X12 820 Payroll Deducted and Other Group Premium Payment For Insurance Products Examples (X218)
This X12 Transaction Set contains the format and establishes the data contents of the Payment Order/Remittance Advice Transaction Set (820) for use within the context of an Electronic Data Interchange (EDI) environment.
The transaction set can be used to make a payment, send a remittance advice, or make a payment and send a remittance advice.
This transaction set can be an order to a financial institution to make a payment to a payee. It can also be a remittance advice identifying the detail needed to perform cash application to the payee's accounts receivable system. The remittance advice can go directly from payer to payee, through a financial institution, or through a third party agent.
- ~ Segment
- * Element
- > Component
- ^ Repetition
Interchange Control Header
To start and identify an interchange of zero or more functional groups and interchange-related control segments
Code identifying the type of information in the Authorization Information
- 00
- No Authorization Information Present (No Meaningful Information in I02)
Information used for additional identification or authorization of the interchange sender or the data in the interchange; the type of information is set by the Authorization Information Qualifier (I01)
Code identifying the type of information in the Security Information
- 00
- No Security Information Present (No Meaningful Information in I04)
This is used for identifying the security information about the interchange sender or the data in the interchange; the type of information is set by the Security Information Qualifier (I03)
Code indicating the system/method of code structure used to designate the sender or receiver ID element being qualified
Identification code published by the sender for other parties to use as the receiver ID to route data to them; the sender always codes this value in the sender ID element
Code indicating the system/method of code structure used to designate the sender or receiver ID element being qualified
Identification code published by the receiver of the data; When sending, it is used by the sender as their sending ID, thus other parties sending to them will use this as a receiving ID to route data to them
Type is not applicable; the repetition separator is a delimiter and not a data element; this field provides the delimiter used to separate repeated occurrences of a simple data element or a composite data structure; this value must be different than the data element separator, component element separator, and the segment terminator
- ^
- Repetition Separator
Code specifying the version number of the interchange control segments
- 00501
- Standards Approved for Publication by ASC X12 Procedures Review Board through October 2003
A control number assigned by the interchange sender
Code indicating sender's request for an interchange acknowledgment
- 0
- No Interchange Acknowledgment Requested
- 1
- Interchange Acknowledgment Requested (TA1)
Code indicating whether data enclosed by this interchange envelope is test, production or information
- I
- Information
- P
- Production Data
- T
- Test Data
Type is not applicable; the component element separator is a delimiter and not a data element; this field provides the delimiter used to separate component data elements within a composite data structure; this value must be different than the data element separator and the segment terminator
- >
- Component Element Separator
Functional Group Header
To indicate the beginning of a functional group and to provide control information
Code identifying a group of application related transaction sets
- RA
- Payment Order/Remittance Advice (820)
Code identifying party sending transmission; codes agreed to by trading partners
Code identifying party receiving transmission; codes agreed to by trading partners
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
Time expressed in 24-hour clock time as follows: HHMM, or HHMMSS, or HHMMSSD, or HHMMSSDD, where H = hours (00-23), M = minutes (00-59), S = integer seconds (00-59) and DD = decimal seconds; decimal seconds are expressed as follows: D = tenths (0-9) and DD = hundredths (00-99)
Assigned number originated and maintained by the sender
Code identifying the issuer of the standard; this code is used in conjunction with Data Element 480
- T
- Transportation Data Coordinating Committee (TDCC)
- X
- Accredited Standards Committee X12
Code indicating the version, release, subrelease, and industry identifier of the EDI standard being used, including the GS and GE segments; if code in DE455 in GS segment is X, then in DE 480 positions 1-3 are the version number; positions 4-6 are the release and subrelease, level of the version; and positions 7-12 are the industry or trade association identifiers (optionally assigned by user); if code in DE455 in GS segment is T, then other formats are allowed
- 005010X218
Heading
820 Header
To indicate the start of a transaction set and to assign a control number
Code uniquely identifying a Transaction Set
- The transaction set identifier (ST01) is used by the translation routines of the interchange partners to select the appropriate transaction set definition (e.g., 810 selects the Invoice Transaction Set).
- 820
- Payment Order/Remittance Advice
Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set
Reference assigned to identify Implementation Convention
- The implementation convention reference (ST03) is used by the translation routines of the interchange partners to select the appropriate implementation convention to match the transaction set definition. When used, this implementation convention reference takes precedence over the implementation reference specified in the GS08.
- The value in ST03 must be the same as the value in GS08.
- 005010X218
Financial Information
To indicate the beginning of a Payment Order/Remittance Advice Transaction Set and total payment amount, or to enable related transfer of funds and/or information from payer to payee to occur
- The BPR addresses the payment total that a premium payer is remitting to the premium receiver. The BPR contains mandatory information, even when not being used to move funds electronically.
Code designating the action to be taken by all parties
- Code designating whether and how money and information are to be processed.
- C
- Payment Accompanies Remittance Advice
Instructs the Originating Depository Financial Institution to move both funds and remittance detail together through the banking system.
- D
- Make Payment Only
Instructs the Originating Depository Financial Institution to move only funds through the banking system, and to ignore any remittance detail.
