ERA Posting and Payment Reconciliation: 835s, EFTs and What Auto-Posting Misses

Updated November 5, 2026, based on CMS, CAQH CORE, X12 and the Code of Federal Regulations as of that date.

An ERA tells you what a payer paid and why. The EFT is the money itself. They travel separately, so reconciliation has two jobs: match each 835 to its deposit using the TRN trace number, then make sure every dollar in that 835 lands on a claim or an account. Auto-posting handles the lines that match cleanly. The manual work is the remainder: a deposit with no remit, a remit with no deposit, provider-level adjustments, reversals, and payers still sending paper.

This guide is for the payment posting lead or billing manager who owns that remainder. It covers how the 835 and the EFT are tied together under HIPAA, which fields to match, how long to wait for the missing half, and a daily routine for closing out the bank account.

The 835 and the EFT are two transactions

HIPAA adopts two standards for paying a claim electronically. Under 45 CFR 162.1602, the remittance advice is the X12 835 (version 005010X221), and the payment initiation is a NACHA CCD+ entry whose addenda record carries the 835's TRN reassociation trace number.

CMS's EFT and ERA reassociation basics describes three stages. The health plan tells its bank to send the funds. The plan's bank sends them through the ACH Network to yours. Your bank then sends you a deposit notice. HHS sets standards for the first stage only. The format of the deposit notice you get from your bank is between you and the bank.

The 835 itself goes to you or your clearinghouse on its own path. CMS states the result plainly: providers often receive the EFT and its ERA at different times, and must reassociate them before they can post.

One rule makes matching possible. The 835 implementation guide, as quoted in the CAQH CORE EFT and ERA Reassociation Rule, sets a one-to-one relationship: one 835 relates to a single payment, and one payment relates to a single 835. If a deposit seems to cover two remits, or a remit seems split across two deposits, treat it as an exception and ask the payer.

Match on the TRN, amount and effective date

The CORE reassociation rule, adopted for all health plans by 45 CFR 162.1603, names the minimum data you need from the deposit to find its 835. Each field in the bank's CCD+ deposit has a partner in the 835:

• Effective Entry Date in the deposit matches BPR16, the EFT effective date.
• Amount in the deposit matches BPR02, the total actual provider payment.
• Payment Related Information (the TRN segment) in the deposit matches TRN02, the EFT trace number, and TRN03, the payer identifier.

Watch two details.

First, the ACH trace number is a different number. The CORE rule says so directly. The ACH trace number is assigned or overwritten by the bank and is used for customer service and returned items. It doesn't link a deposit to a remit. Match on the TRN02 trace number.

Second, your bank may not pass the TRN along by default. Health plans must include it in the payment, but HIPAA doesn't require banks to deliver it to you. Section 4.1 of the rule requires health plans to tell providers, when they enroll for EFT, to contact their bank and arrange delivery of the CCD+ addenda. If your deposit detail shows a payer name and amount but no trace number, start with the bank.

How long to wait for the missing half

The same rule limits the gap between the two transactions. For medical claims, CMS's reassociation summary says a health plan must release the 835 no sooner than three business days before the EFT effective entry date and no later than three business days after it. Plans meet the rule if 90% of their transactions in a calendar month fall inside that window.

An EFT or ERA counts as late or missing four business days after you receive the other one. Each health plan must give providers who enroll for EFT and ERA its written procedure for resolving late or missing transactions. Keep those procedures for your major payers where the posting team can find them, because that's the process the payer has committed to follow.

When the gap runs long, the CORE rule describes your two options. You can post from the ERA and keep working the account, billing secondary insurance or the patient, before the money is confirmed. Or you can hold the ERA until the deposit arrives, which leaves A/R open longer. The first risks rework if the payment never matches. The second can leave patients with wrong balances. Pick one policy per payer and apply it every time, so the team isn't deciding case by case.

Why the deposit doesn't equal the sum of the claims

Even a matched 835 won't always tie out claim by claim. In CMS's Remittance Advice Resources and FAQs booklet, the check amount (BPR02) is the sum of all claim-level payments less any provider-level adjustments, reported in the PLB segment.

Provider-level adjustments usually don't relate to a specific claim or service line. CMS's examples are interest for late payment of a clean claim, a deduction to recover a prior overpayment, and payment under a provider incentive plan. The booklet also sets the sign convention: a negative adjustment increases the payment and a positive one reduces it. A PLB offset can take money from today's deposit for a claim paid months ago, so someone has to find the original claim and book the recovery against it.

