What does the 835 transaction represent in HIPAA standards?

What does the 835 transaction represent in HIPAA standards?

• A. The claim submission format
• B. Patient eligibility responses
• C. Scheduling information
• D. Explanation of benefits and payment information

Answer: (D)

The 835 is the electronic remittance advice, the payment and settlement communication a payer sends to a provider after claims are processed. It details what was paid for each claim, any patient responsibility, and any adjustments, denials, or reason codes behind changes to the payment. It also includes information used to post payments to the provider’s accounts receivable and may provide EFT or payment method details. This isn’t the claim submission format (that’s 837), nor eligibility responses (270/271), nor scheduling information (277/278); those use different HIPAA transaction sets. In short, the 835 conveys the actual payment and benefits information back to the provider.

The 835 is the electronic remittance advice, the payment and settlement communication a payer sends to a provider after claims are processed. It details what was paid for each claim, any patient responsibility, and any adjustments, denials, or reason codes behind changes to the payment. It also includes information used to post payments to the provider’s accounts receivable and may provide EFT or payment method details. This isn’t the claim submission format (that’s 837), nor eligibility responses (270/271), nor scheduling information (277/278); those use different HIPAA transaction sets. In short, the 835 conveys the actual payment and benefits information back to the provider.