items
- How the payment was made