Claim status and EOB terms, defined

The X12 276 is the standard electronic transaction a provider sends to ask a payer for the status of a specific claim.

The X12 277 is the payer’s electronic reply to a 276, reporting a claim’s status with standardized codes.

An 835 ERA is the X12 electronic remittance advice a payer sends to explain how claims were paid, adjusted, or denied.

A claim adjustment reason code (CARC) is a standard code explaining why a payer paid a claim or service line differently from what was billed.

Claim status is the current position of a submitted healthcare claim in a payer’s adjudication process, such as received, pending, paid, or denied.

A claim status category code is the high-level code in a 277 response that groups a claim’s status, such as acknowledged, pending, or finalized.

A clearinghouse is an intermediary that routes electronic claims, status inquiries, and remittances between providers and payers.

An EFT trace number is the reference number that ties an electronic funds transfer from a payer to its matching 835 remittance.

An explanation of benefits (EOB) is a payer document that explains how a claim was processed, what was paid, and what the patient owes.

EOB versus ERA describes the difference between a payer’s human-readable payment explanation and its machine-readable electronic remittance file.

Payment posting is the process of recording payer and patient payments, adjustments, and denials against the right claims in a billing system.

A practice management system (PMS) is the software a healthcare practice uses for scheduling, billing, claims, and payment posting.

A remittance advice remark code (RARC) adds detail to a claim adjustment, such as missing information or required next steps.

Remittance advice is a payer’s explanation of a payment, listing which claims were paid, adjusted, or denied and why.

Timely filing is a payer’s deadline for submitting a claim, correction, or appeal after the date of service or a prior decision.