> ## Documentation Index > Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt > Use this file to discover all available pages before exploring further. # 835 file anatomy > Annotated 835 segment map with a worked dental remittance, deposit reconciliation, downgrade and frequency-limit examples, and common parsing errors. This page maps the 835 remittance advice for operators reconciling deposits and engineers parsing remittance files. ## The segment map | Segment | Level | Carries | | ------------- | ------------- | ---------------------------------------------------------------------------------------------------------------------------- | | **`BPR`** | File | **Total payment amount, payment method, effective date, receiving bank details** | | **`TRN`** | File | **Reassociation trace number**, the key to matching the deposit | | `REF` | File | Additional identifiers, e.g. the payer's EDI number | | `DTM` | File | Production date | | `N1*PR` | File | Payer name | | `N3` / `N4` | File | **Payer street address, city, state, postal code.** Both are required in loop 1000A | | `N1*PE` | File | Payee, your PC, with NPI and Tax ID | | `LX` | Header | Transaction set line number, grouping claims | | **`CLP`** | Claim | **Patient account number, claim status code, total charged, total paid, patient responsibility, payer claim control number** | | `NM1*QC` | Claim | Patient | | `NM1*82` | Claim | Rendering dentist | | **`CAS`** | Claim or line | **Adjustments, group code, reason code, amount** | | `DTM*232/233` | Claim | Statement period | | `AMT` | Claim | Additional amounts, e.g. allowed | | **`SVC`** | Line | **Procedure code, charged, paid, units** | | `DTP*472` | Line | Service date | | **`LQ`** | Line | **Remark codes (RARC)** | | **`PLB`** | File | **Provider-level adjustments**, takebacks, interest, withholds | | `SE` | File | Trailer | ## Annotated example A remittance for a Bluebird Dental claim containing a prophylaxis and a posterior composite: ```text theme={null} ISA*00* *00* *ZZ*PAYERID *ZZ*RECEIVERID *260901*1400*^*00501*000000042*0*P*:~ GS*HP*PAYERID*RECEIVERID*20260901*1400*42*X*005010X221A1~ ST*835*0001~ BPR*I*210.38*C*ACH*CCP*01*011000015*DA*123456789*1234567890**01*021000021*DA*987654321*20260903~ TRN*1*DD20260901001*1234567890~ DTM*405*20260901~ N1*PR*SAMPLE DENTAL PAYER~ N3*1200 MAIN ST~ N4*COLUMBUS*OH*43215~ N1*PE*MAYA OKAFOR DDS PC*XX*1234567893~ REF*TJ*880000000~ LX*1~ CLP*PATACCT001*1*452.00*211.60*28.40*CI*CLAIMCTRL9876*11~ NM1*QC*1*CHEN*MARGARET****MI*ABC123456789~ NM1*82*1*OKAFOR*MAYA****XX*1987654328~ SVC*AD:D1110*142.00*98.00**1~ DTP*472*20260801~ CAS*CO*45*44.00~ SVC*AD:D2391*310.00*113.60**1~ DTP*472*20260801~ CAS*CO*45*168.00~ CAS*PR*2*28.40~ PLB*1234567893*20261231*WO:CLAIMCTRL5432*1.22~ SE*22*0001~ GE*1*42~ IEA*1*000000042~ ``` ### Reading it **`BPR*I*210.38*C*ACH*CCP*...`** `I` = remittance information with payment. **Total payment \$210.38.** `C` = credit. `ACH` with `CCP` = the ACH CCD+ format used for health care EFT. The remaining elements carry the originating and receiving bank routing and account numbers and the **effective date** `20260903`. **`TRN*1*DD20260901001*1234567890`** The **reassociation trace number** `DD20260901001`. This value appears in the ACH addenda record of the corresponding EFT. **This is how you match the deposit to this remittance.** **`CLP*PATACCT001*1*452.00*211.60*28.40*CI*CLAIMCTRL9876*11`** | Element | Value | Meaning | | --------- | --------------- | ------------------------------------------------------------- | | CLP01 | `PATACCT001` | Your patient account number | | **CLP02** | `1` | **Claim status: processed as primary** | | CLP03 | `452.00` | Total charged | | CLP04 | `211.60` | Total paid | | CLP05 | `28.40` | **Patient responsibility** | | CLP06 | `CI` | Claim filing indicator, commercial insurance | | CLP07 | `CLAIMCTRL9876` | **Payer claim control number**, use this on a corrected claim | | CLP08 | `11` | Facility type code | **`SVC*AD:D1110*142.00*98.00**1`** Service line. `AD` qualifies a CDT code. This line reports D1110, adult prophylaxis, with $142.00 charged, $98.00 paid, and one unit. **`CAS*CO*45*44.00`** Adjustment: group code **`CO`** (contractual obligation), **CARC 45** (charge exceeds fee arrangement), \$44.00. If the adjustment is correct under the contract, post it as the PPO contractual write-off rather than billing the patient. **`CAS*PR*2*28.40`** Group code **`PR`** (patient responsibility), **CARC 2** (coinsurance), \$28.40; the patient's 20% share of the composite's allowed amount. After confirming the plan and prior payments, move the amount to the patient ledger. **`PLB*1234567893*20261231*WO:CLAIMCTRL5432*1.22`** **Provider-level adjustment**: `WO` = overpayment recovery, recouping \$1.22 against prior claim `CLAIMCTRL5432`. ## Tying the remittance to the deposit The worked arithmetic: | | | | ----------------------- | ------------ | | Line 1 (D1110) paid | \$98.00 | | Line 2 (D2391) paid | \$113.60 | | **Claim total (CLP04)** | **\$211.60** | | PLB `WO` recoupment | −\$1.22 | | **BPR total payment** | **\$210.38** | The EFT for **\$210.38** will carry `DD20260901001` in its ACH addenda record. **Sum of claim payments ± PLB = BPR total = the deposit.