# How to Read a Remittance Advice for NEMT in 2027: Every Line Explained

Canonical URL: https://nemtguide.com/guides/read-remittance-advice/ · Updated 2026-09-28

To read a remittance advice, start with the payment total, then read each claim line: what you billed, what was paid, and the group and reason codes for every difference. Denied, pended, and reversed claims come next, then deductions such as recoupments. Paid lines, minus reversals and deductions, must equal your deposit, and every line should match one trip.

- Put your own trip number in the patient account number field, and the payer returns it next to each claim on the remittance.
- Paid lines, plus or minus reversals and deductions, must add up to the deposit. If they do not, the difference is in the financial section.
- CO 45 is the normal write-off between your charge and the fee schedule. Denied, reduced, and pended lines are the ones to work.
- A negative line takes back money paid before. Match it to the original trip with the payer's claim number.
- A claim that never shows up on a remittance may have been rejected before processing, so check the front-end report and claim status.

A remittance advice explains one payment. It lists the claims the payer processed that cycle, what it paid on each, why any amount was cut or denied, and what it took back. Read it every time money arrives, and you catch underpayments and deductions while you can still fix them.

## What a remittance advice is and what payers call it

Every payer that processes your claims sends a remittance with each payment cycle. The name and the format change from payer to payer, but the job is the same.

| Name you may see | Who sends it | Format |
|---|---|---|
| Remittance advice (RA) | State Medicaid programs, such as New York and Indiana | Paper, PDF, or a download from the provider portal |
| Electronic remittance advice (ERA), or 835 | HIPAA health plans, including state Medicaid programs, once you enroll for it | An X12 835 file your billing system reads |
| Remittance and Status (R&S) Report | Texas Medicaid, including the Medical Transportation Program | Weekly PDF or paper, with an 835 file on request |
| Broker remittance | NEMT brokers, such as Verida in Indiana | Varies by broker, one for each payment cycle |

The electronic version has one national format. HIPAA made version 5010 of the X12 835 the required standard for remittance advice on January 1, 2012 ([45 CFR 162.1602](https://www.ecfr.gov/current/title-45/section-162.1602)), and the Medicaid program counts as a HIPAA health plan. Paper and PDF versions follow each payer's own layout, so keep that payer's guide open the first few times you read one.

Payment cycles differ too:

- **Indiana Medicaid** runs its financial cycle every Friday. Checks are dated, and direct deposits land, the following Wednesday (financial transactions module, version 7.0, March 13, 2025). This covers trips Indiana pays directly, such as hospital-to-hospital transports. Brokered trips are paid by Verida.
- **Texas** pays Medical Transportation Program claims weekly with an R&S report. A week with no claim activity and no balance owed produces no report (TMPPM, September 2026).
- **Verida in Indiana** pays clean claims received by Wednesday within 14 days, by check or electronic funds transfer, with a remittance for each payment cycle (transportation module, August 19, 2025).
- **MTM Health's** standard agreement, in the January 1, 2023 version Pennsylvania posts, pays properly submitted, uncontested invoices within 30 days of online submission.

A remittance lists only claims the payer accepted for processing. New York reports rejected electronic claims on a front-end edit report called the 277CA, and rejected claims never appear on its remittance. If a trip is missing from every remittance, check the claim's status before you assume it is still waiting. See how to check Medicaid claim status.

## The parts of a remittance, top to bottom

The same parts show up on nearly every remittance, whatever the layout. New York's paper and PDF remittance has five sections: the check or deposit notice, provider notices, claim detail, financial transactions, and the meaning of each edit code used (Remittance Advice Guideline, version 2013-01). Indiana's weekly RA groups claims into paid, denied, in process, and adjusted sections, then ends with a summary page.

| Part | What it tells you | Where it sits in an 835 file |
|---|---|---|
| Payment header | Payment number, date, method (check or deposit), and net amount | BPR segment for the amount, TRN segment for the payment or trace number |
| Claim detail | One entry per claim: your account number, the rider, the payer's claim number, and totals | CLP segment |
| Service lines | Each code on the claim, with units billed and allowed, the billed amount, and the paid amount | SVC segment |
| Adjustments | A group code, a reason code, and the dollars for every amount not paid | CAS segment |
| Remark codes | Extra detail on an adjustment, often the fix | LQ segment on a service line, MOA or MIA on a claim |
| Provider-level adjustments | Money added or taken that is not a claim line in this payment: recoupments, interest, liens | PLB segment |
| Totals and code meanings | Counts and dollars by status, and a definition of every code used | Printed on the paper and PDF versions |

