X12 835 — Healthcare Claim Payment/Advice

Electronic Remittance Advice (ERA) emitted by a health payer to a provider, breaking down for each claim what is paid, adjusted, denied.

Purpose

The 835 is the ERA, typically paired with a NACHA CCD+ EFT carrying a CTX addenda that includes the 835 reference number. For each 837-submitted claim, the ERA details: adjudication (Processed As Primary, Forwarded, Denied), billed amount, allowed amount, contractual adjustments, patient responsibility (deductible, coinsurance, copay) via Claim Adjustment Reason Codes (CARC), and Remark Codes (RARC) on top.

Envelope and structure

The 835 uses the standard triple X12 envelope with GS01 = HP (Health Care Payment / Remittance Advice). Note: in 5010 TR3 the ST03 is usually left empty for 835s (the standard permits this), unlike 270/271/276/277/278. Example remittance covering two claims:

ISA*00*          *00*          *ZZ*PAYER99        *ZZ*PROVIDER01     *260513*0900*U*00501*000000835*0*P*>~
GS*HP*PAYER99*PROVIDER01*20260513*0900*1*X*005010X221A1~
ST*835*0001~
BPR*I*2150.00*C*ACH*CCP*01*123456789*DA*987654321*PAYER99**01*111223333*DA*55667788*20260513~
TRN*1*TRACE-PAY-0001*1PAYER99~
DTM*405*20260512~
N1*PR*PAYER99~
N1*PE*ACME CLINIC*XX*1234567890~
LX*1~
CLP*PATACCT-9911*1*620.00*620.00**HM*CLM-CTRL-87766*11*1~
NM1*QC*1*DOE*JANE****MI*MEMBER12345~
SVC*HC:99213*120.00*120.00**1~
CAS*PR*1*0~
SVC*HC:90834*500.00*500.00**1~
PLB*1234567890*20261231*L6*125.00~
SE*15*0001~
GE*1*1~
IEA*1*000000835~

Common segments (concept)

• Header — BPR Financial Information carries the payment method (ACH, NON, CHK), the total amount, the banking coordinates (routing, account). TRN Trace Number ties the ERA to the matching EFT. N1 Payer and N1 Payee identify the parties.
• Detail — each LX opens a Header Number loop, then CLP Claim Payment Information details each claim: patient account reference, status code (1 Processed as primary, 2 Processed as secondary, 4 Denied…), amounts. SVC Service Payment Information details every service line (CPT/HCPCS, amounts), CAS Claim Adjustment carries adjustments (group code PR Patient Responsibility, CO Contractual Obligation, OA Other Adjustment) with their CARC codes.
• Summary — PLB Provider Adjustment carries provider-level adjustments (advances, recoveries, penalties), and SE closes the transaction.

When you'll see it

The 835 is the financial return of the entire US healthcare ecosystem. RCM platforms (Athenahealth, Waystar, R1 RCM, Optum) build auto-posting on it: automatic reconciliation between emitted claim (837), received payment (835) and bank deposit (NACHA). CARC/RARC variances drive revenue-cycle opportunity: Co-45 (Charge exceeds fee schedule), Co-97 (Service not paid separately), Co-29 (Time limit for filing has expired)… revenue-integrity teams track these by payer cohort.

Related transactions

• 837 — Health Care Claim (the claim being paid). See 837 page →
• 276 / 277 — Claim Status Inquiry / Response. 276 · 277
• 820 — Payment Order/Remittance Advice (used for premiums on the employer side, not claims).
• 999 — Implementation Acknowledgment. See 999 page →

Documentation

• x12.org/products/transaction-sets — public index, name and code 835.
• stedi.com/edi/x12/transaction-set/835 — public editorial reference, examples.
• cms.gov — HIPAA EDI guides .
• TR3 005010X221A1 — available for purchase on x12.org or via DISA.