PREMIUM PAYMENTS TRANSACTIONS 820 (004010X061)
|
|
- Shona Harmon
- 6 years ago
- Views:
Transcription
1 PREMIUM PAYMENTS TRANSACTIONS 820 (00400X06)
2 SECTION I - NARRATIVE 820 Payment Order/Remittance Advice - Header The header section of the 820 file contains information related to the total payment. Examples include: The party receiving the payment (premium receiver) The party responsible for paying the premium (premium payer) Other information contained in the header section is necessary for the Originating and Receiving Depository Financial Institutions to perform the dollars transfer associated with the premium payment. The content of the header area will vary depending upon the payment method, the receiver of the transaction, and the delivery mechanism. Seg. ID Name Usage Repeat ST 820 Header R Financial Information R TRN Reassociation Key R CUR Non-US Dollars Currency S REF Premium Receivers Key S > DTM Process Date S DTM Delivery Date S DTM Coverage Period S LOOP ID 000A PREMIUM RECEIVER S NAME N Premium Receiver s Name R N2 Premium Receiver Additional Name S N3 Premium Receiver s Address S N4 Premium Receiver s City, State, Zip S LOOP ID 000B PREMIUM PAYER S NAME N Premium Payer s Name R N2 Premium Payer Additional Name S N3 Premium Payer s Address S N4 Premium Payer s City, State, Zip S PER Premium Payer s Administrative Contact S > 2
3 Detail, Organization Summary Remittance The detail remittance section can be structured in two ways. The first is used to provide remittance information associated with a summary bill payment. The second provides remittance information associated with an individual or list bill payment. The structure used is dependent on your business needs. A summary bill is submitted to a premium payer with one or more amounts representing a summary of the premiums due. An individual/list bill is submitted to a premium payer with one or more amounts representing detail premiums due for each individual of an organization. There are two possible uses for the detailed remittance information. In the first use, the premium payment is specific to the employee / subscriber. Dependent payments are made as part of the employee payment and the dependents are not included in the detailed remittance information. In the second usage, every individual has an associated specific premium payment. In this case, each employee and dependent must be separately included in the remittance information. Seg. ID Name Usage Repeat LOOP ID 2000A ORGANIZATION SUMMARY REMITTANCE ENT Organization Summary Remittance S LOOP ID 2300A ORGANIZATION SUMMARY > REMITTANCE DETAIL RMR Organization Summary Remittance Detail R LOOP ID 230A SUMMARY LINE ITEM IT Summary Line Item S LOOP ID 235A MEMBER COUNT > SLN Member Count S LOOP ID 2320A ORGANIZATION SUMMARY > REMITTANCE LEVEL ADJUSTMENT > ADX Organization Summary Remittance Level Adjustment S 3
4 Detail, Individual Remittance Seg. ID Name Usage Repeat LOOP ID 2000B INDIVIDUAL REMITTANCE > ENT Individual Remittance S LOOP ID 200B INDIVIDUAL NAME > NM Individual Name S LOOP ID 2300B INDIVIDUAL PREMIUM > REMITTANCE DETAIL RMR Individual Premium Remittance Detail S DTM Individual Coverage Period S LOOP ID 2320B INDIVIDUAL PREMIUM > ADJUSTMENT ADX Individual Premium Adjustment S 820 Payment Order/Remittance Advice - Summary The summary section contains only one segment, the SE transaction trailer, which provides a control number and total count of segments used in the current 820. Seg. ID Name Usage Repeat SE 820 Trailer R 4
5 SECTION II - TABLES TRANSACTION SET REQUIREMENTS FOR: PREMIUM PAYMENT TRANSACTIONS 820 (00400X06) Pg # Seg DE Designator Element Type CONTROL SEGMENTS ISA Interchange Control Header MIN/MAX Usage Description X2 M ID 2/2 R Authorization Information M AN 0/0 R Authorization Information M ID 2/2 R Security Information X2 Definition Value 00 0 spaces 00 UNIPRISE Trading Partner Instructions M AN 0/0 R Security Information 0 spaces M ID 2/2 R Interchange ID ZZ Mutually defined M AN 5/5 R Interchange Provide Federal Tax ID Sender ID M ID 2/2 R Interchange ID ZZ Mutually defined M AN 5/5 R Interchange Usually federal tax id must be 5 Receiver ID characters M DT 6/6 R Interchange Date YYMMDD format M TM 4/4 R Interchange Time HHMM format M ID / R Interchange Control Standards Identifier M ID 5/5 R Interchange Control Version Number U