Every claim entry carries the same core fields, whatever the label:

- **Your account number.** Whatever you put in the patient account number field of the claim. It comes back in the 835 as CLP01. New York prints up to 20 characters of it as the office account number.
- **The payer's claim number.** Indiana calls it the ICN, New York the TCN, and Illinois the DCN. You need it for any replacement claim or appeal.
- **The rider, the Medicaid ID, and the date of service.**
- **Procedure code, modifiers, and units.** Units are trips on a base line and miles on a mileage line.
- **Billed, allowed, and paid amounts.**
- **Group code, reason code, and remark code** for each adjustment.
- **Status.** Paid, denied, pended or in process, adjusted, or voided.

### How to read the codes

Adjustment codes come from national lists kept by X12, so a code means the same thing from any payer. The group code tells you who carries the adjustment.

| Group code | X12 name | What it means for you |
|---|---|---|
| CO | Contractual Obligation | You absorb it. A Medicaid provider cannot bill the rider for it. |
| PR | Patient Responsibility | The rider owes it, such as an allowed copayment |
| OA | Other Adjustment | Used for cases such as exact duplicates and pended lines |
| PI | Payor Initiated Reduction | A reduction the payer made |

The reason code says why. CARC 45, for example, reads "Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement." Some reason codes must come with a remark code. CARC 16, for missing information or billing errors, needs at least one, and that remark code names what failed. States may add codes of their own: New York lists its edit codes, and Indiana its explanation of benefits (EOB) codes, each defined at the end of the remittance.

For more codes, see claim adjustment reason codes and remittance advice remark codes.

## A sample NEMT remittance, line by line

The remittance below is made up. It shows one week for a small wheelchair van company, priced at Arizona's urban fee-for-service rates (Phoenix and Tucson): $11.15 per wheelchair van trip ([A0130](https://nemtguide.com/glossary/a0130/)) and $1.54 per loaded mile ([S0209](https://nemtguide.com/glossary/s0209/)). Both rates are the same in the schedules effective October 1, 2025 and October 1, 2026. The billed charges are example numbers: $30.00 a trip and $2.50 a mile.

| Your trip no. | Date of service | Code | Units | Billed | Paid | Adjustments | Status |
|---|---|---|---|---|---|---|---|
| T1041 | 09/14/2026 | A0130 | 2 | $60.00 | $22.30 | CO 45: $37.70 | Paid |
| T1041 | 09/14/2026 | S0209 | 30 | $75.00 | $46.20 | CO 45: $28.80 | Paid |
| T1047 | 09/15/2026 | A0130 | 2 | $60.00 | $22.30 | CO 45: $37.70 | Paid |
| T1047 | 09/15/2026 | S0209 | 27 billed, 24 allowed | $67.50 | $36.96 | CO 45: $23.04; CO 151: $7.50 | Paid, reduced |
| T1052 | 09/16/2026 | A0130 and S0209 | 1 and 8 | $50.00 | $0.00 | CO 27: $50.00 | Denied |
| T1058 | 09/17/2026 | A0130 and S0209 | 1 and 8 | $50.00 | $0.00 | CO 197: $50.00 | Denied |
| T1063 | 09/18/2026 | A0130 and S0209 | 1 and 10 | $55.00 | $0.00 | OA 133 | Pended |
| T0987 | 08/28/2026 | Reversal of the original claim | 2 and 30 | -$135.00 | -$68.50 | | Adjusted |
| T0987 | 08/28/2026 | Replacement claim | 2 and 26 | $125.00 | $62.34 | CO 45: $62.66 | Adjusted |
| T0912 | 07/22/2026 | Overpayment recovery, provider level | | | -$57.35 | | Recouped |

| Summary | Amount |
|---|---|
| Original claims paid (T1041 and T1047) | $127.76 |
| Replacement minus reversal (T0987) | -$6.16 |
| Provider-level recovery (T0912) | -$57.35 |
| **Net payment, the amount deposited** | **$64.25** |

Here is what each line tells you and what to do about it.

