PREMIUM PAYMENTS TRANSACTIONS 820 (00400X06)
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
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
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
SECTION II - TABLES TRANSACTION SET REQUIREMENTS FOR: PREMIUM PAYMENT TRANSACTIONS 820 (00400X06) Pg # Seg DE Designator Element Type CONTROL SEGMENTS ISA Interchange Control Header 2 3 4 5 6 7 8 9 0 2 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 0040 5
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
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 0 02 03 04 05 06 07 08 09 0 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
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 4 5 6 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
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 000 0 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
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*07000505 *ZZ*58653544 *020626*539*U*0040*000000039*0*T*:~ GS*RA*07000505*58653544*20020626*539*39*X*00400X06~ ST*820*0082~ *I*00000*C*CHK**0*07000505*DA*2***0*07000505**5800358342*20020620~ REF*4*0999359~ 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*07000505*DA*2***0*07000505**5800358342*20020620~ REF*4*0999360~ N*PR*CUSTOMER N/A*FI*02679~ RMR*IK*26854**9000~ SE*9*0083~ ST*820*0084~ *I*6000*C*CHK**0*07000505*DA*2***0*07000505**5800358342*20020620~ REF*4*0999360~ N*PR*CUSTOMER N/A*FI*02679~ RMR*IK*26853**6000~ SE*9*0084~ ST*820*0085~ *I*84000*C*CHK**0*07000505*DA*2***0*07000505**5800358342*20020620~ REF*4*0999360~ 0
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*07000505*DA*2***0*07000505**5800358342*20020620~ REF*4*0999360~ N*PR*CUSTOMER N/A*FI*0268~ RMR*IK*26857**50000~ SE*9*0086~ ST*820*0087~ *I*000000*C*CHK**0*07000505*DA*2***0*07000505**5800358342*20020620~ REF*4*099936~ N*PR*CUSTOMER N/A*FI*0268~ RMR*IK*26858**000000~ SE*9*0087~ GE*6*39~ IEA**000000039~