6 Pg # Seg DE Designator Element Type MIN/MAX Usage Description X2 X2 Definition Value UNIPRISE Trading Partner Instructions 3 M N 9/9 R Interchange Control Number YYMMDDsss where sss is a sequ number M ID / R Acknowledgment 4 Request Acknowledgment requested 5 M ID / R Usage Indicator T = test, P = production 6 M / R Component Element \ Separator GS Functional Group Header GS0 M ID 2/2 R Functional RA Payment Order/Remittance Advi Identifier GS02 M AN 2/5 R Application Same as 6 Sender s GS03 M AN 2/5 R Application Same as 8 Receiver s GS04 M DT 8/8 R Date CCYYMMDD format GS05 M TM 4/8 R Time HHMM format GS06 M N /9 R Group Control Number YYMMDDsss where sss is a sequ number GS07 M ID /2 R Responsible X Agency GS08 M AN /2 R Version/Release/I ndustry Identifier 00400X06 GE Functional Group Trailer GE0 GE0 2 IEA Interchange Control Trailer IEA0 M N /6 R Number of Transaction Sets Included M N /9 R Group Control Number M N /5 R Number of Included Functional Groups Count of ST segments same as GS06 6
7 Pg # Seg DE Designator Element Type IEA0 2 M ID 2/2 S (DFI) ID Number 0 2 MIN/MAX Usage Description X2 M N 9/9 R Interchange Control Number HEADER SEGMENTS ST Transaction Set Header ST0 M ID 3 R Transaction Set Identifier ST02 M AN 4/9 R Transaction Set Control Number Beginning Segment for Payment Order/Remittance Advice X2 Definition Value 820 UNIPRISE Trading Partner Instructions same as 3 Counter starting at 000 M ID /2 R Transaction Handling I M R /8 R Total Premium Dollar amount including decimal Payment character M ID / R Credit/Debit Flag C M ID 2/3 R Payment Method ACH, CHK or FWT M ID /0 S Payment Format CTX or CCP when 04 is ACH M ID 2/2 S (DFI) ID Number 0 M AN 3/2 S (DFI) UHG bank ABA number Number M ID /3 S Account Number DA M AN /35 S Account Number UHG bank account number M AN 0/0 S Originating Company Identifier O AN 9/9 S Originating Company Supplemental Appropriate tax id not used 7
8 Pg # Seg DE Designator Element Type MIN/MAX Usage Description X2 2 M AN 3/2 S (DFI) 3 Number M ID /3 S Account Number TRN Trace TRN 0 TRN 02 TRN 03 TRN 04 REF Reference REF 0 REF 02 This material is provided on the recipient s agreement that it will only be used for the purpose of describing Uniprise products and services to the recipient. Any other use, X2 Definition Value DA UNIPRISE Trading Partner Instructions Customer s bank ABA number M AN /35 S Account Number Customer s bank account number M DT 8/8 R Date CCYYMMDD format M ID /2 R Trace Type M AN /30 R Reference O AN 0/0 S Originating Company Identifier O AN /30 R Reference M ID 2/3 R Reference M AN /30 R Reference N Name (Premium Receiver s Name) N0 M ID 2/3 R Entity Identifier Internal trace number not used not used 4 Master account number Customer reference number PE N02 M AN /60 S Name Appropriate legal entity name N03 M ID /2 S FI N04 M AN 2/80 S Appropriate tax id N Name (Premium Payer s Name) N0 M ID 2/3 R Entity Identifier PR 8
9 Pg # Seg DE Designator Element Type MIN/MAX Usage Description X2 X2 Definition Value UNIPRISE Trading Partner Instructions N02 M AN /60 S Name Customer s name N03 M ID /2 S FI N04 M AN 2/80 S Customer reference number DETAIL SEGMENTS ENT Entity ENT M N /6 R Assigned Number ENT M ID 2/3 S Entity Identifier 2L 02 ENT 03 M ID /2 S FI ENT 04 M AN 2/80 S Same as 6 RMR Remittance Advice Accounts Receivable Open Item Reference RMR M ID 2/3 R Reference IK Invoice number 0 RMR M AN /30 R Reference item reference number / invoice num 02 RMR 03 M ID 2/2 S Payment Action not used RMR 04 M R /8 R Detail Premium Payment Amount TRAILER SEGMENTS SE Transaction Set Trailer SE0 M N /0 R Number of Included Segments SE02 M AN 4/9 R Transaction Set Control Number Amount paid on this remittance Count of segments Same as ST02 9
10 SECTION IV - EXAMPLES X2 820 Sample File The ISA record is a fixed length record. All other records are variable lengths, asterisk delimited, ending with a tilde. Carriage returns and line feeds have been added to enhance readability (the data is wrapped for transmissions). ISA*00* *00* *7* *ZZ* *020626*539*U*0040* *0*T*:~ GS*RA* * * *539*39*X*00400X06~ ST*820*0082~ *I*00000*C*CHK**0* *DA*2***0* ** * ~ REF*4* ~ N*PR*CUSTOMER N/A*FI*02680~ RMR*IK*26855**00000~ RMR*IK*26856**00000~ SE*0*0082~ ST*820*0083~ *I*9000*C*CHK**0* *DA*2***0* ** * ~ REF*4* ~ N*PR*CUSTOMER N/A*FI*02679~ RMR*IK*26854**9000~ SE*9*0083~ ST*820*0084~ *I*6000*C*CHK**0* *DA*2***0* ** * ~ REF*4* ~ N*PR*CUSTOMER N/A*FI*02679~ RMR*IK*26853**6000~ SE*9*0084~ ST*820*0085~ *I*84000*C*CHK**0* *DA*2***0* ** * ~ REF*4* ~ 0
