820 820 Health Insurance Exchange Related Payments (X306)
Centers for Medicare & Medicaid Services (CMS) · X12 005010X306
La spécification 820 publiée par Centers for Medicare & Medicaid Services (CMS), présentée sous forme de guide interactif. Déployez n’importe quel segment pour voir ses éléments, types de données, longueurs et codes acceptés, puis validez votre propre document ci-dessous.
Spécification
28 segments sur 28
HEADING
ST
820 Header
pos. 0100
Facultatif
max. —
BPR
Financial Information
- Use the BPR to address a single payment to a single issuer. The BPR contains mandatory information, even though this transaction is not being used to move funds electronically.
- See section 1.10.2.3, Balancing, for information on balancing requirements.
pos. 0200
Obligatoire
max. —
TRN
Reassociation Trace Number
- The purpose of this segment is to uniquely identify this transaction set and aid in reassociating payment and remittance data that have been separated. See section 1.10.2.4 for more information.
pos. 0350
Obligatoire
max. —
REF
Exchange Assigned Employer Group Identifiervariante 1 de 4
- Required when an exchange assigned employer group identifier was provided in the 834 enrollment transaction and all enrollees within this transaction apply to a single employer group. If not required by this implementation guide, do not send.
pos. 0500
Facultatif
max. —
REF
Exchange Assigned Qualified Health Plan Identifiervariante 2 de 4
- Required when an exchange assigned QHP identifier was provided in the 834 enrollment transaction and all enrollees within this transaction apply to a single QHP. If not required by this implementation guide, do not send.
pos. 0500
Facultatif
max. —
REF
Issuer Assigned Employer Group Identifiervariante 3 de 4
- Required when:
all enrollees within this transaction apply to a single employer group,
the issuer has assigned an identifier to that employer group,
and the identifier is known to the submitter.
If not required by this implementation guide, do not send.
pos. 0500
Facultatif
max. —
REF
Issuer Assigned Qualified Health Plan Identifiervariante 4 de 4
- Required when all enrollees within this transaction apply to a single QHP and the Issuer Assigned QHP Identifier is known to the submitter. If not required by this implementation guide, do not send.
pos. 0500
Facultatif
max. —
Boucle 1000APayee Name Loopobligatoire
N1
Payee Name
pos. 0700
Obligatoire
max. —
REF
Unique Health Plan Identifier
- Required when the Payee has obtained a Unique Health Plan Identifier and that identifier is known to the submitter. If not required by this implementation guide, do not send.
pos. 1100
Facultatif
max. —
Boucle 1000BPayer's Name Loopobligatoire
N1
Payer's Name
- The "payer" in the context of this transaction is not the health plan. The payer is the entity making payment to the plan. This will be either a government entity (HHS, IRS, etc) or a Health Insurance Exchange.
pos. 0700
Obligatoire
max. —
PER
Payer's Administrative Contact Information
- 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.
pos. 1200
Facultatif
max. —
DETAIL
Boucle 2000Remittance Information Loopobligatoire
ENT
Remittance Information
- Each iteration of the ENT loop represents an identifiable detail payment and or adjustment(s). The detail payment or adjustment may be specific to an individual or represent an aggregate to the issuer.;Examples of individual specific detail payments include: premium payments, advance tax credit payments, advance cost share payments, etc.
Examples of detail payments or adjustments that are not individual include: risk adjustments, reinsurance, tax liens, etc.
When reporting a detail payment or adjustment that is not specific to an individual, Loop ID 2100 (Individual Name) is not used.
pos. 0100
Obligatoire
max. —
Boucle 2100Individual Name Loop
NM1
Individual Name
- Required when the payment and/or adjustment amounts within this iteration of Loop ID 2000 are attributed to a specific individual. If not required by this implementation guide, do not send.
pos. 0200
Obligatoire
max. —
REF
Exchange Assigned APTC Contributor/Tax Payer Identifiervariante 1 de 11
- Required when:
an exchange has assigned an identifier to an ATPC contributor/Tax Payer, who is not the subscriber or a dependent of the policy, for which this payment is directed,
AND
the exchange/government agency manages payment information to this level of granularity,
AND
the identifier is permitted for use under applicable regulation.
