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

Position
Segment
Name
Max use
  1. To indicate the start of a transaction set and to assign a control number

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

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

    2. 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. 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. 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. 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. 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. 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. 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. 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. 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

Position
Segment
Name
Max use
  1. 2000A Loop Optional
    Repeat 1
    1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

Position
Segment
Name
Max use
  1. To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)

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