- I
- Remittance Information Only
Indicates to the payee that the remittance detail is moving separately from the payment. This also includes when the resulting payment would be zero.
- P
- Prenotification of Future Transfers
Tests the setup of the premium receiver and verifies the accuracy of the account numbers. Do not use for actual payments or remittance information.
- U
- Split Payment and Remittance
Instructs the third party processor to split the payment and remittance detail and send each one separately.
- X
- Handling Party's Option to Split Payment and Remittance
Instruct the Originating Depository Financial Institution to move the payment and remittance detail, either together or separately, based upon the payee's request or capabilities.
Monetary amount
- BPR02 specifies the payment amount.
- The ACH system can not support dollar amounts greater than 11 characters (including the decimal point). This provides an ACH limit of $99,999,999.99. for the 820. Dollar limits vary by the clearing system used, e.g ACH vs. wire. Contact your ODFI for information.
Code indicating whether amount is a credit or debit
- This indicates a credit to the payee's account, and a debit to the Payer's account.
- C
- Credit
Code identifying the method for the movement of payment instructions
- ACH
- Automated Clearing House (ACH)
Move money electronically through the ACH. Information in BPR05 through BPR09 and BPR12 through BPR15 must also be included.
- BOP
- Financial Institution Option
The Originating Depository Financial Institution will choose the method of payment based upon payee's request or capabilities. Assuming a customized arrangement is in place between the originator and the ODFI, the ODFI at its option may direct the payer to use code BOP when the ODFI will determine the payment method.
- CHK
- Check
A check has been issued for payment.
- FWT
- Federal Reserve Funds/Wire Transfer - Nonrepetitive
The funds were sent through the wire system.
- NON
- Non-Payment Data
For use when BPR01 is "I" Remittance Information Only. This code is needed when the ODFI is sending remittance information only to the Premium Payment Receiver without originating a payment transaction.
- SWT
- Society for Worldwide Interbank Financial Telecommunications (S.W.I.F.T.)
The funds were sent as a S.W.I.F.T. payment.
Code identifying the payment format to be used
- CCP
- Cash Concentration/Disbursement plus Addenda (CCD+) (ACH)
CCD+ format moves money and up to 80 characters of data, enough to reassociate dollars and data when the dollars are sent through the ACH and the remittance data is sent on a separate path. It is suggested that the addenda contains a copy of the TRN segment.
- CTX
- Corporate Trade Exchange (CTX) (ACH)
CTX format is used to move dollars and data through the ACH. It can contain up to 9,999 addenda records of 80 characters each. The CTX will encapsulate the complete 820 and all the envelope segments.
Code identifying the type of identification number of Depository Financial Institution (DFI)
- When using this transaction set to initiate a payment, all or some of BPR06 through BPR16 may be required, depending on the conventions of the specific financial channel being used.
- BPR06 and BPR07 relate to the originating depository financial institution (ODFI).
- BPR06 THROUGH BPR09 relate to the Originating Depository Financial Institution and the premium payer's bank account.
- 01
- ABA Transit Routing Number Including Check Digits (9 digits)
ABA is a unique number identifying every bank in the United States.
- 02
- Swift Identification (8 or 11 characters)
- 04
- Canadian Bank Branch and Institution Number
Depository Financial Institution (DFI) identification number
- This is the identifying number of the Originating Depository Financial Institution sending the transaction into the ACH network.
Code indicating the type of account
- BPR08 is a code identifying the type of bank account or other financial asset.
- ALC
- Agency Location Code (ALC)
For Federal Government use only.
- DA
- Demand Deposit
Account number assigned
- BPR09 is the account of the company originating the payment. This account may be debited or credited depending on the type of payment order.
- This is the premium payer's bank account at the Originating Depository Financial Institution.
A unique identifier designating the company initiating the funds transfer instructions, business transaction or assigning tracking reference identification.
- BPR10 shall be mutually established between the originating depository financial institution (ODFI) and the company originating the payment.
A code defined between the originating company and the originating depository financial institution (ODFI) that uniquely identifies the company initiating the transfer instructions
- This data must be identical to the value sent in the TRN04 data element.
Code identifying the type of identification number of Depository Financial Institution (DFI)
- BPR12 and BPR13 relate to the receiving depository financial institution (RDFI).
- BPR12 THROUGH BPR15 relate to the Receiving Depository Financial Institution and the premium receiver's bank account. BPR12 - BPR15 are required if the 820 transaction set initiates a funds transfer.
- 01
- ABA Transit Routing Number Including Check Digits (9 digits)
ABA is a unique number identifying every bank in the United States.
- 02
- Swift Identification (8 or 11 characters)
See Code Source 327: Society for Worldwide Interbank Financial Telecommunication (SWIFT).
- 04
- Canadian Bank Branch and Institution Number
Depository Financial Institution (DFI) identification number
- This is the identifying number of the Receiving Depository Financial Institution receiving the transaction into the ACH network.
Code indicating the type of account
- BPR14 is a code identifying the type of bank account or other financial asset.
- BPR14 identifies the type of account in BPR15.
- DA
- Demand Deposit
- SG
- Savings
Account number assigned
- BPR15 is the account number of the receiving company to be debited or credited with the payment order.