11 N*PR*CUSTOMER N/A*FI*02682~ RMR*IK*26859**84000~ RMR*IK*26860**84000~ RMR*IK*2686**84000~ RMR*IK*26862**84000~ SE*2*0085~ ST*820*0086~ *I*50000*C*CHK**0* *DA*2***0* ** * ~ REF*4* ~ N*PR*CUSTOMER N/A*FI*0268~ RMR*IK*26857**50000~ SE*9*0086~ ST*820*0087~ *I*000000*C*CHK**0* *DA*2***0* ** * ~ REF*4*099936~ N*PR*CUSTOMER N/A*FI*0268~ RMR*IK*26858**000000~ SE*9*0087~ GE*6*39~ IEA** ~
820 Payment Order/Remittance Advice
820 Payment Order/Remittance Advice HIPAA/V5010X218: 820 Payment Order/Remittance Advice, Louisiana Medicaid Version: 1.0 Created: 9/20/2011 The purpose of this guide is to clarify the usage of the X12
More informationPremium Payment Submission Companion Guide. to the. ANSI X (version 4010x61) implementation guide
Premium Payment Submission Companion Guide to the Premium Payment Submission ANSI X 820 (version 4010x61) implementation guide Document History Revision date Revision Commentary May 2003 1.0 Creation date
More informationEDS Systems Unit. Companion Guide 820 MCE Capitation Payment Transaction
EDS Systems Unit I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Companion Guide 820 MCE Capitation Payment Transaction L I B R A R Y R E F E R E N C E N U M B E R : C L E L 1 0 0 1 7 [ A S C
More informationHP S ystems U nit. Companion Guide: 820 MCE Capitation Payment Transaction
HP S ystems U nit I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Companion Guide: 820 MCE Capitation Payment Transaction L I B R A R Y R E F E R E N C E N U M B E R : C L E L 1 0 0 1 7 [ A S
More informationPayment Order/Remittance Advice
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)
More information820 Payment Order/Remittance Advice
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)
More informationPayroll Deducted and Other Group Premium Payment for Insurance Products
004010X061 820 GROUP PREMIUM PAYMENT FOR INSURANCE PRODUCTS National Electronic Data Interchange Transaction Set Implementation Guide Payroll Deducted and Other Group Premium Payment for Insurance Products
More information835 Health Care Claim Payment/Advice
835 Health Care Claim Payment/Advice Functional Group ID=HP Introduction: This document contains the format and establishes the data contents of the Health Care Claim Payment/Advice Transaction Set (835)
More informationCheck Payment UCS & X12
820 Heading: Check Payment 005010 UCS & X12 Functional Group=RA Pos Id Segment Name Req Max Use Repeat Notes Usage 0200 BPR Beginning Segment for M 1 Must use Payment Order/Remittance Advice 0350 TRN Trace
More informationMortgagee Coverage Notification, Billing and Payment of Insurance Premium. Electronic Data Interchange Transaction Set Implementation Guide
Electronic Data Interchange Transaction Set Implementation Guide 811/820 MORTGAGEE COVERAGE NOTIFICATION, BILLING AND PAYMENT OF INSURANCE PREMIUM Implementation Guide Version 2.0 (3030) 1 1. State 2.
More informationMERCURY MARINE EFT (ACH) IMPLEMENTATION GUIDE (FINANCIAL EDI)
MERCURY MARINE EFT (ACH) IMPLEMENTATION GUIDE (FINANCIAL EDI) The following guide is intended to facilitate the user in implementing Electronic Data Interchange transactions with Mercury Marine. Every
More informationEDS SYSTEMS UNIT. Pre-Release Companion Guide: 835 Remittance Advice Transaction
EDS SYSTEMS UNIT I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Pre-Release Companion Guide: 835 Remittance Advice Transaction L I B R A R Y R E F E R E N C E N U M B E R : C L E L 1 0 0 1 9
More informationIllinois CPWB. Electronic Data Interchange. Implementation Guide For
Illinois Implementation Guide For Electronic Data Interchange CPWB Transaction Set ANSI ASC X12 Version 004010 820 UCB/POR Remittance Advice Version 1.2 CPWG 820 UCB/POR Remittance Advice Version 1.2 Page
More informationFallon Health. 835 Fallon Health Companion Guide. Health Care Payment Advice. 835 Companion Guide
Fallon Health Health Care Payment Advice 835 Companion Guide Refers to the ASC X12N 835 Technical Report Type 3 Guide (Version 005010X221A1) Companion Guide Version Number: 1.3 October 2017 1 Disclosure
More informationChapter 10 Companion Guide 835 Payment & Remittance Advice
Chapter 10 Companion Guide 835 Payment & Remittance Advice This companion guide for the ANSI ASC X12N 835 Healthcare Claim PaymentAdvice transaction has been created for use in conjunction with the ANSI
More informationHEALTHpac 835 Message Elements