### Paid lines and the CO 45 write-off (T1041)

Both lines paid at the fee schedule. The $66.50 gap between billed and paid is CO 45, a charge above the rate. You cannot collect it. Federal rule [42 CFR 447.15](https://www.ecfr.gov/current/title-42/section-447.15) limits Medicaid to providers who accept the agency's payment as payment in full, apart from any cost sharing the state plan allows.

Post CO 45 amounts as contractual write-offs, kept apart from denials. That way your unpaid list shows only money you can still recover. New York adds that the amount you charge may not exceed your usual charge, so bill your usual charge and expect the fee schedule rate.

### A reduced mileage line (T1047)

The base line paid in full. The mileage line paid 24 of the 27 miles billed. CO 45 covers the rate gap on the 24 paid miles. CO 151, "Payment adjusted because the payer deems the information submitted does not support this many/frequency of services," takes the other 3 miles at your billed charge, $7.50. What you actually lost is 3 miles at $1.54, or $4.62. Payers pick different codes for a mileage cut, so read the remark code too.

In Arizona, a cut like this often starts with a gap between the loaded miles going and the loaded miles coming back. AHCCCS asks for a reason on the Daily Trip Report and may reduce the difference when none is given (Chapter 14, revised July 31, 2026). If the return trip really was longer, because of a detour or a closed road, send a replacement claim with the reason. If it was not, fix the setup that caused it. [NEMT mileage billing](https://nemtguide.com/guides/nemt-mileage-billing/) covers how payers check miles.

### Denied lines (T1052 and T1058)

A denied claim shows its full billed amount as an adjustment and $0.00 paid.

- **CO 27,** "Expenses incurred after coverage terminated." The payer found the rider's coverage ended before September 16. If coverage is later restored for that date, bill again. Check [eligibility](https://nemtguide.com/glossary/eligibility-verification/) the day before each ride.
- **CO 197,** "Precertification/authorization/notification/pre-treatment absent." The claim had no matching authorization, or the number was missing or in the wrong field. If you hold the authorization, correct the claim. If the payer lost it, appeal with a copy. See [prior authorization](https://nemtguide.com/glossary/prior-authorization/).

Work every denial inside the payer's deadline. The [NEMT claim denials guide](https://nemtguide.com/guides/nemt-claim-denials/) lists the common codes, their fixes, and filing windows by payer.

### A pended claim (T1063)

A pended claim is neither paid nor denied yet. CARC 133 means the line is pending further review. It is used only with group code OA, and the payer must reverse and correct the line when the review ends.

New York recycles most pended claims for 30, 60, or 90 days while it checks for new eligibility information from the county. A claim pended because the rider was not eligible on the date of service recycles for 30 days and then denies if nothing changes. Indiana lists a claim in process only in the week it first suspends, and tells providers to follow each one to a final answer. Keep pended trips on your own list, because they may not show again until they are paid or denied.

### A reversal and a replacement (T0987)

Last month you billed 30 miles for this round trip and were paid $68.50. Your odometer record showed 26 miles, so you sent a replacement claim. This remittance takes back the old payment and pays the new claim.

- **The reversal** repeats the original claim with negative amounts: -$135.00 billed and -$68.50 paid. In an 835 file it carries claim status code 22, reversal of previous payment.
- **The replacement** pays $62.34 as a new claim with status code 1, processed as primary. Ohio's 835 companion guide (version 1.5, May 23, 2017) lists the full set: 1 processed as primary, 2 processed as secondary, 3 processed as tertiary, 4 denied, and 22 reversal of previous payment.

The net effect on this deposit is -$6.16. New York's paper remittance shows the same change with the status ADJT, a credit for the old payment and a debit for the new one. A void shows only the credit. Indiana prints two header lines for each adjusted claim, the original and the replacement, and sets up an account receivable whenever the replacement pays less than the original.

### A provider-level recovery (T0912)

The last line is not a claim. It takes back $57.35 paid in July for a trip the payer later decided it should not have paid, for example after an audit found no trip record. Recoveries like this sit in their own section.

- **New York** lists them under Financial Transactions, each with a financial control number, reason code, date, and amount. The net financial transaction amount, added to the claim grand total, must equal the check or deposit. An Accounts Receivable section shows each balance you still owe, its original and current amount, and the amount or percentage taken each cycle.
- **In an 835 file**, they arrive in the PLB segment. Illinois Medicaid's 835 companion guide (December 2011) uses WO, overpayment recovery. A negative WO amount means a credit is owed but not yet taken. A positive WO amount, in the same file or a later one, means it was recovered.
- **Brokers** do the same thing. MTM Health's standard agreement lets it recover overpayments by offsetting future payments, and lets it deduct liquidated damages from money it owes you.

