Standard Companion Guide Transaction Information. 820 Healthcare Insurance MHBE Related Payments

Transcription

1 A service of the Maryland Health Benefit Exchange tandard Companion Guide Transaction Information 820 Healthcare Insurance MHBE elated Payments Instructions related to the AC X12 Healthcare Insurance elated Payments Transaction, based on the X306 Implementation Guide and its associated X306 addenda Version: 1.3 Companion Guide Version: 1.3 July 24, 2013

2 PEFACE Maryland Health Benefit Exchange This Companion Guide to the v5010 Accredited tandards Committee (AC) X12N Implementation Guides and associated errata adopted under Health Insurance Portability and Accountability Act (HIPAA) clarifies and specifies the data content when exchanging electronically. Transmissions based on this companion guide, used in tandem with the v5010 AC X12N Implementation Guides, are compliant with both AC X12 syntax and those guides. This Companion Guide is intended to convey information that is within the framework of the AC X12N Implementation Guides adopted for use under HIPAA. The Companion Guide is not intended to convey information that in any way exceeds the requirements or usages of data expressed in the Implementation Guides. This Companion Guide is based on, and must be used in conjunction with, the AC X12 X12N/005010X306 The Companion Guide clarifies and specifies specific transmission requirements for exchanging data. The instructions in this companion guide conform to the requirements of the T3, AC X12 syntax and semantic rules and the AC X12 Fair Use equirements. In case of any conflict between this Companion Guide and the instructions in the T3, the T3 takes precedence. 820 Companion Guide i

3 Disclaimer Companion guides (CG) are documents created to supplement AC X12 Type 3 Technical eports (T3). T3s, commonly known as Implementation Guides (IG), define the data content and format for specific business purposes. This CG was created for distribution to health care issuers, clearinghouses, and software vendors. The instructions in this CG are not intended to be stand-alone requirements, the CG must be used in conjunction with the AC X12/005010X306 Healthcare Insurance Exchange elated Payments (820) T3 and any associated Addenda. AC X12 T3s are copyrighted documents and may be purchased at Companion Guide ii

4 TABLE OF CONTENT 1 OTHE EOUCE GETTING TATED TADING PATNE POFILE TETING TETING OVEVIEW TETING POCE Connectivity: TMIION PECIFIC Delimiters: Control Numbers: Processing Capabilities: File ejection easons: CONTACT INFOMATION PAYMENT (820) PECIFIC BUINE ULE D LIMITATION POLICY LEVEL PAYMENT, INDIVUAL INFOMATION INCLUDED POGAM LEVEL PAYMENT, NO INDIVUAL INFOMATION INCLUDED EMITTCE DETAIL ITEATION FO POGAM LEVEL PAYMENT COMBINATION NET ZEO PAYMENT NET POITIVE PAYMENT NET NEGATIVE PAYMENT PAYMENT CODE INUCE PAYMENT (820) TACTION FLOW MHBE TO QHP IUE 820 TACTION FLOW ACKNOWLEDGEMENT MONTHLY ECONCILIATION FILE POCEE...25 Proposed Payment econciliation Process ACONYM/GLOAY CHGE UMMAY Companion Guide iii

5 820 Companion Guide iv

6 1 OTHE EOUCE The Websites provided in Table 1 contain additional information and documentation for adopted Electronic Data Interchange (EDI) transactions and code sets. Table 1: Exchange Payment Other esources AC X12 T3 Implementation eguides Washington Publishing Company Health Care Code ets To request changes to HIPAA adopted standards Web Addr 11/401/ Companion Guide 5