Version 1.2 April 21, 2003 1 Table of Contents 1 INTRODUCTION...3 1.1 GENERAL COMMENTS...3 1.2 RELATED DOCUMENTS...4 2 835 MESSAGE ELEMENTS...5 2.1 HEADER - INITIAL...5 2.2 PAYER IDENTIFICATION...6 2.3
More informationKansas Department of Revenue 915 SW Harrison Street Topeka, KS ED-100 G (Rev. 07/2004)
ED-100 G (Rev. 07/2004) Kansas Department of Revenue 915 SW Harrison Street Topeka, KS 66626 Table of Contents 1. TRANSACTION SET 811 SEGMENT STRUCTURE ANSI X12 V.3050...2 2. TRANSACTION SET 811 MAPPING
More informationEyeMed Vision Care. HEALTHCARE BENEFIT ELIGIBILITY INQUIRY Companion Document to ASC X12N 270 (004010X092)
HEALTHCARE BENEFIT ELIGIBILITY INQUIRY Companion Document to ASC X12N 270 (004010X092) Welcome to EyeMed Vision Care s HIPAA TCS implementation process. We have developed this guide to assist you in preparing
More information835 Health Care Claim Payment/Advice LA Medicaid
835 Health Care Claim Payment/Advice LA edicaid HIPAA/V5010X221A1/835: 835 Health Care Claim Payment/Advice Version: 1. 1 Created 10/21/2011 Revision 9/23/2013 Author: Publication: EDI Department LA edicaid
More informationCostco Wholesale EDI TRADING PARTNER PROFILE REMITTANCE ADVICE
EDI TRADING PARTNER PROFILE REMITTANCE ADVICE Contacts: Misti Reed Supervisor (425) 313-8677 mreed@costco.com Heidi Dirkes EDI Coordinator Vendors A-F (425) 313-6868 hdirkes@costco.com Sue Crippe EDI Coordinator
More informationStandard Companion Guide
Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 005010X221A1 Health Care Claim Payment/Advice (835) Companion Guide Version Number: 2.0 February 2018 Page 1 of 13 CHANGE
More informationANSI ASC X12N 277P Pending Remittance
ANSI ASC X12N 277P Pending Remittance Acute Care COMPANION GUE For Non-covered Transactions April 29, 2016 Texas Medicaid & Healthcare Partnership Page 1 of 19 Revision Date: 5/5/2016 Table of Contents
More informationUSVI HEALTH CARE CLAIM 837 Companion Guide. Version 0.1 February 6, 2013
USVI HEALTH CARE CLAIM 837 Companion Version 0.1 February 6, 2013 Table of Contents 1.0 COMPANION GUE PURPOSE... 4 2.0 ATYPICAL PROVERS... 4 3.0 CONTROL STRUCTURE DEFINITIONS... 5 3.1 ISA - INTERCHANGE
More informationRefers to the Technical Reports Type 3 Based on ASC X12 version X279A1
HIPAA Transaction Standard Companion Guide Refers to the Technical Reports Type 3 Based on ASC X12 version 005010X279A1 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide Version
More informationStandard Companion Guide for the Vision Business Segment
Standard Companion for the Vision Business Segment Refers to the Implementation Based on ASC X12N/005010X221A1 Health Care Claim Payment/Advice (835) Companion Version Number: 1.3 January-2018 This material
More information837I Institutional Health Care Claim - for Encounters
Companion Document 837I - Encounters 837I Institutional Health Care Claim - for Encounters Basic Instructions This section provides information to help you prepare for the ANSI ASC X12N 837 Health Care
More informationHIPAA Transaction Health Care Claim Payment/Advice Standard Companion Guide (835, X221A1)
(underwritten by Dean Health Plan) HIPAA Transaction Health Care Claim Payment/Advice Standard Companion Guide (835, 005010X221A1) Instructions related to Transactions based on ASC X12 Implementation Guides,
More informationKyHealth Choices MMIS Batch Health Care Dental Health Care Claim and Encounter Claims (837D) Companion Guide Version 2.0 Version X097A1
KyHealth Choices MMIS Batch Health Care Dental Health Care Claim and Encounter Claims (837D) Companion Guide Version 2.0 Version 004010 X097A1 Cabinet for Health and Family Services Department for Medicaid
More information814 General Request, Response or Confirmation
814 General Request, Response or Confirmation Introduction: Functional Group ID=GE This Draft Standard for Trial Use contains the format and establishes the data contents of the General Request, Response
More informationSeg Loop Name TR3 Values Notes Delimiter: Data Element. (:) Colon Separator
Companion Guide for the 005010X223A1 Health Care Claim: Institutional (837I) Lines of Business: Private Business, 65C Plus, QUEST, Blue Card, FEP, Away From Home Care Delimiter: Data Element (*) Asterisk
More information835 Health Care Claim Payment/ Advice Companion Guide
835 Health Care Claim Payment/ Advice Companion Guide Standard Companion Guide Transaction Information Instructions related to Transactions based on ASC X12 Implementation Guides, version 005010 Companion
