EDI 835 Health Care Claim Payment/Advice, also known as the Electronic Remittance Advice (ERA), is a standardized electronic transaction used in healthcare to communicate claim payment information. It serves as a digital explanation of benefits (EOB), detailing how a claim was adjudicated and the resulting payment or denial.
This electronic document complies with the ANSI X12 EDI specification.
All EDI documents are securely encrypted in transit, allowing trading partners to send sensitive data safely. By communicating the acceptance, rejection, and processing status of EDI transactions, it plays a critical role in ensuring efficient, accurate, and seamless data exchange between trading partners.
Enhanced Efficiency
Automate payment posting and reconciliation processes, saving time and reducing manual errors.
Improved Accuracy
Minimize data entry errors and discrepancies in payment information.
Faster Reimbursements
Accelerate the revenue cycle with quicker payment processing and posting.
Cost Reduction
Decrease administrative costs associated with paper-based remittance advice.
Better Cash Flow Management
Gain clearer insights into payment statuses and trends.
EDI 835 transactions follow a structured format, containing essential information about claim payments:
Header: Includes payer and payee identification, payment date, and total payment amount.
Claim Payment Information: Details individual claim payments, adjustments, and denials.
Provider Adjustment Data: Specifies any adjustments not associated with specific claims.
Service Line Items: Breaks down payments for individual services within a claim.
Healthcare providers receive this information electronically, allowing their practice management systems to automatically post payments and update patient accounts.
EDI 835 transactions are highly secure, using encryption and standardized protocols to protect sensitive healthcare and financial data.
Absolutely! EDI 835 is designed to handle a wide range of payment situations, including bundled payments, capitation, and complex adjustments.
Most modern healthcare IT systems support EDI 835. However, it’s essential to check with your software vendor or IT team to ensure compatibility.
Implementation timelines vary, but many organizations can be up and running with EDI 835 in a matter of weeks with proper planning and support.
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With fast and reliable translation, you can rest assured that your EDI processes are in safe hands, allowing you to focus on what truly matters – your business.
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