835 claim status and adjustment group codes
Every claim in an 835 file carries a status code, and every adjustment carries a group code. This page explains both sets in plain words, looks up a code or a pasted segment, and counts how many claims and adjustments in a file carry each one.
Your file never leaves this computer. It is read and processed inside this page, which is built so it cannot make network requests. It keeps working with your internet turned off.
Look up a code
What you type stays in this page. Reason codes and remark codes are not explained here; they are shown as they appear in the file.
Count the codes in a file
Verification
Claims by status code
Adjustments by group code
Claim status codes
The status code is the second element of each claim-level (CLP) segment.
Adjustment group codes
The group code is the first element of each adjustment (CAS) segment. A reason code follows it; reason codes are not explained on this page.
What gets checked
- Claims counted by status add up to the number of claims in the file, and their charges add up to the file's total charges.
- Adjustments counted by group add up to the number of adjustments in the file, and their amounts add up to the file's total adjustments.
- The file's own balancing checks are carried through, so counts from a file that does not balance are marked not verified.
How it works
- Look up a code. Type a claim status code such as 4 or a group code such as CO. The explanation appears as you type.
- Or paste a segment. Paste a claim-level segment (it starts with CLP) or an adjustment segment (it starts with CAS). The status code or group code is read out of it and explained. What you paste stays in the page.
- Count the codes in a file. Drop an 835 file to see how many claims have each status and how many adjustments fall in each group, with totals that are re-added against the file.
Worked example
A made-up file with four claims and nine adjustments, counted by code.
| Code | Kind | Count | Amount |
|---|---|---|---|
| 1 | Claim status | 2 claims | $650.00 charged |
| 2 | Claim status | 1 claim | $400.00 charged |
| 4 | Claim status | 1 claim | $250.00 charged |
| CO | Adjustment group | 5 adjustments | $430.00 |
| OA | Adjustment group | 1 adjustment | $20.00 |
| PR | Adjustment group | 3 adjustments | $100.00 |
Statuses: 2 + 1 + 1 = 4 claims and $650.00 + $400.00 + $250.00 = $1,300.00 charged, the file's totals. Groups: 5 + 1 + 3 = 9 adjustments and $430.00 + $20.00 + $100.00 = $550.00, the file's total adjustments.
The example uses made-up names and numbers.
Questions
Does it explain reason codes and remark codes?
No. Those code lists are published by their maintainers and their description text is not included on this site. Tools here show reason and remark codes exactly as they appear in the file.
Where do the explanations come from?
They are written for this site in plain words to describe how each code affects reading the file. They are not the official code list text and are not a substitute for it.
Is what I paste or open sent anywhere?
No. This page is served with a policy that blocks every kind of network request from the page. Whatever is typed in the box or opened from disk is read inside the page and goes nowhere.
What about a code that is not listed?
The lookup says the code is not one of those explained here, and the file count still counts it under the code as written.
This tool calculates and checks numbers. It is not legal, tax, or medical advice.