More informationKyHealth Choices MMIS Batch Health Care Institutional Health Care Claim and Encounter Claims (837I) Companion Guide Version 3.0 Version X096A1
KyHealth Choices MMIS Batch Health Care Institutional Health Care Claim and Encounter Claims (837I) Companion Guide Version 3.0 Version 004010 X096A1 Cabinet for Health and Family Services Department for
More informationPurpose of the 837 Health Care Claim: Professional
Oklahoma Medicaid Management Information System Interface Specifications 837 Professional Health Care Claim HIPAA Guidelines for Electronic Transactions Companion Document The following is intended to
More information835 Health Care Claim Payment / Advice
Companion Document 835 835 Health Care Claim Payment / Advice This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not
More information835 Health Care Claim Payment / Advice
Companion Document 835 835 Health Care Claim Payment / Advice This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not
More information835 Health Care Claim Payment / Advice
Companion Document 835 835 Health Care Claim Payment / Advice This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not
More information834 Benefit Enrollment and Maintenance
Companion Document 834 834 Benefit Enrollment and Maintenance This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not
More informationBenefit Enrollment and Maintenance
004010X095 834 BENEFIT ENROLLMENT AND MAINTENANCE National Electronic Data Interchange Transaction Set Implementation Guide Benefit Enrollment and Maintenance 834 ASC X12N 834 (004010X095) May 2000 MAY
More informationAppendix 3B. Crosswalk from Retired Minimum Data Element List to Appendix 3A MA Companion Guide
Appendix 3B. Crosswalk from Retired Minimum Data Element List to Appendix 3A MA A3B.1 LOOPS AND SEGMENTS APPLIED TO EDR AND CRR SUBMISSIONS... 3 A3B.2 COLUMN HEADING CROSSWALK FROM APPENDIX 3A MA COMPANION
More informationCREDIT CARD BULK PROVIDER REQUIREMENTS
CREDIT CARD BULK PROVIDER REQUIREMENTS 1 Nature of Changes Date/Version Page Paragraph Change Description 3/13/2012 v0 76-81, Annual Updates 115 3/13/2012 v0 64, 65, Added table footnotes 73, 82 3/13/2012
More informationStandard Companion Guide
Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 005010X221A1 Health Care Claim Payment/Advice (835) Companion Guide Version Number: 1.0 December 17, 2013 1 Change Log Version
More informationCompanion Guide for the X223A2 Health Care Claim: Institutional (837I) Lines of Business: Private Business Senior Plans QUEST Blue Card FEP AFHC
Companion Guide for the 005010X223A2 Health Care Claim: Institutional (837I) Lines of Business: Private Business Senior Plans QUEST Blue Card FEP AFHC Segment Loop Name TR3 Values Notes Delimiter: Data
More informationHP SYSTEMS UNIT. Companion Guide: 270/271 Eligibility Benefit Transaction
HP SYSTEMS UNIT I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Companion Guide: 270/271 Eligibility L I B R A R Y R E F E R E N C E N U M B E R : C L E L 1 0 0 1 2 A S C X 1 2 N 2 7 0 / 2 7
More informationVendor Specifications 837 Professional Claim ASC X12N Version for. State of Idaho MMIS
Vendor Specifications 837 Professional Claim ASC X12N Version 5010 for State of Idaho MMIS Date of Publication: 12/8/2017 Document Number: TL427 Version: 11.0 Revision History Versio Date Author Action/Summary
More information837I Institutional Health Care Claim
Section 2B 837I Institutional Health Care Claim Companion Document Basic Instructions This section provides information to help you prepare for the ANSI ASC X12N 837 Health Care transaction for Institutional
More information835 Payment Advice NPI Dual Receipt
Chapter 5 NPI Dual Receipt This Companion Document explains the from Anthem Blue Cross and Blue Shield (Anthem) during the 835 National Provider Identifier (NPI) Dual Receipt period. The ANSI ASC X12N,
More informationVendor Specifications 834 Outbound Benefit Enrollment and Maintenance ASC X12N Version 5010A1. for. State of Idaho MMIS
Vendor Specifications 834 Outbound Benefit Enrollment and Maintenance ASC X12N Version 5010A1 for State of Idaho MMIS Date of Publication: 7/31/2017 Document Number: TL421 Version: 5.0 Revision History
More informationVendor Specifications 278 Healthcare Services Request for Review and Response ASC X12N Version for. State of Idaho MMIS
Vendor Specifications 278 Healthcare Services uest for Review and Response ASC X12N Version 5010 for State of Idaho MMIS Date of Publication: 07/25/2017 Document Number: TL418 Version: 5.0 Revision History