- This is the premium receiver's bank account at the Receiving Depository Financial Institution.
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
- BPR16 is the date the originating company intends for the transaction to be settled (i.e., Payment Effective Date).
- For check payment, this data element specifies the check issuance date.
- For payments other than check this data element specifies the date the originator (premium payer) intends to provide funds to the receiver (premium receiver).
Reassociation Trace Number
To uniquely identify a transaction to an application
- The purpose of this segment is to uniquely identify this transaction set and aid in the reassociating payment and remittance data that have been separated. See section 1.10.2.5 and 1.10.2.6 for more information.
Code identifying which transaction is being referenced
- 1
- Current Transaction Trace Numbers
The payment and remittance have not been separated.
- 3
- Financial Reassociation Trace Number
The payment and remittance information have been separated and need to be reassociated by the receiver.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
- TRN02 provides unique identification for the transaction.
- This field is used to re-associate the payment with the remittance information.
A unique identifier designating the company initiating the funds transfer instructions, business transaction or assigning tracking reference identification.
- TRN03 identifies an organization.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
- TRN04 identifies a further subdivision within the organization.
- If provided, TRN04 and BPR11 must be identical.
Foreign Currency Information
To specify the currency (dollars, pounds, francs, etc.) used in a transaction
- Required when the payment is not being made in US Dollars. If not required by this Implementation guide, do not send.
Code identifying an organizational entity, a physical location, property or an individual
- This data element identifies the party using the currency defined in Currency Code CUR02.
- 2B
- Third-Party Administrator
- PR
- Payer
Code (Standard ISO) for country in whose currency the charges are specified
CAD Canadian DollarsMXP Mexican Pesos
Premium Receivers Identification Key
To specify identifying information
- This segment provides the premium receiver a key associated with this premium payment. The type of key and value is provided to the premium payer by the premium receiver. Examples of keys are Plan Number, Master Account Number, Consolidated Invoice Number, and Master Policy Number.
- Required when specified by the terms of the trading partner agreement. If not required by this implementation guide, do not send.
Code qualifying the Reference Identification
- 2F
- Consolidated Invoice Number
- 14
- Master Account Number
- 17
- Client Reporting Category
- 18
- Plan Number
- 38
- Master Policy Number
- 72
- Schedule Reference Number
For U.S. Treasury Department Financial Management Service Disbursed payments, this code indicates a payment schedule number will follow.
- LB
- Lockbox
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
- For Treasury Department Financial Management Service Disbursed payments, this data field is schedule number (11 Characters) submitted by the agency authorizing the payment.
Coverage Period
To specify pertinent dates and times
- Required when the premium payer is not paying from an invoice, but paying on account for a coverage period. If not required by this implementation guide, do not send.
- This segment communicates the start and end date of the coverage period associated with this premium payment.
Code specifying type of date or time, or both date and time
- 582
- Report Period
Code indicating the date format, time format, or date and time format
- RD8
- Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD
Expression of a date, a time, or range of dates, times or dates and times
Creation Date
To specify pertinent dates and times
- Required when specified by the terms of the trading partner agreement. If not required by this implementation guide, do not send.
- This segment is used to relay the date that the premium payment was created.
Delivery Date
To specify pertinent dates and times
- Required when specified by the terms of the trading partner agreement. If not required by this implementation guide, do not send.
- Relays the date the payment was delivered to the Originating Depository Financial Institution by the premium payer or a third party processor.
Process Date
To specify pertinent dates and times
- This segment is used to relay the date the payment was processed by the premium payer.
- Required when specified by the terms of the trading partner agreement. If not required by this implementation guide, do not send.
Intermediary Bank Information
To identify a party by type of organization, name, and code
- Required when specified by the terms of the Originating Financial Institution, or 3rd Party Processor, with the payment Originator. If not required by this implementation guide, do not send.
Code identifying an organizational entity, a physical location, property or an individual
- 0B
- Interim Funding Organization
- 04
- Asset Account Holder
- 8W
- Payment Address
- AK
- Party to Whom Acknowledgment Should Be Sent
- BE
- Beneficiary
- BK
- Bank
- C1
- In Care Of Party no. 1
- C2
- In Care Of Party no. 2
- IAT
- Party Executing and Verifying
- MJ
- Financial Institution
- RB
- Receiving Bank
- Z6
- Transferring Party
- ZB
- Party to Receive Credit
- ZL
- Party Passing the Transaction
Code designating the system/method of code structure used for Identification Code (67)
- 31
- Bank Identification Code
- 57
- Department
- 94
- Code assigned by the organization that is the ultimate destination of the transaction set
- A3
- Assigned by Third Party
- A4
- Assigned by Clearinghouse
- A6
- Financial Identification Numbering System (FINS) Number
- CF
- Canadian Financial Institution Routing Number
- G
- Payee Identification Number
- PA
- Secondary Agent Identification
Code identifying a party or other code
- This segment, used alone, provides the most efficient method of providing organizational identification. To obtain this efficiency the "ID Code" (N104) must provide a key to the table maintained by the transaction processing party.
Intermediary Bank Additional Name
To specify additional names
- Required when the sender needs more characters than are available in the N102 or secondary line information is needed. If not required by this implementation guide, do not send.
