835 file anatomy

Structural reference for the 835 remittance advice. Written for humans reconciling a deposit and for engineers or agents parsing files.

The segment map

Segment	Level	Carries
`BPR`	File	Total payment amount, payment method, effective date, receiving bank details
`TRN`	File	Reassociation trace number, the key to matching the deposit
`REF`	File	Additional identifiers, e.g. the payer’s EDI number
`DTM`	File	Production date
`N1*PR`	File	Payer name and address
`N1*PE`	File	Payee, your PC, with NPI and Tax ID
`LX`	Header	Transaction set line number, grouping claims
`CLP`	Claim	Patient account number, claim status code, total charged, total paid, patient responsibility, payer claim control number
`NM1*QC`	Claim	Patient
`NM1*82`	Claim	Rendering provider
`CAS`	Claim or line	Adjustments, group code, reason code, amount
`DTM*232/233`	Claim	Statement period
`AMT`	Claim	Additional amounts, e.g. allowed
`SVC`	Line	Procedure code, charged, paid, allowed units
`DTM*472`	Line	Service date
`LQ`	Line	Remark codes (RARC)
`PLB`	File	Provider-level adjustments, takebacks, interest, withholds
`SE`	—	Trailer

Annotated example

ISA*00*          *00*          *ZZ*PAYERID        *ZZ*RECEIVERID     *260901*1400*^*00501*000000042*0*P*:~
GS*HP*PAYERID*RECEIVERID*20260901*1400*42*X*005010X221A1~
ST*835*0001~
BPR*I*214.60*C*ACH*CCP*01*011000015*DA*123456789*1234567890**01*021000021*DA*987654321*20260903~
TRN*1*ABC20260901001*1234567890~
DTM*405*20260901~
N1*PR*REGIONAL BCBS~
N1*PE*PRIYA SHAH MD PC*XX*1234567890~
REF*TJ*880000000~
LX*1~
CLP*PATACCT001*1*480.00*215.82*53.95*CI*CLAIMCTRL9876*11~
NM1*QC*1*CHEN*MARGARET****MI*ABC123456789~
NM1*82*1*SHAH*PRIYA****XX*1987654321~
SVC*HC:99213:25*285.00*118.66**1~
DTM*472*20260801~
CAS*CO*45*136.68~
CAS*PR*2*29.66~
SVC*HC:11102*195.00*97.16**1~
DTM*472*20260801~
CAS*CO*45*73.55~
CAS*PR*2*24.29~
PLB*1234567890*20261231*WO:CLAIMCTRL5432*1.22~
SE*20*0001~
GE*1*42~
IEA*1*000000042~

Reading it

BPR*I*214.60*C*ACH*CCP*... I = remittance information with payment. Total payment $214.60. C = credit. ACH with CCP = the ACH CCD+ format used for health care EFT. The remaining elements carry the originating and receiving bank routing and account numbers and the effective date 20260903. TRN*1*ABC20260901001*1234567890 The reassociation trace number ABC20260901001. This value appears in the ACH addenda record of the corresponding EFT. This is how you match the deposit to this remittance. CLP*PATACCT001*1*480.00*215.82*53.95*CI*CLAIMCTRL9876*11

Element	Value	Meaning
CLP01	`PATACCT001`	Your patient account number
CLP02	`1`	Claim status: processed as primary
CLP03	`480.00`	Total charged
CLP04	`215.82`	Total paid
CLP05	`53.95`	Patient responsibility
CLP06	`CI`	Claim filing indicator, commercial insurance
CLP07	`CLAIMCTRL9876`	Payer claim control number, use this on a corrected claim
CLP08	`11`	Facility type code

SVC*HC:99213:25*285.00*118.66**1 Service line: CPT 99213 with modifier 25, charged

285.00, **paid

118.66**, 1 unit. CAS*CO*45*136.68 Adjustment: group code CO (contractual obligation), CARC 45 (charge exceeds fee arrangement), $136.68. Write this off — you cannot bill the patient. CAS*PR*2*29.66 Group code PR (patient responsibility), CARC 2 (coinsurance), $29.66. Bill the patient. PLB*1234567890*20261231*WO:CLAIMCTRL5432*1.22 Provider-level adjustment: WO = overpayment recovery, recouping $1.22 against prior claim CLAIMCTRL5432.