7 2 GETTING TATED In order to send and/or receive transactions, trading Partners (clearinghouses, qualified health plan issuers (QHP issuers) must complete a trading partner agreement, exchange profile information and establish connectivity. The following sections outline the steps 2.1 TADING PATNE POFILE Establishing a Trading Partner Profile is a simple process, the Trading Partner completes and signs a Trading Partner Agreement form and submits it to the MHBE for processing. Electronic Data Interchange (EDI) interface should be set up and tested with the Trading Partner. The first step that the MHBE will take is to establish Trading Partner Profile(s). MHBE team will configure a test profile for one or more EDI interfaces with the Trading Partner. A Trading Partner with multiple data centers must acquire multiple Trading Partner Profiles. Once the EDI interface(s) have been successfully tested, MHBE team will notify the MHBE to open the Trading Partner s Qualified Health Plan (QHP) for enrollment and will switch the Trading Partner Profile to a production status. 820 Companion Guide 6

8 3 TETING yntax Integrity and yntax equirement specifications must be met in order for 820 transactions to be processed in a production mode. MHBE team will work with Trading Partners (clearinghouses, QHP Issuers and BEs) throughout the testing process. 3.1 TETING OVEVIEW Testing is conducted to ensure compliance with HIPAA guidelines as related to: yntactical integrity: EDI files must pass verification checks related to valid segment use, segment order, element attributes, proper transmission of numeric values, validation of AC X12 syntax, and compliance with AC X12 rules. yntactical requirements: EDI files must be validated for compliance with HIPAA Implementation Guide-specific syntax requirements, such as limits on repeat counts and the use of qualifiers, codes, elements and segments. Testing will also verify intra-segment situational data elements, non-medical code sets and that values and codes are used according to the Implementation Guide instructions. It s important to know additional testing may be required when the system is upgraded, when business requirements change, or when new versions of the AC X implementation guide are implemented. 3.2 TETING POCE Trading Partners may call MHBE via the Contact Information ection below for help at any point in the testing process outlined below. 1. The Trading Partner downloads the 820 Companion Guides and Trading Partner Payment package from [UL]. 2. The Trading Partner completes and signs the Trading Partner Agreement and submits the signed agreement to MHBE 3. MHBE coordinates the linkage between the Trading Partner ubmitter Identifier, User Logon Identifier and password and notifies the Trading Partner. 4. MHBE provides a limited number of initial test files to the Trading Partner for processing. The Trading Partner downloads the files via ecure File Transfer Protocol (FTP). 5. The Trading Partner processes the files through their validation process and reports any failure via acknowledgement transaction. 6. If all the test files pass cleanly through the validation process, the Trading Partner submits a confirmation 820 to MHBE via [FTP]. 7. MHBE validates the confirmation 820 and reports any issues via an acknowledgement transaction. 8. If the confirmation 820 is successfully validated, the test is considered successful and the trading partner is approved to begin processing in the production environment. 820 Companion Guide 7

9 9. If issues or errors are identified in steps 4, 5, 6 or 7, the test is not considered successful and MHBE and Trading Partner work together until the issues are resolved and a successful test is completed Connectivity: Trading Partners will connect to MHBE s FTP server for all EDI transactions (enrollment, acknowledgement, payment, etc.) via the [File Transfer (EFT) system] which is a batch system. eal-time transmissions are not available at this time. Each Trading Partner is assigned a ubmitter Identifier in the EFT system which allows access to an Inbox and an Outbox. The Trading Partner and MHBE will use these folders to pick up and drop off data files. Detailed information on the requirements for and the use of the Inbox and Outbox folder can be found in the carrier implementation guide. The guide can be downloaded from [location] 3.3 TMIION PECIFIC Delimiters: MHBE is not establishing a requirement or preference for delimiters on inbound transactions. ee Table B.5 in Appendix B of the T3 for AC X12 s requirements related to delimiters Control Numbers: MHBE is not establishing specific requirements for the IA, G and T control numbers, other than a rule that at least one of the control numbers must increment from one day to the next. However, since the AC X12C X231 Implementation Acknowledgement for Health Care Insurance (999) transaction does not reflect the IA control number, we strongly recommend that one or both of the G and T control numbers increment from day to day Processing Capabilities: MHBE can accept multiple: ubmissions in one day. IA-IEA envelopes within a single physical file. G-GE envelopes within a single IA-IEA interchange. T-E envelopes within a single G-GE functional group File ejection easons: File ejection easons: 820 Companion Guide 8

