835 Provider-Level Adjustment Example

Provider-level adjustments account for money added to or deducted from a provider’s overall payment, separate from the payment details for individual claims or services. For example, a health plan may recover an earlier overpayment or settle an advance payment. These adjustments help the provider reconcile the amount received with the claim payments listed on the remittance advice.

This example shows overpayment recovery and the acknowledgment of a provider’s refund. In one transaction, matching adjustments record the refund and clear the amount owed without changing the total payment.

View or download the EDI file here.

Click on the “Remittances” tab and then on an item in the list to view the provider-level adjustments. To export provider-level adjustments, click on the “Export” button and select “Provider Adjustments”.