835 segments explained: BPR, TRN, CLP, CAS, SVC and PLB
Find the payment, trace, claim, adjustment, service and provider-level information in a remittance.
By Visera · Updated
A map, not a complete specification
An 835 is organized into segments and repeating groups of related information. The identifiers below are useful landmarks when you are reading an ERA. Their exact use depends on the implementation version and payer guidance. This table is a reading aid, not a complete segment dictionary or validation specification.
| Segment | Where to look | Reading tip |
|---|---|---|
| BPR | Payment information | Start with the payment amount and method. BPR02 is the total actual provider payment amount; it is not total billed charges. |
| TRN | Reassociation trace | Use the trace information to associate the remittance with its payment. It is not the individual claim number. |
| CLP | Claim payment information | Find the claim reference, status, charges and payment. CLP04 reports the claim payment amount. |
| CAS | Claim or service adjustment | Read the adjustment group, reason and amount together, at the claim or service level where the segment appears. |
| SVC | Service payment information | Review the service/procedure reference and service-level charge and paid amounts, when service detail is supplied. |
| PLB | Provider-level adjustment | Investigate payment differences that are not necessarily tied to an individual claim in this remittance. |
The field names are cross-checked against the CMS 5010A1 field reference; the role of TRN in payment matching is explained in CMS's EFT/ERA basics.
Why the level matters
A CAS adjustment beside a claim describes a different scope from a service-line CAS adjustment. Preserve that relationship when you review the file. Likewise, a PLB item should not be treated automatically as a new denial against the claim you happen to be reviewing.
Keep the original remittance available for provider-level references and payer-specific detail. A summary of claim payments alone may not explain the amount of a deposit.
Read an adjustment fragment
This invented fragment shows two adjustment amounts. It is not a complete, valid 835 file:
CAS*CO*45*30~
CAS*PR*1*20~In a simplified example with a $200 charge and $150 paid, a $30 contractual reduction and a $20 deductible explain the $50 difference. The two groups describe different responsibility categories. Check the actual claim, remarks and usage notes before posting; do not treat every difference as a denial or subtract the same adjustment twice.
Next, read the guide to CO, PR, reason codes and remark codes.
Sources and current references
- CMS: 835 Flat File, 5010A1 field reference (PDF)
- CMS: EFT and ERA transaction basics (PDF)
- CMS: Health Care Payment and Remittance Advice
- X12: transaction set descriptions, including 835 and 837
This is an introductory reading guide. Use the current X12 implementation guide, code-list usage notes and your payer's companion guide for implementation and posting decisions.