Intermediary Bank's Address
To specify the location of the named party
- Required when specified by the terms of the Originating Financial Institution, or 3rd Party Processor, with the payment Originator. If not required by this implementation guide, do not send.
Intermediary Bank's City, State, ZIP Code
To specify the geographic place of the named party
- Required when specified by the terms of the Originating Financial Institution, or 3rd Party Processor, with the payment Originator. If not required by this implementation guide, do not send.
Free-form text for city name
- A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location.
Code (Standard State/Province) as defined by appropriate government agency
- N402 is required only if city name (N401) is in the U.S. or Canada.
Code defining international postal zone code excluding punctuation and blanks (zip code for United States)
Code identifying the country
- Use the alpha-2 country codes from Part 1 of ISO 3166.
Code identifying the country subdivision
- Use the country subdivision codes from Part 2 of ISO 3166.
Intermediary Bank's Administrative Contact
To identify a person or office to whom administrative communications should be directed
- When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc.), the communication number must always include the area code and phone number using the format AAABBBCCCC, where AAA is the area code, BBB is the telephone number prefix, and CCCC is the telephone number. For example, (534)224-2525 would be represented as 5342242525.
- Required when specified by the terms of the Originating Financial Institution, or 3rd Party Processor, with the payment Originator. If not required by this implementation guide, do not send.
Code identifying the major duty or responsibility of the person or group named
- IC
- Information Contact
Code identifying the type of communication number
- EM
- Electronic Mail
- FX
- Facsimile
- TE
- Telephone
Complete communications number including country or area code when applicable
Code identifying the type of communication number
- EM
- Electronic Mail
- EX
- Telephone Extension
When used, the value following this code is the extension for the preceding communications contact number.
- FX
- Facsimile
- TE
- Telephone
Complete communications number including country or area code when applicable
Code identifying the type of communication number
- EM
- Electronic Mail
- EX
- Telephone Extension
When used, the value following this code is the extension for the preceding communications contact number.
- FX
- Facsimile
- TE
- Telephone
Complete communications number including country or area code when applicable
Premium Payer's Name
To identify a party by type of organization, name, and code
Code identifying an organizational entity, a physical location, property or an individual
- PR
- Payer
Code designating the system/method of code structure used for Identification Code (67)
- 1
- D-U-N-S Number, Dun & Bradstreet
- 9
- D-U-N-S+4, D-U-N-S Number with Four Character Suffix
- 24
- Employer's Identification Number
- 75
- State or Province Assigned Number
Used by States when remitting Medicare premium payments (in participation with a "State Buy- In" program).
- EQ
- Insurance Company Assigned Identification Number
- FI
- Federal Taxpayer's Identification Number
- PI
- Payor Identification
Used by the federal government to identify a federal agency's payroll office.
Code identifying a party or other code
- This segment, used alone, provides the most efficient method of providing organizational identification. To obtain this efficiency the "ID Code" (N104) must provide a key to the table maintained by the transaction processing party.
Premium Payer Additional Name
To specify additional names
- Required when the sender needs more characters than are available in the N102 or secondary line information is needed. If not required by this implementation guide, do not send.
Premium Payer's Address
To specify the location of the named party
- Required when specified by the terms of the Originating Financial Institution, or 3rd Party Processor, with the payment Originator. If not required by this implementation guide, do not send.
Premium Payer's City, State, ZIP Code
To specify the geographic place of the named party
- Required when specified by the terms of the Originating Financial Institution, or 3rd Party Processor, with the payment Originator. If not required by this implementation guide, do not send.
Free-form text for city name
- A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location.
Code (Standard State/Province) as defined by appropriate government agency
- N402 is required only if city name (N401) is in the U.S. or Canada.
Code defining international postal zone code excluding punctuation and blanks (zip code for United States)
Code identifying the country
- Use the alpha-2 country codes from Part 1 of ISO 3166.
Code identifying the country subdivision
- Use the country subdivision codes from Part 2 of ISO 3166.
Premium Payer's Administrative Contact
To identify a person or office to whom administrative communications should be directed
- Required when specified by the terms of the trading partner agreement. If not required by this implementation guide, do not send.
- When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc.), the communication number must always include the area code and phone number using the format AAABBBCCCC, where AAA is the area code, BBB is the telephone number prefix, and CCCC is the telephone number. For example, (534)224-2525 would be represented as 5342242525.
Code identifying the major duty or responsibility of the person or group named
- IC
- Information Contact
Code identifying the type of communication number
- This is required when the sender needs to relay communication information.
- EM
- Electronic Mail
- FX
- Facsimile
- TE
- Telephone
Complete communications number including country or area code when applicable
Code identifying the type of communication number
- EM
- Electronic Mail
- EX
- Telephone Extension
When used, the value following this code is the extension for the preceding communications contact number.
- FX
- Facsimile
- TE
- Telephone
Complete communications number including country or area code when applicable
Code identifying the type of communication number
- EM
- Electronic Mail
- EX
- Telephone Extension
When used, the value following this code is the extension for the preceding communications contact number.
