Remittances overview

the remittances tab lets you review insurance payment remittances (era / 835 files) received from payers and see how payments were applied to claims w hat is a remittance (era / 835)? a remittance, also known as an era (electronic remittance advice) or 835 , is a payment file sent by an insurance payer after a claim is processed it includes which claims were paid how much was paid adjustments or contractual reductions patient responsibility amounts payment method and trace information eggmed receives and processes eras through its clearinghouse and applies them to claims and accounts a ccess remittances to view remittances go to billing → remittances you’ll see a list of all remittances received from insurance payers each row represents one remittance file from a payer r emittances list view the remittances table includes transaction id unique identifier from the clearinghouse or payer payer insurance company that sent the payment received date when the remittance was received claims number of claims included in the remittance total payment total amount paid in the remittance status current processing state of the remittance r emittance statuses received – the remittance was received but not yet posted posted – payments were successfully applied to claims and accounts failed – the remittance could not be posted and requires review o pen a remittance click a remittance to view full details at the top, you’ll see a summary including total charged total payment adjustments net payment rate number of claims posting status c laims section the claims table shows all claims included in the remittance for each claim, you’ll see claim control number service date charged amount paid amount adjustments patient responsibility posting status any errors, if applicable this helps you confirm that each claim was processed correctly r emittance details the details section includes technical and payment information, such as external transaction id check number or ach trace posting mode (auto or manual) payer name payment method (e g ach) received date posted date this information is useful for reconciliation and payer follow ups f inancial summary the financial summary provides a high level breakdown of the remittance total charged – sum of all claim charges total paid – total amount paid by the payer variance – difference between charged and paid amounts net payment rate – percentage of charges paid this helps you quickly assess payment accuracy and reimbursement performance r aw 835 data (advanced) the raw 835 data section shows the original era file content this is primarily for advanced billing teams troubleshooting posting issues clearinghouse or payer investigations most users do not need to review this section h ow remittances affect billing once a remittance is posted claim statuses update (e g to paid or partially paid) insurance payments are applied to charge items patient responsibility balances are updated account balances reflect the payment if a remittance fails to post, affected claims and balances will not update until the issue is resolved c ommon use cases use the remittances tab to confirm insurance payments were received verify amounts paid match expectations identify underpayments or zero pay claims reconcile ach or check payments investigate posting or adjustment issues