More informationHIPAA 837I (Institutional) Companion Guide
Companion Guide Prepared for Health Care Providers For use with the Cardinal Innovations claims processing system Version 5.0 January 2011 Table of Contents 1. Introduction...3 2. Approval Procedures...4
More informationCommonwealth of Virginia (State Programs) 834 Benefit Enrollment and Maintenance: Audit File
Sample: ISA*00* *00* *30*54-6024817 *30*99-9999999 *050503*1436*U*00401*100000411*0*P*~ GS*BE*COMMW VIRGINIA*99-9999999*20050503*053645*50320059*X*004010X095A1~ ST*834*1001~ BGN*00*125839*20050503*053645*ET***4~
More information10/2010 Health Care Claim: Professional - 837
837 Health Care Claim: Professional HIPAA/V4010X098A1/837: 837 Health Care Claim: Professional Version: 1.8 Update 10/20/10 (Latest Changes in RED font) Author: Publication: EDI Department LA Medicaid
More informationEarly Intervention Central Billing Office. Companion Document and Transaction Specifications for HIPAA 837 Claim Transactions
Early Intervention Central Billing Office Companion Document and Transaction Specifications for HIPAA 837 Claim Transactions Version 1.0 - January 2012 Table of Contents 1. Introduction... 1 1.1 Document
More information834 Benefit Enrollment and Maintenance
Companion Document 834 834 Benefit Enrollment and Maintenance Basic Instructions This section provides information to help you prepare for the ANSI ASC X12.84, Benefit Enrollment and Maintenance (834)
More informationVendor Specifications 837 Institutional Claim ASC X12N Version X223A2. for. State of Idaho MMIS
Vendor Specifications 837 Institutional Claim ASC X12N Version 005010X223A2 for State of Idaho MMIS Date of Publication: 6/16/2016 Document Number: TL426 Version: 8.0 Revision History Version Date Author
More information837 Health Care Claim: Professional HIPAA/V4010X098A1/837: 837 Health Care Claim: Professional Version: 1.3 Update 06/17/04
837 Health Care Claim: Professional HIPAA/V4010X098A1/837: 837 Health Care Claim: Professional Version: 1.3 Update 06/17/04 Author: Publication: EDI Department LA Medicaid Companion Guide The purpose of
More informationGeisinger Health Plan
Geisinger Health Plan Companion Guide for the 834 Benefit Enrollment and Maintenance Refers to the Implementation Guides Based on X12 version 005010X220 Version Number: 1.01 Revised, October 28, 2010 1
More informationEDS SYSTEMS UNIT. Pre-Release Companion Guide: 270/271 Eligibility Benefit Transaction
EDS SYSTEMS UNIT I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Pre-Release Companion Guide: 270/271 Eligibility Benefit Transaction L I B R A R Y R E F E R E N C E N U M B E R : C L E L 1 0
More information837I Inbound Companion Guide
837I Inbound Companion Institutional Claim Submission Version 2.2 Table of Contents REVISION HISTORY...3 SECTION 01: INTRODUCTION...4 Overview...4 Data Flow...5 Processing Assumptions...5 Basic Technical...6
More information837 Professional Health Care Claim - Outbound
Companion Document 837P 837 Professional Health Care Claim - Outbound Basic Instructions This section provides information to help you prepare for the ANSI ASC X12N 837 Health Care transaction for professional
More informationFarmers Group, Inc. Implementation Standards for EDI Documents
Farmers Group, Inc Implementation Standards for EDI Documents ASC X12 Transaction Set 811 Version 3050 Consolidated Service Invoice/Statement Daily Auto Notification/Billing Created 10/04/2005 Revised
More informationCareOregon (Remittance Advice) Information Guide
CareOregon 5010 835 (Remittance Advice) Information Guide This document is not intended as a comprehensive 5010 companion guide. The objectives of this document are: 1. To clarify what information is needed
More information837 Health Care Claim: Institutional
837 Health Care Claim: Institutional HIPAA/V4010X096A1/837: 837 Health Care Claim: Institutional Version: Final Modified: 11/29/2006 Current: 11/29/2006 837I4010a1.ecs 1 For internal use only 837I4010a1.ecs
More information837 Institutional Health Care Claim. Section 1 837I Institutional Health Care Claim: Basic Instructions
Companion Document 837I This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained
More information835 Health Care Claim Payment/Advice
Companion Document 835 835 Health Care Claim Payment/Advice Basic Instructions This section provides information to help you prepare for the ANSI ASC X12 Health Care Claim Payment/Advice (835) transaction.
