What is in it
Each claim line in an 835 comes back with the amount billed, the amount allowed and paid, and any adjustments with reason codes. One 835 usually covers one payment, which can span many claims and many dates of service.
Posting it
Posting the 835 means matching every paid line to the leg it was for, marking it paid or partly paid, and putting the denied ones on a list to fix. Done by hand from a PDF, this is where unpaid legs get lost, and an unpaid leg found too late is past the timely filing limit for a corrected claim.
Reading the denials
The common reasons for an NEMT denial are the ones the trip record should have caught: no authorization, a missing signature, miles that don’t match, the wrong code or modifier, a duplicate, or a claim filed late.
Going deeper: What an 835 remittance is and how to post it line by line
Related terms
- 837P claim (CMS-1500)An 837P is the standard electronic file for a professional health care claim, and the CMS-1500 is the paper form with the same content.
- Timely filing limitThe timely filing limit is the deadline for submitting a claim after the service date.
- Medi-Cal NEMT billing codes (HCPCS)HCPCS codes are the billing codes for each service on a claim.
- Trip sheet and manifestA trip sheet is the record of what happened on each leg that a payer asks for before it pays: times, miles, driver, vehicle and signatures.