Tying the remittance to the deposit

The worked arithmetic:


Line 1 paid	$118.66
Line 2 paid	$97.16
Claim total (CLP04)	$215.82
PLB `WO` recoupment	−$1.22
BPR total payment	$214.60

The EFT for $214.60 will carry ABC20260901001 in its ACH addenda record. Sum of claim payments ± PLB = BPR total = the deposit. If that equation doesn’t hold, stop and find out why before posting. See Reconcile payments daily.

Claim status codes (CLP02)

Code	Meaning
`1`	Processed as primary
`2`	Processed as secondary
`3`	Processed as tertiary
`4`	Denied
`19`	Processed as primary, forwarded to another payer
`20`	Processed as secondary, forwarded
`21`	Processed as tertiary, forwarded
`22`	Reversal of a previous payment
`23`	Not our claim, forwarded
`25`	Predetermination, pricing only, no payment

Status 4 routes to the denial queue. Status 22 unwinds a payment you already posted.

PLB reason codes

Code	Meaning
`WO`	Overpayment recovery, a takeback
`FB`	Forwarding balance, carried to a future remittance
`L6`	Interest owed to you for late payment
`CS`	Adjustment
`72`	Authorized return
`IR`	Internal revenue withholding
`CV`	Capitation interest
`AH`	Origination fee
`B2`	Rebate

PLB is where naive parsers break. A parser that sums CLP04 values and expects the total to equal the deposit will be wrong on every remittance containing a PLB, which is many of them. Handle PLB explicitly or your reconciliation never ties. See Handle recoupments.

Why one 835 is not one deposit

Four independent reasons:

Aggregation, a payer may combine several remittances into one deposit
Splitting, a large remittance may settle across multiple payments
PLB, shifts the total away from the sum of claims
Method, paper checks and virtual credit cards arrive on entirely different timelines than the 835

Always reassociate by TRN, never by matching dollar amounts. Amount-matching works until two payers send similar amounts on the same day.

Other parser traps

Trap	Detail
`CAS` repeats	One `CAS` segment can carry up to six adjustment triplets. Parse all of them.
*Claim-level and* line-level `CAS`**	Both occur. Summing only one level understates adjustments.
`LQ` remark codes	RARCs live in `LQ`, separate from the `CAS` reason codes.
Multiple `LX` groups	Claims are grouped; don’t assume one group.
Negative amounts	Reversals (`CLP02` = 22) carry negatives.
Zero-dollar remittances	An 835 can carry a $0 `BPR`, denials only, no payment. Still must be posted.
Delimiters vary	`*` and `:` are conventional, not guaranteed. Read them from the `ISA` segment.

PHI

An 835 is protected health information, patient names, member IDs, dates of service, procedure and diagnosis detail. Encrypt in transit and at rest, access-control it, and cover any analytics warehouse in your BAAs and security risk analysis. See HIPAA for MSO-PC operators.

CPOM & Legal

Payers

Clearinghouses & Vendors

EDI & Code Sets

Banking & Payments

Glossary & Appendices

The segment map

Annotated example

Reading it

Tying the remittance to the deposit

Claim status codes (CLP02)

PLB reason codes

Why one 835 is not one deposit

Other parser traps

PHI

​The segment map

​Annotated example

​Reading it

​Tying the remittance to the deposit

​Claim status codes (CLP02)

​PLB reason codes

​Why one 835 is not one deposit

​Other parser traps

​PHI

The segment map

Annotated example

Reading it

Tying the remittance to the deposit

Claim status codes (CLP02)

PLB reason codes

Why one 835 is not one deposit

Other parser traps

PHI