EDI 835: Health Care Claim Payment/Advice (ERA)
The EDI 835 is the X12 Health Care Claim Payment/Advice transaction — the electronic remittance advice (ERA) a payer sends to explain how a claim was adjudicated. It reports what was paid, adjusted, or denied, with reason and remark codes, and pairs with the 837 claim. The 835 is the HIPAA-mandated ERA standard.
- Transaction
- 835 — Health Care Claim Payment/Advice
- Direction
- Payer to provider (inbound)
- Pairs with
- 837 claim (the 835 is its response)
What is the EDI 835?
The 835 is the payer's answer to your claim. After a payer adjudicates the 837 you submitted, it returns an 835 — the electronic remittance advice — spelling out what happened to every claim and line: allowed, paid, adjusted, denied, with the reason codes attached. It is the file your practice-management system reads to auto-post payments.
Under HIPAA the 835 is the mandated ERA format, which is why the same structured data flows from Medicare, Medicaid, and commercial payers alike. See also electronic remittance advice and ERA vs EOB.
What do the 835 segments actually show?
| Segment | What it carries |
|---|---|
| BPR / TRN | Payment amount, method (ACH/check), and the trace/EFT number to match to the deposit |
| CLP | Claim-level status: billed, paid, patient responsibility, and the claim status code |
| CAS | Adjustments — group code + CARC + amount (this is where denials and write-offs live) |
| SVC | Service-line detail: procedure, billed, paid, allowed |
| PLB | Provider-level adjustments (offsets, recoupments) not tied to one claim |
How does auto-posting work?
The 835 flows from the payer through your clearinghouse into your PM system, which reads the CLP and CAS segments and posts payments and adjustments automatically. The TRN trace number links the 835 to the actual EFT deposit, letting you reconcile the bank against the remittance.
What should you watch when reading an 835?
- CAS group codes matter. CO = contractual (write-off), PR = patient responsibility (bill the patient), OA/PI = other.
- PLB is sneaky. Provider-level offsets recoup prior overpayments and can make a deposit smaller than the claims paid.
- Match the TRN. Reconcile the 835 to the EFT by trace number to catch missing or split payments.
- It pairs with the 837. Every 835 responds to a submitted 837; unmatched 835s signal a posting gap.
Frequently asked questions
The 835 is the electronic remittance advice — the X12 transaction a payer sends back after adjudicating a claim. It details, claim by claim and line by line, what was billed, what was allowed, what was paid, and what was adjusted or denied, using standardized reason (CARC) and remark (RARC) codes. It is the electronic counterpart of the paper EOB/remittance and is HIPAA-mandated.
The 835 is the machine-readable file your PM system posts automatically; the EOB (explanation of benefits) is the human-readable version, historically sent to the patient or provider. The 835 carries the same adjudication detail in structured X12 segments so payments can auto-post. An 835 and a patient EOB describe the same decision in different formats.
The CAS (Claim Adjustment) segment carries the adjustments — the group code (CO, PR, OA, PI), the CARC reason code, and the dollar amount for each adjustment. This is where you see, for example, CO-45 (charge exceeds fee schedule) or CO-97 (bundled). Reading the CAS segment tells you exactly why the paid amount differs from the billed amount.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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