More informationBlue Cross Blue Shield of Arizona HIPAA Version 5010 Companion Guide
An Independent Licensee of the Blue Cross Blue Shield Association Blue Cross Blue Shield of Arizona HIPAA Version 5010 Companion Guide September 2010 2010 Blue Cross Blue Shield of Arizona, Inc. All rights
More informationAppendix 3A. MA Companion Guide: CMS Supplemental Instructions for EDR and CRR Data Elements
Appendix 3A. MA Companion Guide: CMS Supplemental Instructions for EDR and CRR Data s A3A.1 LOOPS AND SEGMENTS APPLIED TO EDR AND CRR SUBMISSIONS... 3 A3A.2 CONTROL SEGMENTS: CMS SUPPLEMENTAL INSTRUCTIONS
More informationEyeMed Vision Care. CLAIM PAYMENT Companion Document to ASC X12N 835 (004010X091A1)
CLAIM PAYMENT Companion Document to ASC X12N 835 (004010X091A1) Welcome to EyeMed Vision Care s HIPAA TCS implementation process. We have developed this guide to assist you in preparing to trade HIPAA
More informationTexas Medicaid. HIPAA Transaction Standard Companion Guide
Texas Medicaid HIPAA Transaction Standard Companion Guide Refers to the Implementation Guide Acute Care 835 Health Care Claim Payment/Advice Based on ASC X12 version 005010 CORE v5010 Companion Guide August
More information837 PROFESSIONAL CLAIMS AND ENCOUNTERS TRANSACTION COMPANION GUIDE
837 PROFESSIONAL CLAIMS AND ENCOUNTERS TRANSACTION COMPANION GUIDE JULY 23, 2015 A S C X 1 2 N 8 3 7 (0 0 5 0 10 X 222A1) VERSION 2 TABLE OF CONTENTS 1.0 Background 3 1.1 Overview 3 1.2 Introduction 4
More informationEyeMed Vision Care. BENEFIT ENROLLMENT AND MAINTENANCE Companion Document to ASC X12N 834 (004010X095A1)
BENEFIT ENROLLMENT AND MAINTENANCE Companion Document to ASC X12N 834 (004010X095A1) Welcome to EyeMed Vision Care s HIPAA TCS implementation process. We have developed this guide to assist you in preparing
More informationCompanion Guide for the X222A1 Health Care Claim: Professional (837P) Lines of Business: Private Business Senior Plans QUEST Blue Card FEP AFHC
Companion Guide for the 005010X222A1 Health Care Claim: Professional (837P) Lines of Business: Private Business Senior Plans QUEST Blue Card FEP AFHC Segment Loop Description TR3 Values Notes Delimiter:
More informationHealth Care Claim: Institutional (837)
Health Care Claim: Institutional (837) Standard Companion Guide Transaction Information November 2, 2015 Version 3.1 Express permission to use ASC X12 copyrighted materials within this document has been
More information837 Institutional Health Care Claim. Section 1 837I Institutional Health Care Claim: Basic Instructions
Companion Document 837I This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained
More informationBlue Shield of California
Blue Shield of California HIPAA Transaction Standard Companion Guide Section 1 Refers to the Implementation Guides Based on X12 version 005010 Companion Guide Version Number: 1.9 February, 2018 [February
More information834 Template 1 of 16. Comments and Additional. Info
834 Template 1 of 16 HDR Header (not really a loop) Reference ISA 1 M Required ISA Interchange Control Header R M The ISA is a fixed record length segment and all positions within each of the data elements
More informationEyeMed Vision Care. HEALTH CARE CLAIM: PROFESSIONAL Companion Document to ASC X12N 837 (004010X098A1)
HEALTH CARE CLAIM: PROFESSIONAL Companion Document to ASC X12N 837 (004010X098A1) Welcome to EyeMed Vision Care s HIPAA TCS implementation process. We have developed this guide to assist you in preparing
More informationUSER'S GUIDE ELECTRONIC DATA INTERFACE 834 TRANSACTION. Capital BlueCross EDI Operations
ELECTRONIC DATA INTERFACE 834 TRANSACTION Capital BlueCross EDI Operations USER'S GUIDE Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage
More informationEDS SYSTEMS UNIT. Companion Guide: 837 Institutional Claims and Encounters Transaction
EDS SYSTEMS UNIT I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Companion Guide: 837 Institutional Claims and Encounters Transaction L I B R A R Y R E F E R E N C E N U M B E R : C L E L 1 0
More informationADJ. SYSTEM FLD LEN. Min. Max.