- FX
- Facsimile
- TE
- Telephone
Complete communications number including country or area code when applicable
Premium Receiver's Name
To identify a party by type of organization, name, and code
Code identifying an organizational entity, a physical location, property or an individual
- PE
- Payee
Code designating the system/method of code structure used for Identification Code (67)
- 1
- D-U-N-S Number, Dun & Bradstreet
- 9
- D-U-N-S+4, D-U-N-S Number with Four Character Suffix
- EQ
- Insurance Company Assigned Identification Number
- FI
- Federal Taxpayer's Identification Number
- XV
- Centers for Medicare and Medicaid Services PlanID
Use when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID).
Code identifying a party or other code
- This segment, used alone, provides the most efficient method of providing organizational identification. To obtain this efficiency the "ID Code" (N104) must provide a key to the table maintained by the transaction processing party.
Premium Receiver Additional Name
To specify additional names
- Required when the sender needs more characters than are available in the N102 or secondary line information is needed. If not required by this implementation guide, do not send.
Premium Receiver's Address
To specify the location of the named party
- Required when specified by the terms of the Originating Financial Institution, or 3rd Party Processor, with the payment Originator. If not required by this implementation guide, do not send.
Premium Receiver's City, State, and ZIP Code
To specify the geographic place of the named party
- Required when specified by the terms of the Originating Financial Institution, or 3rd Party Processor, with the payment Originator. If not required by this implementation guide, do not send.
Free-form text for city name
- A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location.
Code (Standard State/Province) as defined by appropriate government agency
- N402 is required only if city name (N401) is in the U.S. or Canada.
Code defining international postal zone code excluding punctuation and blanks (zip code for United States)
Code identifying the country
- Use the alpha-2 country codes from Part 1 of ISO 3166.
Code identifying the country subdivision
- Use the country subdivision codes from Part 2 of ISO 3166.
Premium Receiver's Remittance Delivery Method
To identify remittance delivery when remittance is separate from payment
- Required when specified by the terms of the agreement between originator and financial institution or 3rd party processor. If not required by this implementation guide, do not send.
Code defining timing, transmission method or format by which reports are to be sent
- BM
- By Mail
If this code is used, the mailing address must be placed in the 1000A - Premium Receiver's Name Loop.
- EM
- FT
- File Transfer
- FX
- By Fax
- IA
- Electronic Image
- OL
- On-Line
Free-form name
- RDM02 is used to contain the name of a third party processor if needed, who would be the first recipient of the remittance.
Complete communications number including country or area code when applicable
- RDM03 contains the operative communication number for the delivery method specified in RDM01 (i.e. fax phone number and mail address).
Detail
Individual Remittance
To designate the entities which are parties to a transaction and specify a reference meaningful to those entities
- Required when providing remittance line items that pertain to an individual enrolled in a group plan. If not required by this implementation guide, do not send.
Number assigned for differentiation within a transaction set
Code identifying an organizational entity, a physical location, property or an individual
- 2J
- Individual
Code designating the system/method of code structure used for Identification Code (67)
- 34
- Social Security Number
- EI
- Employee Identification Number
- II
- Standard Unique Health Identifier for each Individual in the United States
Required for use under HIPAA when the national individual identifier has been mandated for use.
Code identifying a party or other code
- This is the identification number of the individual used by the receiver.
Individual Name
To supply the full name of an individual or organizational entity
- Required when individual names or ID numbers are called for by the terms of the trading partner agreement. If not required by this implementation guide, do not send.
Code identifying an organizational entity, a physical location, property or an individual
- DO
- Dependent Name
- EY
- Employee Name
- IL
- Insured or Subscriber
- QE
- Policyholder
Code qualifying the type of entity
- NM102 qualifies NM103.
- 1
- Person
Individual last name or organizational name
Code designating the system/method of code structure used for Identification Code (67)
- 34
- Social Security Number
- EI
- Employee Identification Number
- N
- Insured's Unique Identification Number
Individual Premium Adjustment for Previous Payment
To convey accounts-payable adjustment information for the purpose of cash application, including payer-generated debit/credit memos
- The ADX segment is essential to fulfilling the balancing requirements. See section 1.10.2.4 for additional information.
- Required when the paid amount reflects adjustments related to previous payments. If not required by this implementation guide, do not send.
Monetary amount
- ADX01 specifies the amount of the adjustment and must be signed if negative.
If negative, it reduces the payment amount; if positive, it increases the payment amount.
Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment
- ADX02 specifies the reason for claiming the adjustment.
- 52
- Credit for Overpayment
- 53
- Remittance for Previous Underpayment
- 80
- Overpayment
- 81
- Credit as Agreed
- 86
- Duplicate Payment
- BJ
- Insurance Charge
- H1
- Information Forthcoming
- H6
- Partial Payment Remitted
- RU
- Interest
- WO
- Overpayment Recovery
Individual Premium Remittance Detail
To specify the accounts receivable open item(s) to be included in the cash application and to convey the appropriate detail
- Relays detailed remittance information related to an employee or member of a group plan.
Code qualifying the Reference Identification
- Parties using this segment should agree on the content of RMR01 and RMR02 prior to initiating communication.
