The healthcare remittance and payment setups are covered under the 835 transaction system. It involves electronic transmission of healthcare payment and benefit information. Healthcare insurance plans use this feature to pay the provider or explain the benefits. The 835 detail is used to verify the payment claim after the healthcare service provider has submitted an 837 claim. EOB (Explanation of Benefits) document is submitted to the insurance company after receiving a healthcare service. Mapping of 835 to EOB requires use of a dedicated software program developed for this purpose.
It is important to file the claim within the specified time limit. The provider has to use the map for coinsurance, copayments and deductibles liabilities. The healthcare providers receive payments from insurance plans through EDI 835. The 835 transaction is a well-established format. It is mandated by HIPAA (Health Insurance Portability and Accountability Act). This standard is used for transferring payments and remittance data to settle institutional and adjudicated healthcare claims.