** Resolve any difference before posting. See [Reconcile payments daily](/guides/payments/reconcile-daily-payments). ## Downgrades and frequency limits in the 835 Downgrades and benefit limits do not have dedicated 835 segments. They arrive as ordinary adjustments, so posting logic needs to distinguish them from true denials. **A downgraded line keeps the code you billed.** When a plan applies an alternate-benefit clause, such as pricing a posterior composite at the amalgam allowable, the `SVC` still shows the submitted CDT code. The allowed amount reflects the less expensive alternative, and the difference appears in `CAS` with ordinary group and reason codes. Whether the patient owes any part of that difference depends on the plan and participation agreement, so use the actual group code rather than assuming. See [Denials vs downgrades](/concepts/payments/denials-vs-downgrades) and [Work your first downgrade](/start/first-90-days/work-your-first-downgrade). **Frequency limits and exhausted annual maximums can resemble denials.** A third prophylaxis under a two-per-year plan, or a service after the annual maximum is exhausted, may return unpaid with a benefit-design adjustment. Confirm that the payer applied the plan correctly, then use the group code and contract terms to determine whether any amount moves to the patient. **Predeterminations arrive in the 835 too**: claim status code `25` (see below) is a pricing-only response with no payment. Post it to the treatment plan, not the ledger. ## Claim status codes (CLP02) | Code | Meaning | | -------- | ------------------------------------------------ | | `1` | Processed as primary | | `2` | Processed as secondary | | `3` | Processed as tertiary | | **`4`** | **Denied** | | `19` | Processed as primary, forwarded to another payer | | `20` | Processed as secondary, forwarded | | `21` | Processed as tertiary, forwarded | | **`22`** | **Reversal of a previous payment** | | `23` | Not our claim, forwarded | | **`25`** | **Predetermination, pricing only, no payment** | Route status `4` to the denial queue after ruling out a benefit-design adjustment. Status `22` unwinds a payment you already posted. Status `2` claims are a routine result of dental COB: a child covered under both parents' plans generates a primary and a secondary remittance for the same visit. ## PLB reason codes | Code | Meaning | | -------- | -------------------------------------------------- | | **`WO`** | **Overpayment recovery**, a takeback | | `FB` | Forwarding balance, carried to a future remittance | | **`L6`** | **Interest owed to you** for late payment | | `CS` | Adjustment | | `72` | Authorized return | | `IR` | Internal revenue withholding | | `CV` | Capitation interest | | `AH` | Origination fee | | `B2` | Rebate | A parser cannot assume that the sum of `CLP04` values equals the deposit. A `PLB` can add or subtract amounts at the provider level, so reconciliation logic must account for it explicitly. See [Handle recoupments](/guides/compliance/handle-recoupments). ## Why one 835 is not one deposit Four independent reasons: 1. **Aggregation**, a payer may combine several remittances into one deposit 2. **Splitting**, a large remittance may settle across multiple payments 3. **PLB**, shifts the total away from the sum of claims 4. **Method**, paper checks and virtual credit cards arrive on entirely different timelines than the 835, and dental payers still send plenty of both; see [Paper checks and virtual credit cards](/concepts/payments/paper-checks-and-vcc) Use the `TRN` reassociation trace number to match the 835 to the EFT. Dollar amounts alone are not a reliable key because unrelated payments can have the same amount. ## Other parser traps | Trap | Detail | | -------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **`CAS` repeats** | One `CAS` segment can carry up to six adjustment triplets. Parse all of them. | | **Claim-level *and* line-level `CAS`** | Both occur. Summing only one level understates adjustments. | | **`LQ` remark codes** | RARCs live in `LQ`, separate from the `CAS` reason codes. | | **Multiple `LX` groups** | Claims are grouped; don't assume one group. | | **Negative amounts** | Reversals (`CLP02` = 22) carry negatives. | | **Zero-dollar remittances** | An 835 can carry a \$0 `BPR` containing denials, predeterminations, or benefit-design adjustments without a payment. The remittance still needs to be posted. | | **Delimiters vary** | `*` and `:` are conventional, not guaranteed. Read them from the `ISA` segment. | ## PHI **An 835 is protected health information**: patient names, member IDs, dates of service, procedure detail. Encrypt in transit and at rest, access-control it, and cover any analytics warehouse in your BAAs and security risk analysis. See [HIPAA fundamentals](/concepts/compliance/hipaa-fundamentals).