Claims

Unique operational identifier assigned to a remittance advice record in claims or pharmacy payment systems, used for external provider communications, payment reconciliation, and ERA-to-EOP matching. Referenced in 835 EDI transaction sets and payer adjudication platforms.

Date on which the condition, injury, or illness referenced in a remittance advice first began, as reported on the original claim. Used in claims adjudication to validate medical necessity timelines, apply correct benefit period rules, and assess coordination of benefits sequencing for payment determination.

The blood oxygen level 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 actual dollar amount paid by the payer as documented on the Electronic Remittance Advice (ERA/835 transaction). Reflects the net payment after contractual adjustments, denials, and coordination of benefits deductions applied to the original claim submission.

The date on which the payer issued payment to the provider or facility as recorded on the Electronic Remittance Advice (ERA/835). Used to reconcile provider accounts receivable, calculate payment lag times, and track compliance with prompt payment regulations.

The identifier linking a remittance transaction to its parent remittance batch or summary-level ERA record. Establishes the hierarchical relationship between individual claim payment details and the overarching remittance advice document in claims payment processing.

The gross dollar value of the payment transaction issued by the payer on the ERA/835 remittance advice, representing the total funds transferred for a batch of claims. May differ from individual claim-level paid amounts due to bundled or consolidated payment arrangements.

The current processing state of a remittance payment transaction, such as issued, posted, voided, or reversed. Used in claims reconciliation workflows to track whether ERA payments have been successfully matched to claims and applied to provider accounts receivable ledgers.

Numeric percentage value applied within a remittance record, such as contractual adjustment rates, withhold percentages, or incentive payment allocations in payer and PBM systems. Used in downstream analytics to calculate net payment obligations and provider settlement amounts.

The defined billing or adjudication time interval covered by a remittance advice, indicating the date range of claims included in the ERA/835 payment cycle. Used to reconcile payer payment cycles against provider billing periods and cash flow reporting.

The telephone contact number associated with the payer or clearinghouse issuing the remittance advice. Used by provider billing staff to contact the payer for payment inquiries, dispute resolution, or ERA reconciliation issues identified during claims posting.

The health insurance plan identifier or name associated with the remittance advice, indicating which payer benefit plan adjudicated and funded the claims. Used to reconcile payments across multiple plan types such as commercial, Medicare Advantage, or Medicaid managed care.

The insurance policy or group contract number referenced on the remittance advice, linking the ERA payment back to the specific member coverage under which claims were adjudicated. Critical for matching payments to the correct payer contract and verifying correct adjudication rates.

The preferred display name or alias assigned to a remittance record within the claims management system. Used to identify and label remittance batches in a human-readable format for billing staff reconciling ERA transactions across multiple payers and payment cycles.

The contracted or fee schedule price associated with a service line on the remittance advice, reflecting the allowed amount established under the payer's reimbursement contract. Used to validate that adjudicated payments align with negotiated rates and identify underpayments.

A flag on the remittance advice designating whether the paying entity is the primary payer responsible for first-order adjudication of the claim. Used in coordination of benefits workflows to sequence payer responsibility and determine correct secondary claim submission.

The processing priority level assigned to a remittance transaction within the claims posting workflow. Determines the order in which ERA batches are reconciled and applied to accounts receivable, ensuring high-value or time-sensitive payments are posted to provider ledgers promptly.

The heart rate 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.

Numeric count associated with a remittance record, such as the number of service units, claim lines, or prescription fills included in a payment batch. Used in pharmacy PBM and claims systems to validate remittance completeness and support payment audit processes.

The race or ethnicity classification of the patient associated with the remittance transaction, sourced from enrollment or claims data. Used in population health analytics and health equity reporting to identify disparities in claims payment patterns across demographic groups.