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remittance advice

remit_adv
finance·Updated Jun 13, 2026

Definition

ISO-11179 Definition

A document sent by a health insurance payer to a healthcare provider explaining how a claim was processed, including the amount paid, any adjustments applied, denial reasons for unpaid services, and member cost-sharing amounts. The HIPAA standard electronic remittance advice is the 835 transaction set which enables automated payment posting in provider billing systems. Remittance advice contains Claim Adjustment Reason Codes and Remittance Advice Remark Codes that explain payment decisions at the claim and service line level.

Accurate and timely remittance advice processing is essential for revenue cycle efficiency — automated 835 posting eliminates manual payment entry, accelerates cash posting, and enables systematic denial tracking. Healthcare data teams build remittance processing pipelines that parse 835 transactions, map CARC and RARC codes to denial categories, automate payment posting, and generate denial work queues prioritized by recovery opportunity and payer appeal deadlines.

Standard Abbreviation

remit_adv

Category

finance

Production DDL — FACT_CLAIM_TRANSACTION

FACT_CLAIM_TRANSACTION.sql
CREATE OR REPLACE TABLE FACT_CLAIM_TRANSACTION (
    clm_txn_key     INTEGER        NOT NULL  -- surrogate key,
    clm_id          VARCHAR(50)    NOT NULL  -- claim identifier,
    mbr_key         INTEGER        NOT NULL  -- FK to DIM_MEMBER,
    prvdr_key       INTEGER        NOT NULL  -- FK to DIM_PROVIDER,
    clm_typ_cd      VARCHAR(10)              -- claim type code,
    tot_chrg_amt    DECIMAL(18,2)            -- total charged amount,
    tot_alwd_amt    DECIMAL(18,2)            -- total allowed amount,
    tot_pd_amt      DECIMAL(18,2)            -- total paid amount,
    cntrct_adj_amt  DECIMAL(18,2)            -- contractual adjustment,
    denial_ind      CHAR(1)                  -- denial indicator,
    denial_rsn_cd   VARCHAR(10)              -- denial reason code,
    prior_auth_nbr  VARCHAR(30)              -- authorization number,
    clm_lag_days    SMALLINT                 -- claim lag days,
    days_ar         SMALLINT                 -- days in AR,
    load_dt         TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical finance table. Convert to BigQuery or Databricks →

Why This Term Matters

Healthcare data terminology is foundational for any data engineer working in this industry. Precise understanding of standard terms enables accurate schema design, reduces downstream data quality issues, and ensures pipelines meet the regulatory and interoperability requirements imposed by HIPAA, HL7 FHIR, and CMS reporting frameworks. Without this foundation, even technically well-built pipelines produce data that fails validation when it reaches payers or regulators.

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