Looking for feedback from people experienced with EDI/X12 835 remittance processing
We’re building an 835 remittance sync engine and would appreciate feedback from anyone who has worked on ERA processing, payment posting, clearinghouses, or RCM systems.
Some scenarios we’re currently evaluating:
- Adjustment capping that can create negative balances, particularly when reversals and positive remittances are processed out of order.
- Split remittances where adjustments need to be allocated across multiple service lines.
- Service-line matching when payers omit modifiers (e.g., RT/LT) or other identifying information, potentially causing remittances to be applied to the wrong line.
- PR (Patient Responsibility) calculations across resubmissions, denials, duplicate claims, and re-adjudications.
- Reversal remittances where the original payer/remit type is not clearly identifiable.
For those who have implemented remittance posting systems, what other payer behaviors, 835 edge cases, reconciliation challenges, or architectural pitfalls should we be considering?
Looking for both technical and business-process perspectives. Happy to share more details and examples in the comments.