- 9J
- Pension Contract
- 11
- Account Number
- AZ
- Health Insurance Policy Number
For HIPAA Health Premium Payments this code is REQUIRED when an invoice has not been received from the Health Plan.
- B7
- Life Insurance Policy Number
- CT
- Contract Number
- ID
- Insurance Certificate Number
- IG
- Insurance Policy Number
- IK
- Invoice Number
For HIPAA Health Premium Payments this code is REQUIRED when an invoice has been received from the Health Plan.
- KW
- Certification
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Monetary amount
- RMR04 is the amount paid.
- This is the amount being paid on this remittance item.
Monetary amount
- RMR05 is the amount of invoice (including charges, less allowance) before terms discount (if discount is applicable) or debit amount or credit amount of referenced items.
- RMR05 may be needed by some payees to distinguish between duplicate reference numbers.
- Any difference between the RMR05 and the RMR04 would be explained by the ADX at loop 2320B.
Reference Information
To specify identifying information
- Required when the premium receiver needs additional identifying information pertaining to the individual remittance details. If not required by this implementation guide, do not send.
Code qualifying the Reference Identification
- 2F
- Consolidated Invoice Number
- 14
- Master Account Number
- 18
- Plan Number
- 38
- Master Policy Number
- E9
- Attachment Code
- LU
- Location Number
- ZZ
- Mutually Defined
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Individual Coverage Period
To specify pertinent dates and times
- Required when the premium payer is not paying from an invoice, but paying on account for a coverage period. If not required by this implementation guide, do not send.
- The 2300B DTM overrides the DTM in the header when DTM01 = 582.
- This segment relays the start and end date of the individual coverage period associated with the premium payment segment in the current RMR segment when the date range indicator 582 is used.
- This segment relays the due date of the individual coverage period associated with the premium payment in the currnent RMR segment when the due date indicator AAG is used.
Code specifying type of date or time, or both date and time
- 582
- Report Period
- AAG
- Due Date
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
Code indicating the date format, time format, or date and time format
- RD8
- Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD
Expression of a date, a time, or range of dates, times or dates and times
Individual Premium Adjustment for Current Payment
To convey accounts-payable adjustment information for the purpose of cash application, including payer-generated debit/credit memos
- The ADX segment is essential to fulfilling the balancing requirements. See section 1.10.2.4 for additional information.
- Required when the paid amount differs from the billed amount (RMR05 is present) in the related RMR segment. If not required by this implementation guide, do not send.
Monetary amount
- ADX01 specifies the amount of the adjustment and must be signed if negative.
If negative, it reduces the payment amount; if positive, it increases the payment amount.
Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment
- ADX02 specifies the reason for claiming the adjustment.
- 20
- Balance Due Declined
The entire balance due is being disputed.
- 52
- Credit for Overpayment
- 53
- Remittance for Previous Underpayment
- AA
- Prepaid Benefit or Advances
- AX
- Person No Longer Employed
This adjustment must never be used as a substitute for a termination notice using the 834 transaction.
- H1
- Information Forthcoming
Detailed information related to the adjustment will be provided through a separate mechanism.
- H6
- Partial Payment Remitted
- IA
- Invoice Amount Does Not Match Account Analysis Statement
The invoice does not match the expectation for number or number/type of members and charges.
- J3
- Promised Adjustment Not Received
An adjustment promised by the payee for a previous invoice has not been reflected on the current invoice.
Organization Summary Remittance
To designate the entities which are parties to a transaction and specify a reference meaningful to those entities
- Required when providing company remittance line items that pertain to group level premium or contribution payments. If not required by this implementation guide, do not send.
Number assigned for differentiation within a transaction set
- ENT01 must be a sequential number within the transaction set, starting with one and incrementing by one.
Code identifying an organizational entity, a physical location, property or an individual
- 2L
- Corporation
This code is used to identify an organization level (summary level bill payment only).
- AG
- Agent/Agency
- NH
- Association
- RGA
- Responsible Government Agency
- UN
- Union
Code designating the system/method of code structure used for Identification Code (67)
- 1
- D-U-N-S Number, Dun & Bradstreet
- 9
- D-U-N-S+4, D-U-N-S Number with Four Character Suffix
- 24
- Employer's Identification Number
This is Required for a HIPAA compliant implementation. Code 24 is the HIPAA compliant identifier.
- FI
- Federal Taxpayer's Identification Number
Code identifying a party or other code
Organization Summary Remittance Level Adjustment for Previous Payment
To convey accounts-payable adjustment information for the purpose of cash application, including payer-generated debit/credit memos
- The ADX segment is essential to fulfilling the balancing requirements. See section 1.10.2.4 for additional information.
- Required when the paid amount reflects adjustments related to previous payments. If not required by this implementation guide, do not send.
Monetary amount
- ADX01 specifies the amount of the adjustment and must be signed if negative.
If negative, it reduces the payment amount; if positive, it increases the payment amount.
Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment
- ADX02 specifies the reason for claiming the adjustment.