10 The entire submission will be rejected in the following situations: ubmission of data that is not valid based on the T3. ubmission of a segment or data element specified in the T3 as Not Used. ubmission of non-unique values in the T02 or G06 Control Number elements. 820 Companion Guide 9

11 4 CONTACT INFOMATION Trading Partners that need to interact with customer support shall be able to contact the [Name of Customer upport] at the following number and address: Telephone: TBD TBD 820 Companion Guide 10

12 5 PAYMENT (820) Table Notes: Under the [HIX Information] section of the table below, the columns labeled Min/Max, Usage and Acceptable Values = Definition, all define what the [HIX Information] will be using for processing. There may be a difference in the Usage of the item documented and the same item in the HIPAA X306, in such case, the [HIX Information] prevails as long as it does not conflict with the T3. Any data element who s Usage is NCFP, is Not Considered for Processing. The meaning of NCFP is that the sender may send the data, but the [HIX Information] will not use or save the data X306 Health Care Insurance Exchange elated Payments (820) egments and Data Elements [HIX Information ] Element Identifier Description Loop Min/Max Usage Acceptable Values = Definition Comment IA - INTECHGE CONTOL HEADE IA IA01 IA02 IA03 INTECHGE CONTOL HEADE Authorization Information Qualifier Authorization Information ecurity Information Qualifier HD 1 N/A = No authorization required paces = No Authorization Present IA04 ecurity Information paces IA05 IA06 IA07 Interchange Qualifier Interchange ender Interchange Qualifier 2-2 ZZ = Mutually Defined HIX01cccccccccc HIX concatenated with the state name. Must be fixed length, padded with spaces. Document in Trading Partner Agreement ZZ = Mutually Defined 820 Companion Guide 11

13 X306 Health Care Insurance Exchange elated Payments (820) egments and Data Elements [HIX Information ] Element Identifier IA08 Description Loop Min/Max Usage Acceptable Values = Definition Comment Interchange eceiver IUEccccccccc IUE concatenated with an supplied by the issuer. Must be 15 in length and padded with spaces.. Document in Trading Partner Agreement IA09 Interchange Date DT 6-6 YYMMDD IA10 Interchange Time TM 4-4 HHMM IA11 epetition eparator ^ IA12 IA13 Interchange Control Version Number Interchange Control Number = tandards Approved for publication by AC X12 procedures eview Board through October 2003 NO 9-9 Unique 9-digit number with leading zeroes. tarted at and incremented by 1 for each successive Interchange from ender to eceiver, and not reset to starting value of within each Transmission or day. IA14 Acknowledgement equested 1-1 1= Interchange Acknowledgement equested (TA1) We are requesting TA1 files. There is no current requirement by the exchange that they be sent by the carrier, but they may be required in the future IA15 Usage Indicator 1-1 P = Production Data T = Test Data IA16 Component Element eparator 1-1 : 820 Companion Guide 12

14 X306 Health Care Insurance Exchange elated Payments (820) egments and Data Elements [HIX Information ] Element Identifier Description Loop Min/Max Usage Acceptable Values = Definition Comment G Functional Group Header G G01 G02 G03 Functional Group Header Functional Identifier Code Application ender's Code Application eceiver's Code - HD A = Payment Order/ emittance Advice (820) 2-15 MHBE will send the same value as IA MHBE will send the same value as IA08 G04 Date DT 8-8 CCYYMMDD CUENT-DATE Creation G05 Time TM 4-8 HHMM CUENT-TIME G06 G07 Group Control Number esponsible Agency Code NO 1-9 DDDnnnnnn MHBE will send only one G per File. This number should be unique for a given year. It will be the Julian day plus sequence number to allow for multiple files per day. 1-2 X = Accredited tandards Committee X12 G08 Header Version Identifier Code X306 T TACTION ET HEADE HD 1 T01 Transaction et Identifier Code = Payment Order / emittance Advice Benefit payment T02 T03 Transaction et Control Number Implementation Convention eference 4-9 nnnn The value starts at 0001 and increments for each successive T-E loop X306 BP Financial Information HD Companion Guide 13

