What is Electronic Remittance Advice (ERA)?
Electronic Remittance Advice (ERA) is the HIPAA-standard X12 835 transaction a health care payer sends a provider to explain how submitted claims were paid, denied, or adjusted, using standardized reason codes. Payers must transmit ERAs to providers who request them electronically, and ERA data drives payment reconciliation in Medicare and commercial accounts-receivable workflows.
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Full name: Electronic Remittance Advice
Short explanation
An Electronic Remittance Advice (ERA) is a HIPAA-standard electronic document (ASC X12 835 transaction) that a health care payer sends to a provider explaining payment decisions on submitted claims. ERAs specify which services were paid, denied, or adjusted and include standardized reason codes. Under HIPAA, payers must transmit ERAs to providers who request them electronically. ERA data is the primary mechanism for providers to reconcile Medicare and commercial insurance payments in accounts receivable management systems.
How it’s used
- CMS PECOS Medicare Provider Enrollment: Medicare ERA transactions are routed to the provider's enrolled PTAN/NPI, making PECOS enrollment the prerequisite for receiving electronic Medicare remittance data.
- ASC X12 835 transaction standard: the ERA is the HIPAA-mandated 835 transaction, the standardized payment-decision format payers must support under Administrative Simplification.
- EDI 837 claim pairing: each ERA answers a submitted 837 claim, closing the claim-to-payment loop keyed to the provider's NPI and PTAN.
Frequently asked questions
- What is an ERA?
- An ERA (Electronic Remittance Advice) is an X12 835 transaction that a payer sends electronically to a provider explaining how a claim was processed and paid.
- What is an X12 835?
- X12 835 is the HIPAA-standard EDI transaction set for health care payment and remittance advice — the technical format underlying ERA.
- How is ERA different from EOB?
- An ERA is a provider-facing payment reconciliation document in X12 835 format. An EOB is a member-facing informational document in human-readable format.