Claims

The remaining dollar amount outstanding on a remittance transaction after applying all payer payments, adjustments, and patient responsibility amounts. Used in accounts receivable systems to identify underpaid claims, track residual balances requiring secondary billing or patient billing, and support revenue cycle reconciliation reporting.

The total dollar amount submitted by a provider on a claim before payer adjudication, as reflected on the remittance advice. Used in 835 Electronic Remittance Advice reconciliation to compare original charges against allowed amounts and identify contractual write-offs, denials, and payment variances in revenue cycle systems.

The date of birth of the member or patient associated with a remittance transaction, used to validate member eligibility and identity during claims payment reconciliation. Included in remittance data to confirm that payments correspond to the correct beneficiary when matching EOB or 835 records to enrollment files.

The arterial pressure value for a payment explanation. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for remittance management and reporting.

The date on which a remittance transaction was voided or withdrawn, typically due to payment errors, duplicate disbursements, or claim reversals. Used in revenue cycle and accounts receivable systems to maintain accurate financial records and trigger reprocessing workflows when payments are cancelled and reissued.

Categorization label for remittance within Compliance processes in Healthcare implementations. Used for reporting, integrations, and downstream analytics.

The billed charge amount appearing on an Electronic Remittance Advice (ERA/835) transaction, representing the original amount submitted by the provider for a specific service line before payer adjudication, adjustments, or contractual write-offs are applied.

The primary diagnosis or clinical reason for the service captured within remittance processing, used to reconcile payment explanations against original claim submissions and validate that adjudication aligns with the documented clinical justification for the rendered service.

Identifies a subordinate claim or service line record linked to a parent remittance transaction, enabling hierarchical grouping of related payment explanation records within ERA/835 processing for accurate reconciliation of multi-line or split claims.

The city associated with the payee or payer address on an Electronic Remittance Advice (ERA/835) transaction, used to validate provider or facility location data during payment reconciliation and remittance posting in claims management systems.

The original date a claim was submitted to the payer, as reflected on the Electronic Remittance Advice (ERA/835). Used to reconcile payment timelines, measure payer turnaround compliance, and support audit trails in claims adjudication workflows.

The adjudication status assigned by the payer on an Electronic Remittance Advice (ERA/835), indicating whether a claim was paid, denied, adjusted, or pended. Drives downstream accounts receivable workflows and identifies claims requiring follow-up or appeal.

The classification category assigned to a remittance transaction, such as professional, institutional, or pharmacy claim type, used to segment and route ERA/835 payment explanations for appropriate posting rules and financial reconciliation processes.

Standardized code included in an 835 EDI remittance advice transaction, such as ANSI claim adjustment reason codes (CARC) or remittance advice remark codes (RARC), explaining payment decisions. Critical for provider AR systems and data engineers parsing payer payment files.

The member cost-share amount on an ERA/835 transaction representing the percentage of allowed charges the patient is responsible for after the deductible is met, used in remittance reconciliation to determine the balance billable to the member.

Free-text notation captured within an ERA/835 remittance record, providing supplemental explanation from the payer regarding adjudication decisions, claim adjustments, or payment discrepancies not fully described by standard claim adjustment reason codes.

The date on which remittance processing and payment posting were finalized for a given ERA/835 transaction, used to track processing cycle times, confirm accounts receivable closure, and support financial period reconciliation in healthcare billing systems.

A flag on an ERA/835 remittance record designating that payment or claim information is subject to restricted access due to sensitivity, such as behavioral health or substance abuse services, governing which users or systems may view or process the remittance data.

The fixed patient cost-share dollar amount reflected on an ERA/835 remittance transaction, indicating the portion of allowed charges the member paid or owes at the point of service, used to reconcile member liability against total claim payment.

The total expense value associated with a remittance transaction, representing the net cost of services rendered after payer adjudication. Used in financial reporting to track actual healthcare expenditures and measure variance against billed and allowed amounts.