15 X306 Health Care Insurance Exchange elated Payments (820) egments and Data Elements [HIX Information ] Element Identifier Description Loop Min/Max Usage Acceptable Values = Definition Comment BP01 Transaction Handling Code 1-2 I = emittance Information only 1-18 The total amount paid by this 820. Maximum length is 11 characters, including decimal BP02 Total Premium Payment Amount A zero dollar amount indicates that this transaction is being used for reporting or nonpayment data BP03 Credit or Debit Flag code 1-1 BP04 Payment Method Code 3-3 ACH = Automated Clearing House BP05 Payment format Code 1-10 CCP = Cash Concentration/Disbursement plus Addenda This will be CCP when payment was made by ACH. The TN segment will be copied into the CCD+ addenda record. This will be blank for noncash payment 820s BP06 Identification Number Qualifier 0 N/U 0 BP07 Originating DFI Identifier N/U BP08 Count Number Qualifier 0 N/U BP09 ender Bank Account Number 0 N/U BP10 Originating company Identifier 0 N/U BP11 Originating Company upplemental Code 0 N/U = ABA Transit outing Number Including Check Digits If Payment Method is ACH, this will be populated with 01 BP12 Identification Number Qualifier This will be blank for non-cash transfers 820 Companion Guide 14

16 X306 Health Care Insurance Exchange elated Payments (820) egments and Data Elements [HIX Information ] Element Identifier Description Loop Min/Max Usage Acceptable Values = Definition Comment BP13 eceiving DFI Identifier 3-12 This will be the routing number for the bank account into which the funds were sent. This element will be blank if BP12 is not sent BP14 Account Number Qualifier 1-3 DA = Demand Deposit BP15 eceiver Bank Account Number 1-35 This is the account number into which funds were sent. This element will be blank if BP12 is not sent BP16 Date DT 8-8 CCYYMMDD Date Paid TN EAOCIATION TACE NUMBE HD TN01 Trace Type code = Financial e-association Trace Number TN02 Check of EFT Trace Number 1-50 For EFT (ACH) this is a unique number created by the HIX that was sent in the ACH file, and will be used by the Issuer to match this 820 payment to the ACH dollars received. For ACH, in the CCD entry detail record, populate field 7 "Identification Number" with a unique number composed of Julian date plus 12 digit sequence number Loop Id 1000A PAYEE NAME (Loop epeat: 1) N1 Payee Name 1000A 1 N101 Entity Code Identifier PE = Payee N102 Information eceiver Last or Organization Name 1-60 Health Plan Name N103 Identification Code Qualifier 1-2 FI = Federal Taxpayer s Identification Number 820 Companion Guide 15

17 X306 Health Care Insurance Exchange elated Payments (820) egments and Data Elements [HIX Information ] Element Identifier Description Loop Min/Max Usage Acceptable Values = Definition Comment N104 Identification Code EF EF01 Unique Health Plan 1000A eference Identification Qualifier EF02 eference Identifier ABY = Centers for Medicare and Medicaid ervices Plan Payee s TAX Centers for Medicare and Medicaid ervices Plan Unique Health Plan Loop Id 1000B - PAYE NAME (Loop epeat: 1) N1 Payer s Name - N101 Entity Identifier Code N102 Name N103 Identification Code Qualifier N104 Identification Code PE PE01 PAYE' ADMINITATIVE CONTACT Contact Function Code PE02 Name PE03 PE04 PE05 PE06 PE07 PE08 Communication Number Qualifier Communication Number Communication Number Qualifier Communication Number Communication Number Qualifier Communication Number 1000B B > Loop Id 2000 EMITTCE INFOMATION (Loop epeat: >1) M = Party that remits payment [exchange Name] Payer Name 58 = Operating Company Qualifier Originating Company IC = Information Contract TE = Telephone EM = Electronic Mail FX = Facsimile If MHBE is making the payment, use the value in IA06. We will always send one contact Contact Person Telephone number, 10 digits only Contact Address Contact Fax 820 Companion Guide 16

