Electronic Remittance Advice (ERA)
An ERA, transmitted as an HIPAA X12 835 transaction, is the electronic version of the Explanation of Benefits that payers send to providers detailing claim payments and adjustments, enabling automated payment posting in practice management systems.
What is an ERA?
The Electronic Remittance Advice (ERA) is the machine-readable counterpart to the paper Explanation of Benefits, transmitted in the HIPAA X12 835 standard transaction format. All HIPAA-covered payers are required to support ERA transmission. While a paper EOB presents the same adjudication data in human-readable form, the 835 ERA enables practice management systems to automatically post payments, apply contractual adjustments, identify patient balances, and categorize denial reason codes — without manual data entry. ERA enrollment must be completed separately with each payer; many payers default to paper EOBs unless the provider proactively enrolls. The reassociation trace number in the 835 file links the ERA to the corresponding Electronic Funds Transfer (EFT) deposit, enabling complete payment reconciliation. ERA-based denial management leverages the Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RASCs) embedded in the 835 to systematically categorize denial types by payer — enabling analytics rather than case-by-case review. ERA reconciliation against expected contractual rates — comparing what the payer actually paid to what the contract specifies — identifies underpayments that average 2–3% of total collections when not actively monitored.
Why It Matters for Healthcare Analytics
Without ERA, payment posting is manual and denial analysis is anecdotal. With ERA, the 835 transaction becomes a structured data feed for systematic revenue cycle analytics — enabling denial rate trending by payer, underpayment identification by CPT code, and payment velocity tracking to detect payers paying outside contracted timely payment standards.
How Vizier Processes ERAs
Upload your 835 ERA files, then ask "Which payers are consistently paying below contracted rates and by how much?" — Vizier reconciles ERA payments against expected contractual amounts, quantifies underpayments by payer and CPT code, and trends CARC-coded denial patterns over time.