A lot of practices are still getting remittance information as PDFs. The data is there, but it's locked in a format that can't be used for automation, reporting, or denial management without someone manually entering it. This module converts those PDFs into ANSI-standard 835 files so the data is structured, actionable, and ready to work with.
The engine is built to the CMS 835 TR3 5010A1 specification. It handles all required segments and dynamically maps situational segments like MIA (Inpatient) and MOA (Outpatient) when the data is present. Before any 835 is generated, a built-in reconciliation engine verifies that Check Amount equals the sum of Claim Payments plus Adjustments. If the numbers don't balance, you'll know.
This isn't just a file converter. It reads, maps, validates, and reconciles remittance data according to CMS standards. Here's what's happening at each stage.
Reads remittance PDFs and extracts the data, mapping each field to the correct 835 segment. No manual data entry required.
All required segments are always included. Situational segments (like MIA for inpatient or MOA for outpatient) are pulled in automatically when the data is present.
Before the 835 is generated, the engine verifies that check amounts, claim payments, and adjustments all balance. If something doesn't add up, it gets flagged.
Here's a breakdown of the key segments the engine processes, organized by loop. If you're familiar with 835 file structure, this will show you exactly what's being mapped.
| Loop | Segment | Status | What It Does |
|---|---|---|---|
| Header | BPR | Required | Financial Information: Total provider payment and handling codes |
| Header | TRN | Required | Reassociation Trace: Matches 835 remittances to EFT payments |
| 1000A | N1-01 | Required | Payer Identification: Who is making the payment |
| 1000B | N1-01 | Required | Payee Identification: Who is receiving the payment |
| 2100 | CLP | Required | Claim Level Data: Status, total charges, and payment amounts |
| 2100 | CAS | Situational | Claim Adjustment: Adjustment and denial details via group/reason codes |
| 2100 | MIA | Situational | Inpatient Adjudication: PPS operating outliers and DRG amounts |
| 2100 | MOA | Situational | Outpatient Adjudication: Reimbursement rates and HCPCS payable amounts |
| 2110 | SVC | Required | Service Payment Info: Line-item breakdown of adjudicated codes |
| PLB | Situational | Provider Level Adjustment: Overpayments and interest adjustments |
Revenue acceleration through automation. When remittance data is structured and reconciled automatically, your team spends less time on manual entry and more time on the work that actually recovers revenue.