At the claim and line level, every adjustment carries a group code and a claim adjustment reason code (CARC), often with a remittance advice remark code (RARC). The Medicare Claims Processing Manual, chapter 22, defines the group codes. CO is a contractual obligation, generally written off and not billed to the patient. PR is patient responsibility, such as deductible and copay. OA covers anything else. CMS's operating rules page adds that all health plans must use the standard CARCs and RARCs, not proprietary codes. X12 publishes the current CARC list and RARC list.

The CORE rule set in 45 CFR 162.1603 also includes required code combinations for defined business scenarios, which narrows how plans report common situations. Payers still differ in the codes they pick outside those scenarios, so expect to tune posting rules payer by payer.

What auto-posting usually leaves for a person

Posting software handles a clean 835 well: claim found, amounts balance, adjustments mapped to transaction codes. The exceptions tend to fall into the same groups. Which of them your system resolves on its own varies by product and by how its rules are set up.

• Deposits with no 835, or 835s with no deposit. Possible causes include a missing TRN in the bank feed, a remit that went to an old clearinghouse route, or a payer you haven't enrolled with for ERA. EFT and ERA enrollment is done separately with each health plan, per CMS.
• PLB lines. Interest, overpayment recoveries and other provider-level amounts need a decision about which account or claim they belong to.
• Reversals and corrections. CMS's booklet identifies claim status 22 as a reversal of a previous payment. The reversal and any corrected payment both have to post against the right original claim.
• Claims the system can't find. Patient or claim identifiers in the 835 that don't match the charge on file, often after a corrected claim or a change to the patient's insurance.
• Patient payments taken before adjudication. A copay collected at check-in can't be applied with certainty until the 835 shows the PR amount. Until then it sits as unapplied cash, and it needs a regular sweep.
• Paper EOBs and portal-only remits. Anything that doesn't arrive as an 835 is keyed by hand or pulled from the payer's portal.

A daily reconciliation routine

The goal is a bank account where every deposit has a posted 835 behind it, and every posted 835 has a deposit.

1. Pull the day's deposit detail from the bank with the CCD+ addenda, and the day's 835 files from your clearinghouse or payers.
2. Match each deposit to an 835 on TRN02, then confirm the amount against BPR02 and the date against BPR16.
3. Post the matched 835s. Review the auto-posting exceptions before the end of the day, not in a weekly batch.
4. List what didn't match on either side, with the date each item arrived.
5. For anything past four business days, follow that payer's late or missing EFT and ERA procedure.
6. Work PLB adjustments and reversals against the original claims.
7. Sweep unapplied patient payments against newly posted 835s.
8. Close the day by tying total deposits to total posted payments, and carry any difference forward with a reason.

Balances still open after posting move to follow-up. Our guide to A/R recovery covers working them.

Frequently asked questions

Does a payer have to send me an ERA?

Under 45 CFR 162.925, if you ask a health plan to conduct a transaction as a standard transaction, it must do so, and it can't delay or reject it because it's a standard transaction. In practice you still enroll for ERA with each plan, as CMS notes in its reassociation summary.

What's the difference between the ACH trace number and the TRN?

The TRN02 trace number is the reassociation number the payer puts in both the 835 and the EFT addenda. The ACH trace number is a banking number, often assigned or changed by the payer's bank, used for research and returns. The CORE rule says they are not the same number, so don't match on the ACH trace.

The 835 arrived but the money didn't. What should I do?

Wait until four business days have passed since the 835 arrived. Then follow the payer's written late or missing transaction procedure, which every health plan must provide at EFT and ERA enrollment. Confirm with your bank first that the deposit didn't arrive without its addenda.

Why is there a negative amount in the PLB segment?

In CMS's convention, a negative provider-level adjustment increases the payment, for example interest on a late clean claim. A positive amount reduces it, for example an overpayment recovery. Check the PLB reason code to see which applies.

Can we post from the ERA before the deposit clears?

Yes. The CORE rule describes the trade-off: posting early risks rework if the payment doesn't match, and holding the ERA keeps A/R open and patient balances out of date. Set the policy once per payer so the team handles it the same way each time.

Still posting remits and reconciling deposits by hand?

Champ automates the portal and document work behind payment posting, like pulling remittances from payer portals and reading paper EOBs. We set it up and run it, so your posting team sees only the finished results. If ERA exceptions take up your team's day, learn more here.

This post is general information, not legal, compliance or billing advice. Rules vary by payer and change often, so confirm with the payer, your clearinghouse and your bank before acting. Champ is not affiliated with or endorsed by CMS, HHS, CAQH, X12 or NACHA.