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Updated:09/19/2008
Copyright
© 1996-2008 Skip Stein

HIPAA 820 Payment Order/Remittance Advice

Management Systems Consulting, Inc.

VERSION: 1.0 DRAFT

   
 Author:Skip Stein
  
  
  
  
 Notes:In order to protect the security and confidentiality of electronic health information, Congress has passed The Health Insurance Portability and Accountability Act, also known as HIPAA, which was the result of efforts by the Clinton Administration and congressional healthcare reform proponents to reform healthcare in a way that would streamline industry inefficiencies, reduce paperwork, make it easier to detect and prosecute fraud and abuse and enable workers of all professions to change jobs, even if they (or family members) had pre-existing medical conditions.

 


820
Payment Order/Remittance Advice

Functional Group=RA

This Draft Standard for Trial Use 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:
 PosIdSegment NameReqMax UseRepeatNotesUsage                    
 010ST820 HeaderM1  
 020BPRFinancial InformationM1  
 035TRNReassociation KeyO1N1/035 
 040CURNon-US Dollars CurrencyO1N1/040 
 050REFPremium Receivers Identification KeyO>1  
 060DTMProcess DateO1  
 060DTMDelivery DateO1  
 060DTMCoverage PeriodO1  
Loop ID - 1000A1    
 070N1Premium Receiver’s NameO1N1/070    
 080N2Premium Receiver Additional NameO1     
 090N3Premium Receiver’s AddressO1     
 100N4Premium Receiver’s City, State, ZipO1     
Loop ID - 1000B1    
 070N1Premium Payer’s NameO1N1/070    
 080N2Premium Payer Additional NameO1     
 090N3Premium Payer’s AddressO1     
 100N4Premium Payer’s City, State, ZipO1     
 120PERPremium Payer’s Administrative ContactO>1     
Detail:
 PosIdSegment NameReqMax UseRepeatNotesUsage                    
Loop ID - 2000A1    
 010ENTOrganization Summary RemittanceO1N2/010    
Loop ID - 2300A>1      
 150RMROrganization Summary Remittance DetailO1N2/150      
Loop ID - 2310A1        
 190IT1Summary Line ItemO1N2/190        
Loop ID - 2315A>1          
 204SLNMember CountO1           
Loop ID - 2320A>1        
 210ADXOrganization Summary Remittance Level AdjustmentO1N2/210        
Loop ID - 2000B>1    
 010ENTIndividual RemittanceO1N2/010    
Loop ID - 2100B>1      
 020NM1Individual NameO1N2/020      
Loop ID - 2300B>1      
 150RMRIndividual Premium Remittance DetailO1N2/150      
 180DTMIndividual Coverage PeriodO1       
Loop ID - 2320B>1        
 210ADXIndividual Premium AdjustmentO1N2/210        
Summary:
 PosIdSegment NameReqMax UseRepeatNotesUsage                    
 010SE820 TrailerM1  
 

 


 

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Copyright © 1996-2008  Skip Stein
Last modified: September 19, 2008