Denial and adjustment analyzer
Open one or more 835 remittance files and see where the adjustments went: by payer, by group code, by reason code, and by all three together, with denied claims counted and totaled. Every table is re-added against the file before it is shown.
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.
Verification
Summary
Adjustments by payer
Adjustments by group code
Adjustments by reason code
Reason codes are shown exactly as they appear in the file.
Adjustments by payer, group, and reason
Denied claims by payer
Denied claims
What gets checked
- The total of all adjustments is computed a second, separate way, claim by claim and line by line, and both totals must agree.
- Each table (by payer, by group, by reason, and by all three) adds up to that same total, and the number of adjustments is the same in every table.
- The three-way table, collapsed one way at a time, gives back the by-payer, by-group, and by-reason tables.
- Total charges minus total claim payments equals total adjustments.
- The denied claim count and denied charges re-add from the claim list and from the by-payer table.
- Each file's own balancing checks are carried through: a file that does not balance, or cannot be read, makes the result not verified.
How it works
- Choose the files. Drop one or more 835 files on the page. They are read by your browser and stay on your computer.
- Each file is balanced first. Every service line, claim, and payment is checked against the totals inside the file, the same way the 835 to Excel tool does it.
- Adjustments are grouped. Every adjustment on every claim and service line is added into four tables: by payer, by group code, by reason code, and by payer, group, and reason together. Payments that carry the same payer ID count as one payer however the name is written; without an ID the name is used, and two payers that share a name under different IDs are shown apart with the ID beside the name. Claims with status 4 are listed as denied.
- The tables are checked. The grand total is recomputed in a separate pass and each table is re-added against it. Anything that does not agree is shown as a failed check.
- Download. Export an Excel workbook with one sheet per table, separate CSV files, or the certificate listing every check.
Worked example
A made-up file with two payments from two payers and four claims. The claims were charged $1,300.00 in total and paid $750.00, so $550.00 was adjusted across 9 adjustments. One claim (PCN0002, charged $250.00) is denied.
| Group | Reason code | Adjustments | Amount |
|---|---|---|---|
| CO | 29 | 1 | $250.00 |
| CO | 45 | 3 | $180.00 |
| CO | 253 | 1 | $0.00 |
| PR | 1 | 2 | $60.00 |
| PR | 2 | 1 | $40.00 |
| OA | 23 | 1 | $20.00 |
By group: CO $430.00 (5 adjustments), PR $100.00 (3), OA $20.00 (1), which adds to $550.00 across 9 adjustments. By payer: $500.00 (8 adjustments) and $50.00 (1), again $550.00 and 9. Charges of $1,300.00 less payments of $750.00 is $550.00. Denied: 1 claim, $250.00.
The example uses made-up names and numbers.
Questions
Does my file get uploaded?
No. This page is served with a policy that blocks every kind of network request from the page, so it has no way to send your file anywhere. You can disconnect from the internet after the page loads and it still works.
Does it say what each reason code means?
No. Group and reason codes are shown exactly as they appear in the file. The published reason code description text is not included on this site. The adjustment group codes have a short plain-language label, and the codes page explains them further.
What counts as a denied claim?
A claim whose status code in the file is 4. Its charge is added to the denied total. Claims paid at zero under another status are not counted as denied; their adjustments still appear in every table.
Why can an amount be negative?
A claim that takes back an earlier payment carries negative charges and adjustments. They are added in with their sign, so a takeback reduces the totals the same way it reduces the payment.
What if a file does not balance?
The failed check is shown with the amounts involved, the result is marked not verified, and any export is named UNVERIFIED so it is not mistaken for a checked result.
This tool calculates and checks numbers. It is not legal, tax, or medical advice.