The segment map
Annotated example
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*12*CLAIMCTRL9876*11
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*1234567893*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:
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)
Status
4 routes to the denial queue. Status 22 unwinds a payment you already posted.
PLB reason codes
Worked example: a refunded overpayment
A patient is covered by two plans. Plan A is primary under coordination-of-benefits rules, Plan B is secondary.- The practice performs a procedure and bills $1,200. Plan B is billed first and pays as though it were primary: $720.
- Plan A later pays its share for the same procedure: $720. It arrives as a second remittance against a second claim. Total paid: $1,440 instead of $1,200.
- Plan B’s correct secondary liability was only $480. It has overpaid by $240 and requests it back.
- The practice writes Plan B a refund check for $240.
- Plan B’s next remittance acknowledges receipt, carrying two provider-level adjustments against the same claim:
WOfor $240 andB3for −$240.
WO records the $240 recovery, which on its own would reduce the deposit by that amount. The negative B3 increases the payment by the same amount, because the money arrived by check rather than by offset. The two net to zero and the deposit still equals the sum of claim payments on that remittance. Reason codes and sequencing differ between payers.
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
TRN, never by matching dollar amounts. Amount-matching works until two payers send similar amounts on the same day.