Module 5.1

Intelligent Remittance Engine

The Intelligent Remittance Engine is built for those situations where your remits are still coming as paper or PDF EOBs, being downloaded from payer portals or other situations where you cannot get a native ERA file. This robust conversion engine takes those files and converts them to structured, actionable, standardized 835 files.

This engine is built to industry standard 835 format, but because some systems have minor variances that can't be predicted, it can be customized to work with your requirements. It is designed to dynamically map all required data segments and any situational segments when the data is present. A built-in reconciliation engine verifies the amount equals the sum of payments plus adjustments and that there are no errors before the 835 is generated. Generated 835s are structured, and ready to auto-post to your system. A dynamic dashboard gives you the details of each EOB and 835 file created in real time.

For technical details: View technical documentation

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EOB to 835: Sample Transformation

A sample claim conversion. Allergy and immunology, six service lines. Hover any row on the EOB side to highlight the 835 segments it produced. Hover a segment on the right to highlight the source line on the left.

Payer: United Healthcare EOBs Processed: 47 Total Payment: $125,847.50
Successfully Converted
45
of 47 EOBs
95.7% Success
Claims Processed
342
Across all EOBs
Reconciled
Avg Payment / EOB
$2,797
Per remittance document
On track
Processing Time
12.3min
Full batch
Within target
Sample Transformation. Claim CLM0200100
Hover any service line in the EOB (left) to see exactly which 835 segments it produces on the right.
Input EOB, PDF from payer
Payer: Blue Cross Blue Shield
Patient: Ryan Young · Member ID GRP60178531
Provider: Stephen Young, MD · NPI 1000002011
Service dates: 10/06/2025
CPT Description Billed Paid Adj
95044 Patch allergy test $80.00 $40.00 CO-45 $30.00 · PR-3 $10.00
95180 Rapid desensitization $250.00 $0.00 CO-167 $250.00
95115 Allergen immunotherapy $20.00 $0.00 CO-45 $20.00
95004 Percutaneous allergy skin test $8.00 $0.00 CO-16 + N290 $8.00
94375 Respiratory flow volume $100.00 $30.00 CO-45 $60.00 · PR-3 $10.00
94060 Bronchospasm evaluation $150.00 $70.00 CO-45 $70.00 · PR-3 $10.00
Claim totals $608.00 $140.00 $468.00
Output ANSI 835
ISA*00* *00* *ZZ* *ZZ*1000002011 **1500*^*00501*000000001*0*P*:~ GS*HP**1000002011**1500*1*X*005010X221A1~ ST*835*0001*005010X221A1~ BPR*I*140.00*C*CHK********01***~ TRN*1*BCBS0200100*1000002011~ N1*PR*BLUE CROSS BLUE SHIELD~ N3*PO BOX 1000~ N4*DALLAS*TX*75201~ N1*PE*Stephen Young, MD*XX*1000002011~ N3*9715 Sunset Blvd~ N4*San Antonio*TX*78201~ CLP*CLM0200100*1*608.00*140.00*30.00*BL*BCBS0200100~ NM1*QC*1*Young*Ryan***MI*GRP60178531~ SVC*HC:95044*80.00*40.00**1~ DTM*472*20251005~ CAS*CO*45*30.00~ CAS*PR*3*10.00~ AMT*B6*50.00~ SVC*HC:95180*250.00*0.00**1~ DTM*472*20251005~ CAS*CO*167*250.00~ AMT*B6*0.00~ SVC*HC:95115*20.00*0.00**1~ DTM*472*20251005~ CAS*CO*45*20.00~ AMT*B6*0.00~ SVC*HC:95004*8.00*0.00**1~ DTM*472*20251005~ CAS*CO*16*8.00~ REF*LQ*HE*N290~ AMT*B6*0.00~ SVC*HC:94375*100.00*30.00**1~ DTM*472*20251005~ CAS*CO*45*60.00~ CAS*PR*3*10.00~ AMT*B6*40.00~ SVC*HC:94060*150.00*70.00**1~ DTM*472*20251005~ CAS*CO*45*70.00~ CAS*PR*3*10.00~ AMT*B6*80.00~ SE*42*0001~ GE*1*1~ IEA*1*000000001~
Patient responsibility (PR)
Contractual / denial (CO)
Paid to provider
Claim / patient identifiers
Reconciled before write: BPR total $140.00 = sum of all six AMT*B6 amounts $170.00 less the $30.00 in patient responsibility. Balances cleanly. The 835 file 835_from_eob_allergy_immunology_001.edi is released for posting.
Dashboard Human-readable line-item view
The same six service lines, after the 835 is reconciled, in language your posting team can read at a glance.
Service Line CPT Billed Allowed Paid Patient Owes Why Next Step
Patch allergy test 95044 $80.00 $50.00 $40.00 $10.00 copay Auto-post
Rapid desensitization 95180 $250.00 $0.00 $0.00 — Diagnosis not covered (CO-167) Appeal eligible
Allergen immunotherapy 95115 $20.00 $0.00 $0.00 — Contractual write-off (CO-45) Write off
Percutaneous allergy skin test 95004 $8.00 $0.00 $0.00 — Missing rendering provider ID (CO-16 + N290) Correct and resubmit
Respiratory flow volume 94375 $100.00 $40.00 $30.00 $10.00 copay Auto-post, bill patient
Bronchospasm evaluation 94060 $150.00 $80.00 $70.00 $10.00 copay Auto-post, bill patient
Claim total $608.00 $170.00 $140.00 $30.00
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