18 X306 Health Care Insurance Exchange elated Payments (820) egments and Data Elements [HIX Information ] Element Identifier Description Loop Min/Max Usage Acceptable Values = Definition Comment ENT INDIVUAL EMITTCE ENT01 Assigned Number N0 Loop 2100 Individual Name (Loop epeat 1) tart with 1 and then INCEMENT BY 1 for each loop sent NM1 INDIVUAL NAME NM101 Entity Identifier Code IL = Insured or ubscriber NM102 Entity Type Qualifier = Person NM103 Name Last or Organization Name 1-60 ecipient Last Name NM104 Individual First Name 1-35 ecipient First Name NM105 Individual Middle Name 1-25 ecipient Middle Initial NM106 Individual Name Prefix 1-10 NCFP NM107 Individual Name uffix 1-10 ecipient uffix NM108 Identification Code Qualifier 1-2 C1 = Insured or ubscriber NM109 Individual Identifier 2-80 Exchange Assigned ubscriber EF Exchange Assigned QHP This will always be sent EF01 eference Identification Qualifier 38= Master Policy Number Master Policy Number EF02 eference Identifier 1-50 HOI /QHP EF Issuer Assigned QHP EF01 eference Identification Qualifier TV = Line of Business Line of Business EF02 eference Identifier 1-50 HOI /QHP EF Exchange Assigned Employer/Group Will only be sent for HOP files EF01 eference Identification Qualifier 18 = Plan Number Plan Number 820 Companion Guide 17

19 X306 Health Care Insurance Exchange elated Payments (820) egments and Data Elements [HIX Information ] Element Identifier Description Loop Min/Max Usage Acceptable Values = Definition Comment EF02 eference Identifier 1-50 Exchange Assigned Employer Group EF Issuer Assigned Employer/Group EF01 eference Identification Qualifier 1L Group or Policy Number EF02 eference Identifier 1-50 IUE Assigned Employer Group EF Exchange Assigned Policy This will always be sent EF01 eference Identification Qualifier POL = Policy Number EF02 eference Identifier 1-50 Exchange Assigned Policy EF Issuer Assigned Policy EF01 eference Identification Qualifier AZ = Health Insurance Policy Number EF02 Premium eceiver eference Identifier 1-50 Issuer Assigned Policy EF Exchange Assigned APTC Contributor/Tax Payer EF01 eference Identification Qualifier 4A = Personal Identification Number (PIN) EF02 Premium eceiver eference Identifier 1-50 Exchange Assigned APTC EF Issuer Assigned APTC Contributor/Tax Payer EF01 eference Identification Qualifier 23 = Client Number EF02 Premium eceiver eference Identifier 1-50 Issuer Assigned APTC EF Exchange Assigned Dependent EF01 eference Identification Qualifier 6O = Cross eference Number ix oh 820 Companion Guide 18

