What is an 835 in NEMT billing?

The 835 is the HIPAA standard electronic file a payer sends to explain a payment. It lists each claim and service line with the amount billed, the amount paid, and a reason code for every difference. The current version is 5010, implementation guide 005010X221A1. The paper version is usually called a remittance advice or RA.

Why does my deposit not match the claims on the remittance?

Usually because of provider-level adjustments in the PLB segment. The payment amount equals the claim-level payments minus any provider-level adjustments, such as the recovery of an earlier overpayment (code WO). Interest (code L6) moves the other way. Find the PLB lines and the deposit will reconcile.

What does CO-45 mean on a remittance?

CO-45 means "Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement." It is the normal reduction from your billed charge to the payer's rate, not a denial. Because the group code is CO, you write it off rather than billing the rider.

What does claim status code 22 mean?

Code 22 in the CLP segment means "Reversal of Previous Payment." The payer is taking back an earlier payment on that claim, shown as negative amounts. If the payer reprocesses the claim, the corrected payment appears as its own claim entry. Post both against the original trip.

How do I start receiving ERAs?

Enroll with each payer. Federal operating rules at 45 CFR 162.1603 include standard ERA and electronic funds transfer enrollment data rules, so the forms look similar across payers. Nevada Medicaid, for example, links a trading partner to the provider through its provider web portal before sending 835 files.

Do brokers send 835 files?

It depends on the broker and your contract. Some brokers send their own statement or portal report instead. Whatever the format, check the same things: which trips were paid, at what rate, what was adjusted or taken back, and why.

NEMT Remittance Advice: Reading an 835 (2026)

What a remittance advice is

A remittance advice is the payer’s explanation of a payment. It lists every claim in the payment, what you billed, what the payer allowed, what it paid, and a code for every difference. Without it, a deposit is just a number.

Medicaid programs and managed care plans send it in one of two forms:

Electronic (ERA). The HIPAA standard is the ASC X12 835 Health Care Claim Payment/Advice, adopted at 45 CFR 162.1602. Medicare’s EDI manual lists 005010X221A1 as the current version, and state companion guides, such as Nevada’s, use the same one.
Paper. A printed remittance, often called an RA, with the same information. Colorado’s NEMT manual, for example, notes that the patient account number you enter on the claim appears on the RA, which helps you match it.

The money usually moves separately, by electronic funds transfer. HHS rules require the EFT to carry the 835’s reassociation trace number, so the deposit and the remittance can be matched. Federal operating rules at 45 CFR 162.1603 also standardize how providers enroll for EFT and ERA and how payers use reason codes.

Brokers work differently. A broker pays under its contract and may send its own payment statement rather than an 835. That is covered further down.

How an 835 is organized

An 835 is a text file of segments, like the 837P you sent. It is built for software to read, but knowing the segments helps when the numbers do not add up.

Segment	What it tells you
BPR	The total payment, the method, and the date. Method codes include ACH (electronic transfer), CHK (check), and NON (no payment).
TRN	The trace number: the check number or EFT number that matches the deposit. Nevada puts the RA number here when all claims denied and no check was issued.
N1	The payer and the payee.
CLP	One claim: your claim ID, the claim status, the billed amount, the paid amount, the patient’s share, and the payer’s claim number.
CAS	An adjustment: a group code, a reason code, and the amount.
NM1	The patient, as the payer has them on file.
SVC	One service line: the procedure code and modifiers, the billed and paid amounts, and the units.
DTM	Dates, such as the date of service.
LQ	Remark codes (RARCs) that add detail to an adjustment.
PLB	Provider-level adjustments that are not tied to one claim, such as recoupments and interest.

The claim status code in the CLP segment tells you what happened to each claim. Ohio’s 835 companion guide lists the common values:

1: Processed as primary
2: Processed as secondary
3: Processed as tertiary
4: Denied
22: Reversal of previous payment

How the numbers add up

Every 835 must balance at three levels: the service line, the claim, and the provider. Medicare’s remittance chapter states the rule plainly: the check amount is “the sum of all claim-level payments, including claims and service-level adjustments, less any provider level adjustments.”

