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EDI 820 X218 - Payroll Deducted and Other Group Premium Payment For Insurance Products Examples

Functional Group RA

X12F Finance Subcommittee

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.

Heading

1. 0100 · ST · 820 Header · Max 1 · Mandatory

   To indicate the start of a transaction set and to assign a control number

2. 0200 · BPR · Financial Information · Max 1 · Mandatory

   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.

3. 0350 · TRN · Reassociation Trace Number · Max 1 · Mandatory

   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.

4. 0400 · CUR · Foreign Currency Information · Max 1 · Optional

   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.

5. 0500 · REF · Premium Receivers Identification Key · Max >1 · Optional

   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.

6. 0600 · DTM · Process Date · Max 1 · Optional

   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.

7. 0600 · DTM · Delivery Date · Max 1 · Optional

   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.

8. 0600 · DTM · Coverage Period · Max 1 · Optional

   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.

9. 0600 · DTM · Creation Date · Max 1 · Optional

   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.

10. 1000A Loop Mandatory Repeat 1

    1. 0700 · N1 · Premium Receiver's Name · Max 1 · Mandatory

       To identify a party by type of organization, name, and code

    2. 0800 · N2 · Premium Receiver Additional Name · Max 1 · Optional

       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.

    3. 0900 · N3 · Premium Receiver's Address · Max 1 · Optional

       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.

    4. 1000 · N4 · Premium Receiver's City, State, and ZIP Code · Max 1 · Optional

       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.

    5. 1300 · RDM · Premium Receiver's Remittance Delivery Method · Max 1 · Optional

       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.

11. 1000B Loop Mandatory Repeat 1

    1. 0700 · N1 · Premium Payer's Name · Max 1 · Mandatory

       To identify a party by type of organization, name, and code

    2. 0800 · N2 · Premium Payer Additional Name · Max 1 · Optional

       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.

    3. 0900 · N3 · Premium Payer's Address · Max 1 · Optional

       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.

    4. 1000 · N4 · Premium Payer's City, State, ZIP Code · Max 1 · Optional

       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.

    5. 1200 · PER · Premium Payer's Administrative Contact · Max >1 · Optional

       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.

12. 1000C Loop Optional Repeat 14

    1. 0700 · N1 · Intermediary Bank Information · Max 1 · Mandatory

       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.

    2. 0800 · N2 · Intermediary Bank Additional Name · Max 1 · Optional

       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.

    3. 0900 · N3 · Intermediary Bank's Address · Max 1 · Optional

       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.

    4. 1000 · N4 · Intermediary Bank's City, State, ZIP Code · Max 1 · Optional

       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.

    5. 1200 · PER · Intermediary Bank's Administrative Contact · Max >1 · Optional

       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.

Detail

1. 2000A Loop Optional Repeat 1

   1. 0100 · ENT · Organization Summary Remittance · Max 1 · Mandatory

      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.

   2. 2200A Loop Optional Repeat >1

      1. 0800 · ADX · Organization Summary Remittance Level Adjustment for Previous Payment · Max 1 · Mandatory

         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.

   3. 2300A Loop Mandatory Repeat >1

      1. 1500 · RMR · Organization Summary Remittance Detail · Max 1 · Mandatory

         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.

      2. 1700 · REF · Reference Information · Max >1 · Optional

         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.

      3. 1800 · DTM · Organizational Coverage Period · Max 1 · Optional

         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.

      4. 2310A Loop Optional Repeat 1

         1. 1900 · IT1 · Summary Line Item · Max 1 · Mandatory

            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.

         2. 2312A Loop Optional Repeat 4

            1. 2020 · SAC · Service, Promotion, Allowance, or Charge Information · Max 1 · Mandatory

               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.

         3. 2315A Loop Optional Repeat 3

            1. 2040 · SLN · Member Count · Max 1 · Mandatory

               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).

      5. 2320A Loop Optional Repeat >1

         1. 2100 · ADX · Organization Summary Remittance Level Adjustment for Current Payment · Max 1 · Mandatory

            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.

2. 2000B Loop Optional Repeat >1

   1. 0100 · ENT · Individual Remittance · Max 1 · Mandatory

      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.

   2. 2100B Loop Optional Repeat >1

      1. 0200 · NM1 · Individual Name · Max 1 · Mandatory

         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.

   3. 2200B Loop Optional Repeat >1

      1. 0800 · ADX · Individual Premium Adjustment for Previous Payment · Max 1 · Mandatory

         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.

   4. 2300B Loop Mandatory Repeat >1

      1. 1500 · RMR · Individual Premium Remittance Detail · Max 1 · Mandatory

         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.

      2. 1700 · REF · Reference Information · Max >1 · Optional

         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.

      3. 1800 · DTM · Individual Coverage Period · Max 1 · Optional

         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.

      4. 2320B Loop Optional Repeat >1

         1. 2100 · ADX · Individual Premium Adjustment for Current Payment · Max 1 · Mandatory

            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.

Summary

1. 0100 · SE · Transaction Set Trailer · Max 1 · Mandatory

   To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)