- 52
- Credit for Overpayment
- 53
- Remittance for Previous Underpayment
- 80
- Overpayment
- 81
- Credit as Agreed
- 86
- Duplicate Payment
- BJ
- Insurance Charge
- H1
- Information Forthcoming
- H6
- Partial Payment Remitted
- RU
- Interest
- WO
- Overpayment Recovery
- WW
- Overpayment Credit
Organization Summary Remittance Detail
To specify the accounts receivable open item(s) to be included in the cash application and to convey the appropriate detail
- The RMR segment is essential to fulfilling the balancing requirements. See section 1.10.2.4 for additional information.
Code qualifying the Reference Identification
- Parties using this segment should agree on the content of RMR01 and RMR02 prior to initiating communication.
- 1L
- Group or Policy Number
In addition to private sector health care contract numbers, Group or Policy Number can be used to identify the Federal Employees Health Benefits Program (FEHB) "Enrollment Code" being paid. The FEHB Enrollment Code identifies an insurer's specific health benefits plan. For HIPAA Health Premium Payments this code is REQUIRED when an invoice has not been received from the Health Plan.
- 11
- Account Number
- CT
- Contract Number
- IK
- Invoice Number
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Code specifying the accounts receivable open item(s), if any, to be included in the cash application.
- If RMR03 is present, it specifies how the cash is to be applied.
- If RMR03 is not present, this is a payment for an open item. If paying an open item, RMR02 must be present. If not paying a specific open item, RMR04 must be present.
- PA
- Payment in Advance
- PI
- Pay Item
- PO
- Payment on Account
- PP
- Partial Payment
Monetary amount
- RMR04 is the amount paid.
- The amount being paid on this remittance item.
Monetary amount
- RMR05 is the amount of invoice (including charges, less allowance) before terms discount (if discount is applicable) or debit amount or credit amount of referenced items.
- RMR05 may be needed by some payees to distinguish between duplicate reference numbers.
- Any difference between the RMR05 and the RMR04 would be explained by the ADX at loop 2320A and/or the SAC at 2312A.
Reference Information
To specify identifying information
- Required when the premium receiver needs additional identifying information pertaining to the organizational remittance details. If not required by this implementation guide, do not send.
Code qualifying the Reference Identification
- 2F
- Consolidated Invoice Number
- 14
- Master Account Number
- 17
- Client Reporting Category
- 18
- Plan Number
- 38
- Master Policy Number
- E9
- Attachment Code
- LB
- Lockbox
- LU
- Location Number
- ZZ
- Mutually Defined
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Organizational Coverage Period
To specify pertinent dates and times
- Required when the premium payer is not paying from an invoice, but paying on account for a coverage period. If not required by this implementation guide, do not send.
- The 2300A DTM overrides the DTM in the header when DTM01 = 582.
- This segment relays the start and end date of the organizational coverage period associated with the premium payment in the current RMR segment when the date range indicator 582 is used.
- This segment relays the due date of the organizational coverage period associated with the premium payment in the currnent RMR segment when the due date indicator AAG is used.
Code specifying type of date or time, or both date and time
- 582
- Report Period
- AAG
- Due Date
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
Code indicating the date format, time format, or date and time format
- RD8
- Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD
Expression of a date, a time, or range of dates, times or dates and times
Summary Line Item
To specify the basic and most frequently used line item data for the invoice and related transactions
- Required when additional charges exist, or when member counts are specified by the terms of the trading partner agreement. If not required by this implementation guide, do not send.
- Additional charges are transmitted in 2312A/SAC.
- The member count is transmitted in 2315A/SLN.
Alphanumeric characters assigned for differentiation within a transaction set
- IT101 is the line item identification.
- Assigned for uniqueness. Start with "1" and increment by "1" for every occurrence of the segment within a specific transaction.
Service, Promotion, Allowance, or Charge Information
To request or identify a service, promotion, allowance, or charge; to specify the amount or percentage for the service, promotion, allowance, or charge
- Required when additional charges must be reported. If not required by this implementation guide, do not send.
Code which indicates an allowance or charge for the service specified
- If SAC01 is "A" or "C", then at least one of SAC05, SAC07, or SAC08 is required.
- C
- Charge
Code identifying the service, promotion, allowance, or charge
- A172
- Administrative
- B680
- Contract Service Charge
- D940
- Insurance Premium
- G740
- Service Charge
Monetary amount
- SAC05 is the total amount for the service, promotion, allowance, or charge.
- If SAC05 is present with SAC07 or SAC08, then SAC05 takes precedence.
Member Count
To specify product subline detail item data
- Required when member counts are specified by the terms of the trading partner agreement. If not required by this implementation guide, do not send.
- The member count is the total number of members included in the summary line item payment (2300A/RMR).
Alphanumeric characters assigned for differentiation within a transaction set
- SLN01 is the identifying number for the subline item.
- SLN01 is related to (but not necessarily equivalent to) the baseline item number. Example: 1.1 or 1A might be used as a subline number to relate to baseline number 1.
- Assigned for uniqueness. Start with "1" and increment by "1" for every occurrence of the segment within a specific transaction.
Code indicating the relationship between entities
- SLN03 is the configuration code indicating the relationship of the subline item to the baseline item.
- O
- Information Only
Numeric value of quantity
- This is the number of contract holders with the type of coverage identified in SLN05-1.
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
- 10
- Group
Used to identify that the value in SLN04 represents the number of contract holders with Family coverage.
