Revenue Cycle Management Glossary
Essential definitions for EDI standards, denial adjudication codes, and payer compliance rules.
835 Electronic Remittance Advice (ERA)
The HIPAA-standard electronic data interchange (EDI) format used by health insurance payers to communicate claim payment decisions, deductibles, co-pays, and CARC/RARC denial reason codes to healthcare providers.
Claim Adjustment Reason Code (CARC)
Standardized national code set maintained by X12 that explains why a claim or service line was paid differently than billed, or denied in full (e.g. CO-197 for prior authorization).
CMS-0057-F Final Rule
The CMS Interoperability and Prior Authorization Final Rule enacted in 2024, requiring Medicare Advantage, state Medicaid MCOs, and ACA Marketplace insurers to publicly disclose standard prior-authorization approval, denial, and overturn rates starting in 2026.
Coordination of Benefits (COB)
The process by which multiple health insurance plans determine which insurer pays first (primary) and which pays remaining eligible balances (secondary/tertiary).
See what your denials are actually worth.
Send us one month of 835 remittances under a signed BAA. We'll show you exactly how many dollars are recoverable — before you pay anything.