Loop Loop Repeat Segme nt Element Id Description X12 Page No. ID Min. Max. ADJ. SYSTEM FLD LEN Usage Req. ANSI VALUES COMMENTS 1 ISA Interchange Control Header B.3 1 R ISA08 Interchange Receiver ID AN
More information13. IEHP P PROFESSIONAL CLAIM COMPANION GUIDE A. Included ASC X12 Implementation Guides X222A1 Health Care Claim: Professional
13. IEHP 5010 837P PROFESSIONAL CLAIM COMPANION GUIDE 1. 005010X222A1 Health Care Claim: Professional Standard Companion Guide (CG) Transaction Information Effective January 1, 2018 IEHP Instructions related
More information837 Professional Health Care Claim Outbound. Section 1 837P Professional Health Care Claim: Basic Instructions
Companion Document 837P 837 Professional Health Care Claim Outbound This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and
More information(Delaware business only) HIPAA Transaction Standard Companion Guide
AmeriHealth (Delaware business only) HIPAA Transaction Standard Companion Guide Refers to the Implementation Guides Based on ASC X12 Implementation Guides, version 005010 June 2016 June 2016 005010 v1.3
More information837 Institutional Health Care Claim. Section 1 837I Institutional Health Care Claim: Basic Instructions
Companion Document 837I This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained
More informationPersonal Health Record Data Transfer Between Health Plans (275)
005010271 Based on ASC 12 275, Version 005010 Standards for Electronic Data Interchange Personal Health Record Data Transfer Between Health Plans (275) VERSION 3.1.4 BASED ON ASC 12 275 VERSION 005010
More informationIndiana Health Coverage Programs
Indiana Health Coverage Programs Standard Companion Guide Transaction Information Instructions related to Transactions based on ASC X12 Implementation Guides, version 005010 Group Premium Payment for Insurance
More informationTax. Third (TPP. d Party. Payments 7/29/2013. All Rights Reserved
Third d Party Tax Payments (TPP P) Banking Convention Standardized Formatting for Remittance Information in Third Party Tax Paymen nt Addenda Record 7/29/2013 2013 National Automated Clearing Housee Association
More information837 Institutional Health Care Claim. Section 1 837I Institutional Health Care Claim: Basic Instructions
Companion Document 837I This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained
More information837 PROFESSIONAL CLAIMS AND ENCOUNTERS TRANSACTION COMPANION GUIDE
837 PROFESSIONAL CLAIMS AND ENCOUNTERS TRANSACTION COMPANION GUIDE JUNE 22, 2011 A S C X 1 2 N 8 3 7 (0 0 5 0 10 X 222A1) VERSION 1 TABLE OF CONTENTS 1.0 Background 3 1.1 Overview 3 1.2 Introduction 4
More information834 Benefit Enrollment and Maintenance 5010 Companion Guide
834 Benefit Enrollment and Maintenance 5010 Companion Guide HIPAA/V5010220A1/834 Version 1.3 Company: Blue Cross of Idaho Created 5/29/2013 Updated 1/21/2016 An Independent Licensee of the Blue Cross and
More informationTexas Medicaid. HIPAA Transaction Standard Companion Guide
Texas Medicaid HIPAA Transaction Standard Companion Guide Refers to the Implementation Guide Long Term Care 837 Health Care Claim: Institutional Based on ASC X12 version 005010 CORE v5010 Companion Guide
More informationGeisinger Health Plan
Geisinger Health Plan Companion Guide for the 835 Health Care Claim Payment Advice Refers to the Implementation Guides Based on X12 version 005010X221A1 Version Number: 2.00 Revised: December 31, 2013
More information- - - Virginia. Implementation Standard. For Electronic Data Interchange. March 21, 2003 Open Access Version 2.3
Virginia Implementation Standard For Electronic Data Interchange - - - TRANSACTION SET 814 Reinstatement Request and Response Ver/Rel 004010 VA 814 Reinstatement 1 814r-stan2-3.doc August 27, 2001 Version
More informationTax Payment (TXP) Banking Convention
Tax Payment (TXP) Banking Convention A Guide for Formatting Electronic Tax Payments NACHA s Banker s EDI Council Revised December 2012 1996, revised 2012 National Automated Clearing House Association 13450
More informationStandard Companion Guide
Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 005010X279A1 Eligibility Inquiry and Response (270/271) Companion Guide Version Number: 1.0 October 24, 2016 GE-WEB-0317-001
More informationemedny New York State Department of Health Office of Health Insurance Programs Pended Claims Report:
emedny New York State Department of Health Office of Health Insurance Programs Pended Claims Report: Specification Version: 1.2 Publication: 10/26/2016 Trading Partner: emedny NYSDOH 1 emedny Pended Claims
More informationPGW EDI Implementation Guideline
PGW EDI Implementation Guideline For Transaction Set 810 LDC (Rate Ready) Invoice X12 v4010 810 LDC Invoice Rev 1.5 February 4, 2016 Contents Revision Notes:... 3 810 LDC Invoice X12 Structure... 4 Segment:
More informationDelivery/Return Base Record UCS & X12
894 Heading: Delivery/Return Base Record 005010 UCS & X12 Functional Group=DX Delivery/Return Base Record - 894 Pos Id Segment Name Req Max Use Repeat Notes Usage 0200 G82 Delivery/Return Base Record M
More information837 Institutional Health Care Claim Outbound. Section 1 837I Institutional Health Care Claim: Basic Instructions
Companion Document 837I This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained
More information5010 Upcoming Changes: Response Transaction. Based on Version 5, Release 1 ASC X12N X212
HP Systems Unit I N D I A N A H E A L T H C O V E R A G E P R O G R A M S 5010 Upcoming Changes: 276/277 Claim Status Request and Response Transaction Based on Version 5, Release 1 ASC X12N 005010X212
More informationNPI Utilization in Healthcare EFT Transactions March 5, 2012
WEDI Strategic National Implementation Process (SNIP) WEDI SNIP Transactions Workgroup EFT Subworkgroup EFT NPI Utilization Issue Brief NPI Utilization in Healthcare EFT Transactions March 5, 2012 Workgroup
More information