Here is a hypothetical payment for three claims, using Colorado’s July 2026 wheelchair van rates for a 12-mile trip:

Line	Billed	Adjustment	Paid
Claim A, status 1: A0130 and S0209	$80.00	CO-45, $12.98	$67.02
Claim B, status 4	$80.00	CO-197, $80.00	$0.00
Claim C, status 1: A0130 and S0209	$80.00	CO-45, $12.98	$67.02
PLB, code WO (overpayment recovery)		$25.00	minus $25.00
Payment in BPR and on the deposit			$109.04

Claim A and Claim C paid at the fee schedule, and the $12.98 difference on each is a normal contractual write-off. Claim B was denied for a missing authorization and needs work. The $25.00 recovery is for an earlier trip the payer overpaid. The deposit is $67.02 plus $67.02 minus $25.00.

Reading the codes

Adjustments use three kinds of codes. The X12 code lists define them all, and the reason code list is updated three times a year.

Group codes say who owns the amount. CO (Contractual Obligation) is a write-off that is generally not billed to the patient. PR (Patient Responsibility) may be billed to the patient. OA (Other Adjustment) and PI (Payor Initiated Reduction) cover the rest.
Claim adjustment reason codes (CARCs) say why. CO-45 is the everyday fee schedule reduction. CO-197 (authorization absent), CO-29 (filing time limit expired), and OA-18 (exact duplicate) are denials.
Remittance advice remark codes (RARCs) add detail, such as N30 (patient ineligible for this service) or MA130 (unprocessable claim).

Provider-level adjustments in the PLB segment use their own list. Common ones include WO (overpayment recovery amount), L6 (interest amount), FB (forward balance, a non-claim balance carried forward), and CS (an adjustment explained separately).

The NEMT claim denials guide lists the reason codes transportation providers see most and how to fix each one.

Broker payment statements

A broker pays you under your contract, and its payment report is your remittance. The format varies, but the questions are the same: which trips were paid, at what rate, what was adjusted, and why.

Broker rules differ. A few examples from broker and plan provider materials:

SafeRide Health asks providers to bill trips daily with timestamps and driver and vehicle information, and pays within 30 days of a properly completed ride.
CareOregon audits a share of trips, adjusts payment when a provider billed above the contracted rate, and can recover an overpayment by deducting it from a future invoice. That deduction shows up as a negative line on a later statement.
New York is different. The broker, Medical Answering Services, authorizes trips, but providers bill the state’s claims system with the authorization number, so the remittance comes from Medicaid.

On every broker statement, check each trip against your records: the rider, the date, the service level, the miles, and the rate in your contract. Dispute errors in the way and within the time your contract sets. See NEMT broker rates for how those rates are usually structured.

Posting a remittance, step by step

Post every remittance the same way, the day it arrives:

Match the payment. Tie the deposit or check to the remittance using the trace number and the total.
Post the paid lines. Record each payment against the trip or invoice it pays.
Write off contractual adjustments. CO-45 and similar reductions close the difference between your charge and the rate.
Queue the denials. Every CO-197, CO-16, or CO-29 goes on a work list with its deadline.
Handle reversals and recoveries. Match a status 22 reversal or a PLB recovery to the original trip, not to today’s trips.
Look for what is missing. Any trip you billed that is not on a remittance within the payer’s normal cycle needs a status check.
Keep the files. Nevada, for example, only re-posts an 835 file within a 60-day retention window, so save each one when it arrives.

Nevada releases 835 files every Wednesday. Learn each payer’s cycle, because it tells you when a missing payment is actually late.

One ledger for every payment

A broker check, a facility’s ACH deposit, and a family’s card payment all need to land against the right trips. In HealthRide, you record each payment, whether a check, an ACH deposit, cash, or a card, against the invoices and trips it pays, and partial payments are handled cleanly. The payer summary report shows what was billed and what is still owed for each payer.

NEMT remittance advice: how to read an 835 and a broker payment statement