20 X306 Health Care Insurance Exchange elated Payments (820) egments and Data Elements [HIX Information ] Element Identifier Description Loop Min/Max Usage Acceptable Values = Definition Comment EF02 Premium eceiver eference Identifier 1-50 Exchange Assigned Dependent EF Issuer Assigned Dependent EF01 eference Identification Qualifier 1W = Member Identification Number EF02 Premium eceiver eference Identifier Issuer Assigned Dependent EF Issuer Assigned ubscriber EF01 eference Identification Qualifier 0F = ubscriber Number Zero F EF02 Premium eceiver eference Identifier 1-50 Issuer Assigned ubscriber Loop Id 2300 INDIVUAL PEMIUM EMMITCE DETAIL (Loop epeat: >1) M EMMITCE DETAIL 2300 >1 M01 eference Identification Qualifier ZZ = Mutually Defined Exchange Payment Type M02 Exchange Payment Type 1-50 APTC, APTCADJ, APTCMADJ, BAL, C, CADJ, CMADJ, CN, CNADJ, DEBTADJ, FPLPNT, FPLPT, INVOICE, A, AADJ, AUF, AUFADJ, C, CADJ, EDUCED, IC, ICADJ, IP, IPADJ, UF, UFADJ, UFMADJ, COMM, COMMADJ, MF, MFADJ, INTPEM, MDCA, MDCAADJ, MIC, NONPAYADJ, OPMUF, OPMUFADJ, PEM, PEMALL, PEMADJ, PEMALLADJ, EFUND, ETUN, MD, MDADJ, TIBE, TPP, TIBEADJ, TPPADJ ( efer 6.8 for description of the codes) M03 Payment Action Code 0 N/U M04 Payment Amount 1-18 Payment Amount. Cannot be zero. Can be negative or positive only. DTM INDIVUAL COVEAGE PEIOD DTM01 Date Time Qualifier = eport Period 820 Companion Guide 19

21 X306 Health Care Insurance Exchange elated Payments (820) egments and Data Elements [HIX Information ] Element Identifier Description Loop Min/Max Usage Acceptable Values = Definition Comment DTM02 DTM03 DTM04 DTM05 Date Time Time Code Date Time Period Format Qualifier DTM06 Coverage Period E E01 E02 GE GE01 GE02 IEA IEA01 IEA02 Transaction et Trailer Number of Included egments Transaction et Control Number Functional Group Trailer Number of Transaction ets Included Group Control Number Interchange Control Header Number of Included Functional Groups Interchange Control Number HD 1 N/U N/U N/U D8 = ange of dates Expressed in Format CCYYMMDD-CCYYMMDD Coverage dates being paid for by this payment Coverage Period N end the number of included transaction segments including T-E 4-9 NNNN The value starts at 0001 and increments for each successive T-E loop - HD 1 N0 1-6 end the number of Transaction ets included N0 1-9 end value from G06 - HD 1 N0 1-5 end number of functional groups N0 9-9 end same value as IA Companion Guide 20

22 6 PECIFIC BUINE ULE D LIMITATION Maryland Health Benefit Exchange 6.1 POLICY LEVEL PAYMENT, INDIVUAL INFOMATION INCLUDED Detailed information about the subscriber will be included in the 820 transmission when portions of the payment can be directly attributed to the subscriber s policy information. In that situation, a 2100 Individual Name Loop will be transmitted within the 2000 emittance Information Loop. The 2100 Individual Name Loop will be followed by one or more 2300 emittance Detail Loop(s). 6.2 POGAM LEVEL PAYMENT, NO INDIVUAL INFOMATION INCLUDED If no detailed information on the subscriber is provided in the 820 transmission, the 2100 Individual Name Loop will not be included within the 2000 emittance Information Loop. Within the 2000 emittance Information Loop, there will be one or more 2300 emittance Detail Loop(s). 6.3 EMITTCE DETAIL ITEATION FO POGAM LEVEL PAYMENT A 2300 emittance Detail loop will be generated for each policy and program level Exchange Payment Type applicable to an 820 transaction. For illustrative purposes, a number of Exchange Payment Types are listed in the ection [X] detail. A limited number of Exchange Payment Types have been included to ensure that the sum of the remittance detail records for any given payment is greater than or equal to zero, examples include invoice and recoupment. When the sum of the specific component detail payments transmitted in 2300 emittance Detail Loops result in a negative total, additional 2300 loop(s) will be included to force the sum of the detail payment information to equal zero. 6.4 COMBINATION A singe 820 transaction may contain only Policy Level Payments, only Program Level Payments or both types of payments. 6.5 NET ZEO PAYMENT When the sum of the detail payment information transmitted in 2300 emittance Detail Loops is zero, no corresponding funds transfer will occur. 820 Companion Guide 21