If not required by this implementation guide, do not send.
pos. 0600
Facultatif
max. —
REF
Exchange Assigned Dependent Identifiervariante 2 de 11
- Required when the associated payment for a subscriber policy is not directly attributable to the subscriber.
If not required by this implementation guide, do not send.
- An example of when this would be used is as follows. When dependents of a policy file taxes separately from the subscriber, it is possible they may be eligible for an Advance payment of the Premium Tax Credit (APTC) separate from, and in addition to, any APTC of which the subscriber may qualify.
pos. 0600
Facultatif
max. —
REF
Exchange Assigned Employer Group Identifiervariante 3 de 11
- Required when the enrollment is from a SHOP exchange and the header exchange assigned employer group segment is not used. If not required by this implementation guide, do not send.
pos. 0600
Facultatif
max. —
REF
Exchange Assigned Policy Identifiervariante 4 de 11
- For the purposes of this implementation, policy is defined as the collective of enrollees constituting a family unit or household.
pos. 0600
Obligatoire
max. —
REF
Exchange Assigned Qualified Health Plan Identifiervariante 5 de 11
- Required when the header level Exchange Assigned QHP Identifier segment is not used and an exchange assigned QHP identifier was provided to the issuer in the 834. If not required by this implementation guide, do not send.
pos. 0600
Facultatif
max. —
REF
Issuer Assigned APTC Contributor/Tax Payer Identifiervariante 6 de 11
- Required when:
the issuer has assigned an identifier to an ATPC contributor/Tax Payer who is not the subscriber or a dependent of the policy for which this payment is directed,
AND
that identifier has been made known to the submitter,
AND
the exchange/government agency manages payment information to this level of granularity.
If not required by this implementation guide, do not send.
pos. 0600
Facultatif
max. —
REF
Issuer Assigned Dependent Identifiervariante 7 de 11
- An example of when this would be used is as follows. When dependents of a policy file taxes separately from the subscriber, it is possible they may be eligible for an Advance payment of the Premium Tax Credit (APTC) separate from, and in addition to, any APTC of which the subscriber may qualify.
- Required when the associated payment for a subscriber policy is not directly attributable to the subscriber AND the issuer assigned identifier is known by the payer.
If not required by this implementation guide, do not send.
pos. 0600
Facultatif
max. —
REF
Issuer Assigned Employer Group Identifiervariante 8 de 11
- Required when:
the enrollment is from a SHOP exchange,
the header issuer assigned employer group segment is not used,
the issuer has assigned an identifier to that employer group,
and the identifier is known to the submitter.
If not required by this implementation guide, do not send.
pos. 0600
Facultatif
max. —
REF
Issuer Assigned Policy Identifiervariante 9 de 11
- Required when known by the submitter. If not required by this implementation guide, do not send.
pos. 0600
Facultatif
max. —
REF
Issuer Assigned Qualified Health Plan Identifiervariante 10 de 11
- Required when the Issuer Assigned QHP segment in the header is not used, and the Issuer Assigned QHP Identifier is known by the submitter.
If not required by this implementation guide, do not send.
pos. 0600
Facultatif
max. —
REF
Issuer Assigned Subscriber Identifiervariante 11 de 11
- Required when the issuer assigned subscriber number is known to the payer.
If not required by this implementation guide, do not send.
pos. 0600
Facultatif
max. —
Boucle 2300Remittance Detail Loopobligatoire
RMR
Remittance Detail
- Relays detailed health insurance exchange-related remittance information.
pos. 1500
Obligatoire
max. —
REF
Exchange Report Document Control Number
- Required when the Exchange needs to provide supporting documentation pertaining to this payment.
If not required by this implementation guide, do not send.
pos. 1700
Facultatif
max. —
DTM
Individual Coverage Period
- This segment relays the start and end dates related to the payment reported in the RMR segment.
pos. 1800
Obligatoire
max. —
SUMMARY
SE
Transaction Set Trailer
pos. 0100
Facultatif
max. —
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