Demonstration environment. Fictional organization, fictional payers, synthetic data throughout. No patient data. Changes you make stay in this browser only.
ParvinCorpPayer Remittance Bridge

Ridgeline Health Partners. Multi-specialty physician group, 6 sites, 14 providers. This demo covers 12 billing providers, 4 billing locations and 4 contracted payers.

Signed in as

Dana Whitfield, Billing Operations Lead. Imports remittance files, works denials and underpayments, and is the only role that can open a raw remittance file from a payer (835).

Import a fileMenu
OverviewThe numbers that matterWork queue (102)What to fix, by deadlineDenialsWhy money did not arriveAwaiting paymentBilled, no answer yetImport a fileCheck and load a payer's payment fileClaimsEvery claim and its resultRemittancesPayments receivedPayersContracts and performanceReason codesPlain language lookupOrganizationEntities, regions and sitesGuided tourFive minute walkthrough
Appearance

Import a remittance file

The payer's remittance file (835) is checked before anything is stored: it must parse, every claim and the payment must balance to the cent, and the payment must not have been imported already. Then each claim is matched to what was billed and checked against the contract.

Sample files from the payers

Synthetic remittance files (835), dated relative to today. Check one to see what the import would do.

FCC_835_B.edi

A Fernhollow payment whose check amount is $10.00 less than its claims add up to. The import refuses it and says where.

Show the first lines
ISA*00*          *00*          *ZZ*PAYER99904     *ZZ*RIDGELINE999   *261002*0800*^*00501*000000109*0*T*:~
GS*HP*PAYER99904*RIDGELINE999*20261002*0800*109*X*005010X221A1~
ST*835*0001~
BPR*I*165.5*C*CHK************20261003~
TRN*1*99900004455*1999999904~
DTM*405*20261002~
N1*PR*FERNHOLLOW COMMUNITY CARE~
REF*2U*99904~
GPM_ERA_A_resend.835

Granite Plains sent its earlier payment file again. Same trace number, so the import refuses to count the money twice.

Show the first lines
ISA*00*          *00*          *ZZ*PAYER99902     *ZZ*RIDGELINE999   *260831*0800*^*00501*000000110*0*T*:~
GS*HP*PAYER99902*RIDGELINE999*20260831*0800*110*X*005010X221A1~
ST*835*0001~
BPR*I*21833.51*C*ACH*CCP*01*999999992*DA*000111222*1999999999**01*999999993*DA*000333444*20260901~
TRN*1*GP99900000587*1999999902~
DTM*405*20260831~
N1*PR*GRANITE PLAINS MUTUAL~
REF*2U*99902~
SMA_REMIT_B.txt

A new Silver Mesa payment: thirteen claims, one partial denial and one authorization denial. Imports cleanly.

Show the first lines
ISA*00*          *00*          *ZZ*PAYER99903     *ZZ*RIDGELINE999   *261004*0800*^*00501*000000111*0*T*:~
GS*HP*PAYER99903*RIDGELINE999*20261004*0800*111*X*005010X221A1~
ST*835*0001~
BPR*I*3259.09*C*ACH*CCP*01*999999992*DA*000111222*1999999999**01*999999993*DA*000333444*20261005~
TRN*1*SM9990031240*1999999903~
DTM*405*20261004~
N1*PR*SILVER MESA SENIOR ADVANTAGE~
REF*2U*99903~
TCH_835_C_pipe.x12

A Tallow Creek payment that uses | and line breaks instead of * and ~. The delimiters are read from the file header.

Show the first lines
ISA|00|          |00|          |ZZ|PAYER99901     |ZZ|RIDGELINE999   |261003|0800|^|00501|000000112|0|T|:
GS|HP|PAYER99901|RIDGELINE999|20261003|0800|112|X|005010X221A1
ST|835|0001
BPR|I|139|C|ACH|CCP|01|999999992|DA|000111222|1999999999||01|999999993|DA|000333444|20261004
TRN|1|EFT9990000530|1999999901
DTM|405|20261003
N1|PR|TALLOW CREEK HEALTH PLAN
REF|2U|99901

Paste or open your own remittance file (835)

Synthetic files only in this demonstration. Real remittances carry patient information and belong in a deployment covered by a business associate agreement.

Your imports and follow-ups are kept in this browser only, so other visitors never see them.