What Is an 835 ERA? The Electronic Remittance Advice Behind Every NEMT Payment

What an 835 ERA is

When a payer pays you, it also tells you what the money is for. That explanation is the remittance advice. The 835 is its electronic form: a data file in the national X12 format that billing software reads line by line. ERA stands for electronic remittance advice, and people use “835” and “ERA” for the same thing.

The 835 is a federal HIPAA standard. The required version has been X12 835 version 5010 since January 1, 2012 (45 CFR 162.1602). The Medicaid program counts as a health plan under HIPAA, and a health plan must use the standard when a provider asks for it (45 CFR 162.925). It may not delay or refuse a transaction because it is standard.

The 835 pairs with the payment. Since January 1, 2014, when a health plan pays through the ACH network, the EFT must carry the same reassociation trace number that appears in the 835. That number is how you match each deposit to the file that explains it. See EFT enrollment for setting up the deposit side.

835 vs paper remittance

A paper or PDF remittance is a statement a person reads. The 835 carries the same payment data in a form software can post. The two are not always identical, and Indiana Medicaid shows why.

	Paper, PDF, or portal remittance (Indiana)	835 file (Indiana)
Format	The state’s own layout	The national X12 835
Reason codes	Four-digit state EOB codes	National reason and remark codes only. EOB codes are state codes and cannot be written to the 835.
Claims shown	Paid, denied, in process, on hold, and adjusted	Paid and denied
How you get it	PDF copies download free from the provider portal. Printed copies by mail cost $0.15 a page.	A trading partner agreement, then ERA sign-up in the portal
Best use	Reading one claim’s detail	Posting every payment in your billing system

Keep both until you trust the file. Federal operating rules in effect since January 1, 2014 require a health plan that issues its own paper remittance to keep offering it for at least 31 days after your ERA starts. They also require the EFT and its matching ERA to go out within three days of each other.

What is inside an 835 file

An 835 is built from segments, each a short line of data with a label. State companion guides, such as South Dakota’s, list how the payer fills each one. The segments you will read most:

Segment	What it holds	What to check on a NEMT payment
BPR	The total payment, whether it is a credit or a debit, the method (ACH, check, or no payment), and the payment date	That the total matches your deposit
TRN	The check number or EFT trace number	That it matches the bank record
N1	The payer and the payee	That the payee is your company
CLP	One claim: your claim number, its status, the amount billed, the amount paid, and the payer’s claim number	Status 1 is processed as primary, 4 is denied, 22 is a reversal of an earlier payment
CAS	An adjustment: a group code, a reason code, and the amount	Why the paid amount differs from what you billed
NM1	Names, including the patient	That the rider matches the trip
SVC	One service line: the procedure code with up to four modifiers, the charge, the payment, and the units paid	The base code, the mileage code, and the miles paid
DTM	Dates, such as the date of service	That it matches the trip date
LQ	Remark codes for a service line	The detail behind the reason code
PLB	Adjustments to your whole account, not one claim, such as an overpayment recovery	Money taken back from this payment for an older claim

Every 835 must balance. CMS’s remittance chapter, applying the 835 standard, says the total paid must equal the charges plus or minus the adjustments, at the service, claim, and provider levels. If your deposit is lower than the sum of your paid claims, look for a PLB line.

Example. An Indiana wheelchair van company bills its own charge of $40.00 for a one-way trip under A0130. Indiana’s fee schedule rate for A0130 is $31.79 as of January 1, 2026, rising to $32.71 on January 1, 2027. When a payer pays that rate, the SVC line in the 835 shows A0130, a $40.00 charge, and $31.79 paid. The CAS line on it reads CO 45 for $8.21. CO is the group code for a contractual obligation, and reason code 45 means the charge exceeds the fee schedule. You write off the $8.21 and never bill the rider for it, because Medicaid providers must accept the program’s payment as payment in full (42 CFR 447.15). See claim adjustment reason codes for the other codes you will see.

How to get 835s from each payer

You enroll with each payer that pays you. CMS’s guidance letter GL-2022-04 (March 22, 2022) says a provider must enroll with each health plan it bills to get EFT and ERA. The federal operating rules cap the details a plan may ask for on its ERA enrollment form. A plan may have you enroll through a vendor that works for it, but it may not make you accept that vendor’s payment services or choose who receives your 835s. You may use your own clearinghouse or billing company. See medical billing clearinghouse.

Payer	How to get the 835	Good to know
Indiana Medicaid	Complete a trading partner profile and agreement, then sign up in the provider portal under My Home, Provider Maintenance, ERA Changes	The 835 carries paid and denied claims, and the portal keeps PDF copies of each remittance
Texas Medicaid (TMHP), including the Medical Transportation Program	Demand response companies and rideshare companies can download remittance and status reports as a PDF or as an 835 in TexMedConnect. The Electronic Remittance and Status (ER&S) Agreement goes to the EDI Help Desk after you set up access to the TMHP EDI Gateway.	To download the 835 through TexMedConnect or vendor software, get a submitter ID from the EDI Help Desk at 1-888-863-3638. Companies that use a billing agent do not need one.
Medicaid health plans	The plan’s own ERA enrollment form	Each plan is a separate enrollment, even in one state
NEMT brokers	Ask provider relations	A broker paying under its own contract may send its own statement instead

How to work an 835 when it arrives

1. Match the payment. Compare the BPR total and TRN number with your bank deposit or check.
2. Post each claim to its trip. The CLP line carries the claim number you sent, so use a number that points to one trip leg.
3. Read every adjustment. Post CO 45 as a write-off. Send anything else, such as missing authorizations or miles, to whoever fixes it.
4. Work the denials and reversals. Status 4 means denied. Status 22 means the payer reversed an earlier payment, so look for a replacement claim before you rebill. See how to read a remittance advice for a full sample.
5. Find the provider-level lines. A PLB recovery can shrink a deposit without any claim on this payment being wrong. See Medicaid recoupment.
6. Chase what is missing. Rejected claims never entered processing, so they never appear on an 835. If a trip you billed is on neither the 835 nor a rejection report, check its status. See claim rejection vs denial.