Provider-level lines can add money too. Indiana pays interest on clean electronic claims it does not process within 21 days of receipt, and on clean paper claims not processed within 30 days. The interest shows at the claim level and as a PLB line with the code L6. See Medicaid recoupment for how to dispute a recovery.

## How to match every dollar to a trip

1. **Put your trip number on every claim.** Use the patient account number: item 26 on the CMS-1500, or CLM01 in the 837P. NUCC notes that payers report it back on the 835, and the paper form holds 14 characters. Every remittance line then points straight to a trip.
2. **Match the deposit to the remittance.** HIPAA rules put a reassociation trace number, in the same TRN format the 835 uses, into the record of each health care electronic funds transfer (EFT). Ask your bank to give you each deposit's effective date, amount, trace number, and payer ID. The federal operating rules expect providers to arrange that with their bank.
3. **Tie the totals.** Original claims paid, plus or minus reversals and replacements, plus or minus provider-level lines, must equal the deposit. In the sample, $127.76 minus $6.16 minus $57.35 equals $64.25.
4. **Mark every trip.** Paid in full, paid reduced, denied, pended, reversed, or recouped. A NEMT payment log keeps one row per trip.
5. **Post write-offs apart from denials.** CO 45 is expected. Denials and cuts are work to do.
6. **Queue the fixes.** List each denial and cut with its reason code and deadline. Correct your own errors with a corrected claim. Appeal the payer's errors: see [how to appeal a denied Medicaid claim](https://nemtguide.com/guides/appeal-denied-nemt-claim/).
7. **Track pends and balances.** Carry every pended claim until it resolves, and every recoupment balance until it reaches zero.
8. **Look for overpayments.** If a trip was paid twice, or paid for more than you gave, report and return the overpayment within 60 days after you identify it. Money kept past that deadline becomes an obligation under the False Claims Act (42 U.S.C. 1320a-7k(d)). See the 60-day overpayment rule.
9. **Save the remittance.** New York requires Medicaid providers to keep all information about claims for six years from the date of service (18 NYCRR 504.3). MTM Health's standard agreement requires records for 10 years. Indiana keeps RAs from February 21, 2017 on in its portal, free to download, and charges $0.15 a page for printed copies.

Brokers pay the same way, on their own schedules. [How to bill NEMT brokers](https://nemtguide.com/guides/how-to-bill-nemt-brokers/) covers their offsets and deadlines, and NEMT broker late payment covers what to do when a payment does not come.

## How to get remittances electronically (ERA and EFT)

Paper remittances come by mail and must be matched by hand. An electronic remittance (ERA) lets billing software post each payment to its trip, and an EFT puts the money in your account without a mailed check.

| Payer | How to get the 835 file | Good to know |
|---|---|---|
| New York Medicaid (eMedNY) | Electronic Remittance Request Form | A PDF remittance is available by request. PDF remittances are not held with the check for two weeks, so they arrive sooner, and paper remittances are being phased out. |
| Texas Medicaid (TMHP) | ER&S Agreement sent to the EDI Help Desk, 1-888-863-3638, after you set up access to the TMHP EDI Gateway | Vendor software needs a submitter ID. Providers that use a billing agent do not. Not offered to individual transportation participants. |
| Indiana Medicaid (IHCP) | Trading partner profile and agreement, then ERA Changes in the IHCP Provider Healthcare Portal | PDF copies of each RA download free from the portal |
| NEMT brokers | Ask provider relations | Verida pays by check or EFT, with a remittance each cycle |

Federal operating rules have covered EFT and ERA since January 1, 2014 ([45 CFR 162.1603](https://www.ecfr.gov/current/title-45/section-162.1603)). Health plans may ask only for a standard set of details when you enroll for either one. A plan must send the EFT and its matching ERA within three days of each other. A plan that issues its own paper remittance must keep offering it for at least 31 days after your ERA starts, so compare the two before you drop paper. See 835 ERA and EFT enrollment.

