Get the free explanation of payment 835

Fallon's community health plan explanation of payment 835 companion guides to the health care payment×advice ANSI X12 835 (Version 004010×091A1) implementation guide V2.2 document history Revision

How to fill out explanation of payment 835

How to fill out explanation of payment 835:

1. Gather all relevant information and documents, including the original payment details, billing statements, and any supporting documents.
2. Start by entering the necessary identification details, such as the name of the healthcare provider, the patient's name, and the date of service.
3. Next, carefully review the payment information, including the payment amount, any adjustments or deductions, and the reason codes provided.
4. Use the appropriate codes and descriptions to explain any adjustments or deductions made to the payment. This could include reasons such as denied claims, contract adjustments, or coordination of benefits.
5. Include any additional information or comments that may be required, such as clarifications on specific claims or services.
6. Double-check all entered information for accuracy and completeness before submitting the explanation of payment 835.

Who needs explanation of payment 835:

1. Healthcare providers: Explanation of payment 835 is primarily required by healthcare providers who receive electronic remittance advice (ERA) from payers. It helps them understand the payment details, adjustments, and any denials related to their claims.
2. Medical billing and coding staff: The explanation of payment 835 is essential for medical billing and coding professionals who need to accurately process and reconcile payments, identify possible billing errors, and update patient records accordingly.
3. Insurance companies and payers: Insurance companies and payers utilize the explanation of payment 835 to communicate payment details to healthcare providers. It helps them provide transparency about payment adjustments, denials, and payment amounts for specific services or claims. Additionally, payers may need it for their internal auditing and reporting purposes.

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What is explanation of payment 835?

Explanation of payment 835 is a standardized electronic remittance advice (ERA) transaction which provides detailed information about healthcare claims payment, adjustments, and denials.

Who is required to file explanation of payment 835?

Healthcare providers, billing companies, and insurance companies are required to file explanation of payment 835.

How to fill out explanation of payment 835?

Explanation of payment 835 is typically filled out electronically using a HIPAA-compliant software or clearinghouse.

What is the purpose of explanation of payment 835?

The purpose of explanation of payment 835 is to help healthcare providers reconcile payments, understand claim adjustments, and track denials.

What information must be reported on explanation of payment 835?

Information such as payment amounts, adjustments, patient responsibility, claim numbers, and denial reasons must be reported on explanation of payment 835.