EDI X12N 835 Parsing

The Problem

Your an atypical provider and don't have the resources for an enterprise EDI platform and need a simple, cost effective, and reliable tool to read the 835 remittance advice.

You are a provider and want to focus on providing quality services and not spend critical time in deciphering the 835 remittance advice in order to understand how claims have been processed.

 

You and your team are working on a B2B integration to read the 835 remittance advice and need another tool to validate your results.

It's after normal business hours and you're a business analyst responsible for reporting back to upper management the results of a recent payor adjudication cycle.

You have the 835 remittance advice in hand and need a utility to quickly parse the file into a easily readable file so that you can include it in your report to upper management.

It's the last hour and your team is trying to finalize the cost for responding to a request for proposal (RFP) and needs the financial information located in the 835 remittance advice in order to properly respond.


 

 

 

 

The Solution 

1.  Securely register at https://edi.dorightsolutions.com. 

 

2.  Start parsing your 835 remittance advice to Excel to see how your claims are being paid as soon as possible.  Which is extremely important during these unprecedented times.

 

3.  It's that simple. 

 

4.  Here is a sample 835 remit file that you can use to test the process, 835 Sample

 

 

Parsing Constraints 

  • A Business Associates agreement is needed, please complete and return to cecilio.thomas@dorightsolutions.com before submitting live claims with PHI data.
  • The system reports Service line adjustments and not claim adjustments, If no services exist for a claim it will not be written to the output file. 
  • All segments should be terminiated with a ~ (tilda).
  • Files must be 5MB or less. 
  • The following information will be returned: 
  • Total Amount Paid on the Remit 
  • ABA number of the bank the payment is coming from 
  • Account number of the bank the payment is coming from 
  • Payers Federal Tax ID ABA number of the bank the payment is going to 
  • Account number of the bank the payment is going to 
  • Check Issue or EFT Effective Date 
  • Files Batch Number 
  • Payer Name 
  • Payer City 
  • Payer Address 
  • Payer State 
  • Payer Zip Code 
  • Payee Name 
  • Payee Provider Number 
  • Rendering Provider Number 
  • Patient ID Patient's Last Name 
  • Patient's First Name 
  • Patient's Middle Name 
  • Patient's Medicaid Number 
  • Claim/Encounter Status Code 
  • Total Claim Charges 
  • Paid Amount 
  • Co Insurance Amount 
  • Transaction Control Number 
  • First Service Adjustment Group Code 
  • First Service Adjustment Reason Code 
  • First Service Adjustment - Adjustment Code 
  • First Service Remark Code 
  • Second Service Adjustment Group Code 
  • Second Service Adjustment Reason Code 
  • Second Service Adjustment - Adjustment Code 
  • Second Service Remark Code 
  • Third Service Adjustment Group Code 
  • Third Service Adjustment Reason Code 
  • Third Service Adjustment - Adjustment Code 
  • Third Service Remark Code 
  • Fourth Service Adjustment Group Code 
  • Fourth Service Adjustment Reason Code 
  • Fourth Service Adjustment - Adjustment Code 
  • Fourth Service Remark Code 
  • Fifth Service Adjustment Group Code 
  • Fifth Service Adjustment Reason Code 
  • Fifth Service Adjustment - Adjustment Code 
  • Fifth Service Remark Code 
  • Begin Date of Service 
  • End Date of Service 
  • Procedure Code 
  • Units 
  • Interchange Date, this is usually translated as the Remit Date 
  • Interchange Control Number 
  • Biller Reference Number, the unique ID of the claim sent to the payer 
  • Receiver ID 
  • First Provider Adjustment Amount
  • First Prompt Pay Amount
  • First Provider Adjustment Id
  • First Provider Adjustment Reason Code
  • First Provider Adjustment Reason Id

 

Is there anything else I should know? Nothing other than if you have any questions, take a look at our FAQ, register to use the tool at edi.dorightsolutions.com, or email us at cecilio.thomas@dorightsolutions.com. We learn as much or more from simply talking with clients and better understanding there unique challenges.