835 / EOB Remittance Balancing

835 / EOB remittance balancing: billed minus paid minus the CO/PR/OA/PI adjustments; flags out-of-balance and the patient responsibility to bill.

Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.

Example

Billed charge: 200 $
Paid amount: 120 $
CO contractual-obligation adjustments: 50 $
PR patient-responsibility adjustments: 30 $

Result: Balances: $0.00 residual; post the payment and bill the patient $30.00 (Sigma PR).

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What you enter

Billed charge
Paid amount
CO contractual-obligation adjustments
PR patient-responsibility adjustments
OA other adjustments
PI payer-initiated adjustments

How this is calculated

ASC X12 835 (Health Care Claim Payment/Advice) balancing and the CAS claim-adjustment group codes CO (contractual), PR (patient responsibility), OA (other), PI (payer-initiated): billed = paid + the sum of the adjustments, and patient responsibility = the sum of PR. Read the source ↗

A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.