## When the numbers do not add up

- **The deposit is smaller than the paid claims.** Read the financial transactions or provider-level section. Recoupments, offsets, and liens all come out there. Indiana also takes payments to lien holders out of the net payment.
- **No money came at all.** New York sends a "summout" instead of a check when the approved claims are less than or equal to the recoupments scheduled for the cycle. Illinois does not pay vouchers under one dollar and uses a J1 line in the 835 to bring the payment to zero.
- **A trip is missing.** It may have been rejected before processing, or it may still be pended. Check the front-end report, then the claim status. Resending too soon creates a duplicate.
- **A negative amount appears.** It is a reversal or a recovery. Find the payer's original claim number and match it to the trip.
- **Your year-end total does not match.** Indiana reports "net earnings" to the IRS on the 1099: the net payment plus manual payouts, minus refunds and voids. Keep every remittance so the total can be traced.

For the rest of the collections picture, see [NEMT accounts receivable](https://nemtguide.com/guides/nemt-accounts-receivable/) and [how long Medicaid takes to pay](https://nemtguide.com/guides/how-long-medicaid-takes-to-pay/).

## Frequently asked questions

### What is the difference between a remittance advice and an EOB?

The terms overlap. A remittance advice is the payer's statement to you, the provider, about one payment. Some Medicaid programs also print their own explanation of benefits (EOB) codes on it. Indiana lists them next to the national adjustment reason codes and defines each one at the end of the remittance. The federal HIPAA rule for this transaction, 45 CFR 162.1601, names explanation of benefits and remittance advice side by side.

### What do CO, PR, OA, and PI mean on a remittance?

They are X12 group codes that say who carries an adjustment. CO is contractual obligation: you absorb it, and a Medicaid provider cannot bill the rider for it. PR is patient responsibility, such as an allowed copayment. OA is other adjustment, used for duplicates and pended lines. PI is payor initiated reduction. Every group code comes with a reason code that says why.

### Why is my Medicaid deposit less than the claims marked paid?

Deductions come out after the claims are totaled. Look for the financial transactions, accounts receivable, or provider-level adjustment section. It lists recoupments of earlier overpayments, balances left by replacement claims that paid less than the original, liens, and broker offsets such as liquidated damages. New York says the net financial transactions plus the claim grand total must equal the check or deposit.

### What does a negative amount on a remittance mean?

It takes back money paid before. A reversal repeats an earlier claim with negative billed and paid amounts, and in an 835 file it carries claim status code 22. It usually comes with a replacement claim that pays the corrected amount. A negative provider-level line, such as WO for overpayment recovery, is a recoupment. Match each negative line to the original trip with the payer's claim number.

### Why is a claim I sent not on my remittance?

A remittance lists only claims the payer accepted for processing. New York reports rejected electronic claims on its 277CA front-end report, and they never appear on the remittance. A claim can also be pended and show up only in the week it first pended, as in Indiana. Check the front-end report and the claim status before you resend anything, so you do not create a duplicate.

### How do I get an electronic remittance (835) instead of paper?

Enroll with each payer. New York Medicaid uses its Electronic Remittance Request Form. Texas uses an ER&S Agreement sent to the TMHP EDI Help Desk at 1-888-863-3638. Indiana requires a trading partner profile, then an ERA Changes request in its provider portal. For a broker, ask its provider relations team. Then ask your bank for each deposit's trace number.

### How long should I keep remittance advices?

At least as long as your trip records. New York requires Medicaid providers to keep all information about claims for six years from the date of service. MTM Health's standard provider agreement requires records for 10 years. A remittance proves what was paid and what was taken back, which matters in an audit or a recoupment dispute.

## Official resources

- [X12: Claim Adjustment Reason Codes (the full list)](https://x12.org/codes/claim-adjustment-reason-codes)
- [X12: Remittance Advice Remark Codes (the full list)](https://x12.org/codes/remittance-advice-remark-codes)
- [X12: Claim Adjustment Group Codes](https://x12.org/codes/claim-adjustment-group-codes)
- [eMedNY: Remittance Advice Guideline (paper and PDF layout)](https://www.emedny.org/ProviderManuals/AllProviders/General_Remittance_Guidelines.pdf)
- [Indiana Medicaid: Financial Transactions and Remittance Advice module](https://www.in.gov/medicaid/providers/files/modules/financial-transactions-and-remittance-advice.pdf)
- [TMHP: Medical Transportation Program Handbook (R&S reports)](https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2026/2026-09-september/2_14_med_transport_program.pdf)
- [eCFR: 45 CFR 162.1603, EFT and remittance advice operating rules](https://www.ecfr.gov/current/title-45/section-162.1603)