23 6.6 NET POITIVE PAYMENT When the sum of the detail payment information transmitted in 2300 emittance Detail Loops is greater than zero, a corresponding funds transfer will occur. 6.7 NET NEGATIVE PAYMENT There will never be a net negative payment transaction transmitted to an issuer. The sum of the detail payment information transmitted in 2300 emittance Detail Loops will always be greater than or equal to zero. 6.8 PAYMENT CODE The list of Exchange Payment Type Codes are mentioned in the document below that will be included in the 2300 Loop M 02 egment. Payment_Codes.xlsx 820 Companion Guide 22

24 7 INUCE PAYMENT (820) TACTION FLOW 7.1 MHBE TO QHP IUE 820 TACTION FLOW 820 Companion Guide 23

25 8 ACKNOWLEDGEMENT MHBE expects to receive a TA1 acknowledgement for every outbound Interchange in which an AC X transaction set is sent. MHBE expects to receive a 999 acknowledgement for every functional group in every outbound 820 file sent. MHBE will send a TA1 acknowledgement for every inbound 820 file received. MHBE will send a 999 acknowledgement for every inbound functional group in every inbound 820 file received. 820 Companion Guide 24

26 9 MONTHLY ECONCILIATION FILE POCEE MHBE requires that a QHP Issuer reconcile payment files with the exchange no less than once a month and that the exchange reconcile payment information with QHP Issuers and HH no less than on a monthly basis. Proposed Payment econciliation Process MHBE will send two separate payment files to the Carrier for reconciliation purposes on monthly basis. 1) Full 820 file containing all Individual payment Data to QHP Issuer. 2) Full 820 file containing all HOP payment Data to HH. Carriers need to analyze and reconcile the files with the data in the Carrier system. Carriers need to update full 820 file and contact MHBE customer care or case worker if there are any questions or discrepancies. 820 Companion Guide 25

27 10 ACONYM/GLOAY Acronym/Term Description ACA Affordable Care Act APTC Advance Payments of the Premium Tax Credit AC Accredited tandards Committee Cancellation of Health Coverage Termination of health coverage PIO to the effective date of the health coverage. The enrollee requests that the health coverage they previously selected is cancelled prior to the first possible effective date. (Cancellation = Prior to effective date of coverage Termination = After effective date of coverage) CCIIO Center for Consumer Information and Insurance Oversight CG Companion Guide CM Centers for Medicare & Medicaid ervices C Cost-haring eduction Advance C Advance Cost-sharing eduction Payment DHH Department of Health and Human ervices EDI Electronic Data Interchange ED Enrollment Data tore EFT Enterprise File Transfer FEP Federal Exchange Program ystem FF-HOP Federally Facilitated mall Business Health Option Program FFE Federally Facilitated Exchange HH operates HH Department of Health and Human ervices HIPAA Health Insurance Portability and Accountability Act of 1996 Hub Data ervices Hub eferred to as the Hub IG Implementation Guide PH Public Health ervice QHP Qualified Health Plan MEC Minimum Essential Coverage BE tate Based Exchange tate operates all Exchange activities FTP ecure File Transfer Protocol HOP mall Business Health Option Program Termination of Health Coverage T3 XOC Terminate (end-date) health coverage after the health coverage effective date. (Cancellation = Prior to effective date of coverage Termination = After effective date of coverage) Type 3 Technical eport exchange Operational upport Center 820 Companion Guide 26

28 11 CHGE UMMAY Date Version By Description of Changes 4/2/ Noridian Initial elease 4/8/ Noridian Update to revise initial 820 file 6/24/ Noridian Updates on the fields 7/24/ Noridian Updated Payment Codes 820 Companion Guide 27