- IE
- Person
Used to identify that the value of SLN04 represents the number of contract holders with Individual coverage.
- PR
- Pair
Used to identify that the value in SLN04 represents the number of contract holders with Self and Spouse Only coverage.
Organization Summary Remittance Level Adjustment for Current Payment
To convey accounts-payable adjustment information for the purpose of cash application, including payer-generated debit/credit memos
- The ADX segment is essential to fulfilling the balancing requirements. See section 1.10.2.4 for additional information.
- Required when the paid amount differs from the billed amount (RMR05 is present) in the related RMR segment and the difference is not completely accounted for by amounts in related SAC segments, position 5. If not required by this implementation guide, do not send.
Monetary amount
- ADX01 specifies the amount of the adjustment and must be signed if negative.
If negative, it reduces the payment amount; if positive, it increases the payment amount.
Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment
- ADX02 specifies the reason for claiming the adjustment.
- 20
- Balance Due Declined
Indicates the entire balance due is being disputed.
- 52
- Credit for Overpayment
- 53
- Remittance for Previous Underpayment
- AA
- Prepaid Benefit or Advances
- AX
- Person No Longer Employed
- H1
- Information Forthcoming
Detailed information related to the adjustment will be provided through a separate mechanism.
- H6
- Partial Payment Remitted
- IA
- Invoice Amount Does Not Match Account Analysis Statement
Indicates the invoice does not match the expectation for number or number/type of members and charges.
- J3
- Promised Adjustment Not Received
Indicates an adjustment promised by the payee for a previous invoice has not been reflected on the current invoice.
Summary
Transaction Set Trailer
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)
Total number of segments included in a transaction set including ST and SE segments
Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set
Functional Group Trailer
To indicate the end of a functional group and to provide control information
Total number of transaction sets included in the functional group or interchange (transmission) group terminated by the trailer containing this data element
Assigned number originated and maintained by the sender
Interchange Control Trailer
To define the end of an interchange of zero or more functional groups and interchange-related control segments
Example 1: Summary Bill Payment
BPR*C*19000*C*ACH*CTX*01*999999992*DA*12345678*1030449999**01*199999999*DA*98765*20070516~
TRN*1*12345*1030449999~
REF*14*12345~
N1*PE*DEF HEALTH CARE INC.*FI*012222222~
N1*PR*ABC PLASTICS*FI*123456789~
ENT*1*2L*FI*123456789~
RMR*IK*970501001*PI*16500~
IT1*1~
SLN*1**O*5*IE~
SLN*2**O*75*10~
RMR*IK*970501002*PI*250~
IT1*1~
SLN*1**O*25*IE~
SE*15*0001~
Example 2: List Bill Payment
BPR*C*255*C*ACH*CTX*01*999999992*DA*12345678*1345678901**01*199999999*DA*98765*20071103~
TRN*1*78905*1345678901~
REF*14*0011001~
N1*PE*BATA INSURANCE CO.*FI*012222222~
N1*PR*ALFA MEDAL CO*FI*123456789~
ENT*1*2J*34*030440099~
NM1*EY*1*DOE*JOHN****EI*777222~
RMR*IG*555666**30~
RMR*IG*555667**35~
ENT*2*2J*34*029500563~
NM1*EY*1*FIRSTONE*EMILY****EI*777333~
RMR*IG*555777**45~
ENT*3*2J*34*029480664~
NM1*EY*1*MIDDLEONE*JULIE****EI*777444~
RMR*IG*544477**50~
ENT*4*2J*34*030498099~
NM1*EY*1*NEWONE*KELLY****EI*777111~
RMR*IG*551166**45~
RMR*IG*558766**50~
SE*21*0001~
Example 3: Summary Bill
BPR*U*20000*C*ACH*CCP*01*934257813*DA*1234587*1231555555**01*025677833*DA*99887766*20070620~
TRN*3*12345*1231555555~
REF*14*673001~
REF*2F*0004369123~
N1*PE*DEF HEALTHCARE CO*FI*998216353~
N1*PR*ABC PLASTICS*FI*1231555555~
ENT*1*2L*FI*000057811~
RMR*IK*0004369123*PI*20000~
IT1*1~
SLN*1**O*100*IE~
SLN*2**O*75*PR~
SLN*3**O*125*10~
SE*14*0002~
Example 4: List Bill
BPR*U*20000*C*ACH*CCP*01*934257813*DA*1234587*1231555555**01*025677833*DA*99887766*20070620~
TRN*3*12345*1231555555~
REF*14*673001~
REF*2F*0004369123~
N1*PE*DEF HEALTHCARE CO*FI*998216353~
N1*PR*ABC PLASTICS*FI*000057811~
ENT*1*2J*34*190206123~
NM1*EY*1*SMITH*JOHN****EI*123456~
RMR*CT*190206123**7000~
ENT*2*2J*34*163910163~
NM1*EY*1*JONES*MARY****EI*793016~
RMR*CT*163910163**10000*11000~
ADX*-1000*52~
ENT*3*2J*34*179203456~
NM1*EY*1*JOHNSON*JOE****EI*934213~
RMR*CT*179203456**3000*3100~
ADX*-100*52~
SE*19*0002~
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