> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# 835 file anatomy

> Annotated 835 with the segment map, a worked example tying one remittance to one deposit, and why naive parsers break.

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

```text theme={null}
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](/guides/payments/reconcile-daily-payments).

## 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                                             |

<Warning>
  **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](/guides/compliance/handle-recoupments).
</Warning>

## Why one 835 is not one deposit

Four independent reasons:

1. **Aggregation**, a payer may combine several remittances into one deposit
2. **Splitting**, a large remittance may settle across multiple payments
3. **PLB**, shifts the total away from the sum of claims
4. **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](/concepts/compliance/hipaa-fundamentals).


## Related topics

- [Step 11: Read your first 835 and get paid](/start/zero-to-paid/read-your-first-835.md)
- [The 835: how payers answer](/concepts/payments/understanding-835s.md)
- [EDI and X12, gently](/concepts/payments/edi-and-x12-basics.md)
- [Post payments from 835s](/guides/billing/post-payments-from-835s.md)
- [Reconcile payments daily](/guides/payments/reconcile-daily-payments.md)
- [CARC codes (Claim Adjustment Reason Codes)](/reference/edi/carc-codes.md)
- [RARC codes (Remittance Advice Remark Codes)](/reference/edi/rarc-codes.md)
- [Group codes (CO, PR, OA, PI)](/reference/edi/group-codes.md)