Remittance Advice
A remittance advice (RA) is the payer's claim-by-claim explanation of what it paid, adjusted, and denied, sent to the provider. It arrives electronically as the X12 835 (ERA) or on paper as a standard paper remittance. Every adjustment carries a group code, a CARC, and often a RARC explaining why.
- Electronic form
- X12 835 transaction (ERA)
- Paper form
- Standard Paper Remittance (SPR)
- Adjustment language
- Group codes + CARCs + RARCs
- Sent to
- The provider (the EOB goes to the patient)
What does a remittance advice show?
For every claim in the payment batch: billed amount, allowed amount, adjustments with reason codes, patient responsibility split into copay, coinsurance, and deductible, and the amount paid, plus check or EFT details tying it all to money in the bank. The electronic version is the X12 835 transaction, covered in depth under electronic remittance advice; the paper version (SPR) carries the same content in a flat layout. "Remittance advice" is the umbrella term for both.
How do you read the adjustment codes?
Every dollar not paid is explained by a group code plus a CARC. The group code assigns liability: CO (contractual obligation, provider absorbs it), PR (patient responsibility, billable to the patient), OA (other adjustment), PI (payer-initiated). The CARC gives the reason: 45 is the fee-schedule reduction, 97 is bundling, 197 is missing auth, and so on. RARCs add fine print.
Worked line: 99213 billed $150. The remit shows CO-45 $52.80, PR-3 $25.00 (copay), payment $72.20. Reconciliation: 52.80 + 25.00 + 72.20 = 150.00. The contractual adjustment posts as a write-down, the copay transfers to the patient, done. Now the dangerous version: the same line arrives as CO-45 $77.80 and payment $72.20, with no PR segment, because the payer misapplied the copay as contractual. Post it blindly and you just donated $25. Group codes are posting instructions, not decoration. When a code combination is unfamiliar, run it through the denial code lookup before posting, not after.
What are PLB segments and why do totals not match?
The provider-level balance (PLB) section adjusts the check itself rather than any single claim: recoupments of prior overpayments, interest payments, and withholds all live there. Classic scenario: the remit lists $4,812 in claim payments but the EFT is $4,312 because a PLB shows a $500 recoupment referencing a claim from four months ago. If your posting process ignores PLB, your bank deposits will never reconcile to your posted payments, and recoupments will silently reopen balances you thought were resolved. Post every PLB to the specific original claim it references, never to a suspense bucket that nobody empties.
What does good posting discipline look like?
- Post within 48 hours, auto-posting ERAs with exception rules for anything unusual.
- Route by group code: PR amounts to patient statements, CO denials to the follow-up queue, PI/OA to review.
- Flag allowed-amount variances against loaded fee schedules; underpayments hide inside routine-looking CO-45s.
- Reconcile remit totals to bank deposits weekly, including PLB activity.
Frequently asked questions
No. The remittance advice goes to the provider and drives payment posting; the explanation of benefits goes to the patient and explains their cost-share. They describe the same adjudication event from two angles, and their numbers should agree. When a patient calls confused, you are usually reconciling their EOB against your RA.
CARCs (claim adjustment reason codes, like 45, 97, 197) state why money was adjusted, always paired with a group code (CO, PR, OA, PI) that assigns liability. RARCs (remark codes, like N130 or M15) add explanatory detail. The full picture usually requires reading the group code, CARC, and RARC together.
The provider-level balance segment in the 835 reports adjustments that are not tied to a specific claim line: overpayment recoupments, interest, withholds, and reissued payments. When a payer takes back money from a prior claim, it flows through PLB, which is why a remit's check total can be less than the sum of its claim payments.
Within 24 to 48 hours of receipt. Every unposted day delays secondary claims, patient statements, and, most costly, denial follow-up, because the denial clock and the appeal deadline started when the payer adjudicated, not when you got around to posting.
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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