The deposit tells you money arrived. Only the remittance tells you what you were paid for, what you weren't, and why. Most unrecovered revenue is sitting in a document nobody reads past the total.
EFT — electronic funds transfer. The money itself: the payer's deposit landing in the agency's bank account. It carries a trace number and a total, and nothing else useful.
ERA — electronic remittance advice. The explanation: a claim-by-claim, line-by-line statement of what was billed, what was allowed, what was paid, and what was adjusted away. Delivered as an X12 file called the 835 — ERA and 835 are the same document; one is the name, the other the format.
The 837 is the other half of the pair: the claim file the agency (or its clearinghouse) sent out. Reconciliation is the act of matching every line of the 837 to a line on an 835 — and chasing every line that never gets one.
One EFT usually covers many claims, and the deposit total rarely matches any single billing batch — payers bundle claims across weeks, take back money from old claims, and pay partials. The trace number on the EFT appears on the 835 too; matching the two is the first step, and in many agencies the last one anyone performs.
Each service line on the 835 shows the billed amount, the allowed amount, the paid amount, and adjustment codes explaining every dollar of difference. The codes come in two layers: CARC — claim adjustment reason codes, the standardized "why" (denied, reduced, applied to another payer) — and RARC — remark codes that add detail. The codes are national standards, but payers use them with local dialects: the same CARC can mean an authorization problem at one Medicaid MCO and an enrollment problem at another. The companion guide for each payer, not intuition, is the reference.
Below the claim lines sits the section that quietly explains "the deposit was smaller than expected": PLB — provider-level adjustments. Recoupments of prior overpayments, interest, penalties, withholds. PLB entries reduce the check without touching any current claim, which is why a week of clean claims can still produce a short deposit.
Four passes through a month of 835s, in order of yield:
— Zero-pays and partials. Filter paid = $0 and paid < allowed. Each is either a fixable denial or a permanent loss with a deadline attached.
— Missing claims. Every 837 line with no 835 answer after the payer's normal turnaround. Nothing denied it; it's simply gone — these never appear on a denial report.
— Recurring CARCs. Count denial codes by frequency. The top two usually name one broken process upstream — an authorization not tracked, a caregiver not linked, a code mismatch.
— Paid units vs. verified units. Compare units paid to units the EVV system verified, member by member. Gaps here are the rounding and exception losses that pay "clean" and flag nothing.
None of this requires software beyond what the clearinghouse already provides — most render the 835 as a readable report and export it to a spreadsheet. What it requires is a standing appointment: once a month, EFT totals tied to 835s, the four passes above, and a short list of claims to work, ordered by filing deadline. The remittance is the only document in the building where the payer tells the truth about your revenue. It deserves an hour.