820

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Updated:05/16/2008

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:
Pos Id Segment Name Req Max Use Repeat Notes Usage
010 ST 820 Header M 1
020 BPR Financial Information M 1
035 TRN Reassociation Key O 1 N1/035
040 CUR Non-US Dollars Currency O 1 N1/040
050 REF Premium Receivers Identification Key O >1
060 DTM Process Date O 1
060 DTM Delivery Date O 1
060 DTM Coverage Period O 1
Loop ID - 1000A 1
070 N1 Premium Receiver’s Name O 1 N1/070
080 N2 Premium Receiver Additional Name O 1
090 N3 Premium Receiver’s Address O 1
100 N4 Premium Receiver’s City, State, Zip O 1
Loop ID - 1000B 1
070 N1 Premium Payer’s Name O 1 N1/070
080 N2 Premium Payer Additional Name O 1
090 N3 Premium Payer’s Address O 1
100 N4 Premium Payer’s City, State, Zip O 1
120 PER Premium Payer’s Administrative Contact O >1
Detail:
Pos Id Segment Name Req Max Use Repeat Notes Usage
Loop ID - 2000A 1
010 ENT Organization Summary Remittance O 1 N2/010
Loop ID - 2300A >1
150 RMR Organization Summary Remittance Detail O 1 N2/150
Loop ID - 2310A 1
190 IT1 Summary Line Item O 1 N2/190
Loop ID - 2315A >1
204 SLN Member Count O 1
Loop ID - 2320A >1
210 ADX Organization Summary Remittance Level Adjustment O 1 N2/210
Loop ID - 2000B >1
010 ENT Individual Remittance O 1 N2/010
Loop ID - 2100B >1
020 NM1 Individual Name O 1 N2/020
Loop ID - 2300B >1
150 RMR Individual Premium Remittance Detail O 1 N2/150
180 DTM Individual Coverage Period O 1
Loop ID - 2320B >1
210 ADX Individual Premium Adjustment O 1 N2/210
Summary:
Pos Id Segment Name Req Max Use Repeat Notes Usage
010 SE 820 Trailer M 1

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