todd-test

X12 820 [Oscar] 820 ICHRA - Health Insurance Exchange Related Payments (X306)

X12 Release 5010Revised

Jul 17, 2024, 11:18 PM

Delimiters

• ~ Segment
• * Element
• > Component
• ^ Repetition

ISA Interchange Control Header

Required · Max use 1

ISA-01 · I01 · Authorization Information Qualifier · Required · Identifier (ID)

• 00: No Authorization Information Present (No Meaningful Information in I02)

ISA-02 · I02 · Authorization Information · Required · String (AN) · Min 10 Max 10

ISA-03 · I03 · Security Information Qualifier · Required · Identifier (ID)

• 00: No Security Information Present (No Meaningful Information in I04)

ISA-04 · I04 · Security Information · Required · String (AN) · Min 10 Max 10

ISA-05 · I05 · Interchange ID Qualifier · Required · Identifier (ID) · Min 2 Max 2

Codes

• 01: Duns (Dun & Bradstreet)
• 02: SCAC (Standard Carrier Alpha Code)
• 03: FMC (Federal Maritime Commission)
• 04: IATA (International Air Transport Association)
• 07: Global Location Number (GLN)
• 08: UCC EDI Communications ID (Comm ID)
• 09: X.121 (CCITT)
• 10: Department of Defense (DoD) Activity Address Code
• 11: DEA (Drug Enforcement Administration)
• 12: Phone (Telephone Companies)
• 13: UCS Code (The UCS Code is a Code Used for UCS Transmissions; it includes the Area Code and Telephone Number of a Modem; it Does Not Include Punctuation, Blanks or Access Code)
• 14: Duns Plus Suffix
• 15: Petroleum Accountants Society of Canada Company Code
• 16: Duns Number With 4-Character Suffix
• 17: American Bankers Association (ABA) Transit Routing Number (Including Check Digit, 9 Digit)
• 18: Association of American Railroads (AAR) Standard Distribution Code
• 19: EDI Council of Australia (EDICA) Communications ID Number (COMM ID)
• 20: Health Industry Number (HIN)
• 21: Integrated Postsecondary Education Data System, or (IPEDS)
• 22: Federal Interagency Commission on Education, or FICE
• 23: National Center for Education Statistics Common Core of Data 12-Digit Number for Pre-K-Grade 12 Institutes, or NCES
• 24: The College Board's Admission Testing Program 4-Digit Code of Postsecondary Institutes, or ATP
• 25: ACT, Inc. 4-Digit Code of Postsecondary Institutions.
• 26: Statistics of Canada List of Postsecondary Institutions
• 27: Carrier Identification Number as assigned by Health Care Financing Administration (HCFA)
• 28: Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration (HCFA)
• 29: Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration (HCFA)
• 30: U.S. Federal Tax Identification Number
• 31: Jurisdiction Identification Number Plus 4 as assigned by the International Association of Industrial Accident Boards and Commissions (IAIABC)
• 32: U.S. Federal Employer Identification Number (FEIN)
• 33: National Association of Insurance Commissioners Company Code (NAIC)
• 34: Medicaid Provider and Supplier Identification Number as assigned by individual State Medicaid Agencies in conjunction with Health Care Financing Administration (HCFA)
• 35: Statistics Canada Canadian College Student Information System Institution Codes
• 36: Statistics Canada University Student Information System Institution Codes
• 37: Society of Property Information Compilers and Analysts
• 38: The College Board and ACT, Inc. 6-Digit Code List of Secondary Institutions
• AM: Association Mexicana del Codigo de Producto (AMECOP) Communication ID
• NR: National Retail Merchants Association (NRMA) - Assigned
• SA: User Identification Number as assigned by the Safety and Fitness Electronic Records (SAFER) System
• SN: Standard Address Number
• ZZ: Mutually Defined

ISA-06 · I06 · Interchange Sender ID · Required · String (AN) · Min 15 Max 15

ISA-07 · I05 · Interchange ID Qualifier · Required · Identifier (ID) · Min 2 Max 2

Codes

• 01: Duns (Dun & Bradstreet)
• 02: SCAC (Standard Carrier Alpha Code)
• 03: FMC (Federal Maritime Commission)
• 04: IATA (International Air Transport Association)
• 07: Global Location Number (GLN)
• 08: UCC EDI Communications ID (Comm ID)
• 09: X.121 (CCITT)
• 10: Department of Defense (DoD) Activity Address Code
• 11: DEA (Drug Enforcement Administration)
• 12: Phone (Telephone Companies)
• 13: UCS Code (The UCS Code is a Code Used for UCS Transmissions; it includes the Area Code and Telephone Number of a Modem; it Does Not Include Punctuation, Blanks or Access Code)
• 14: Duns Plus Suffix
• 15: Petroleum Accountants Society of Canada Company Code
• 16: Duns Number With 4-Character Suffix
• 17: American Bankers Association (ABA) Transit Routing Number (Including Check Digit, 9 Digit)
• 18: Association of American Railroads (AAR) Standard Distribution Code
• 19: EDI Council of Australia (EDICA) Communications ID Number (COMM ID)
• 20: Health Industry Number (HIN)
• 21: Integrated Postsecondary Education Data System, or (IPEDS)
• 22: Federal Interagency Commission on Education, or FICE
• 23: National Center for Education Statistics Common Core of Data 12-Digit Number for Pre-K-Grade 12 Institutes, or NCES
• 24: The College Board's Admission Testing Program 4-Digit Code of Postsecondary Institutes, or ATP
• 25: ACT, Inc. 4-Digit Code of Postsecondary Institutions.
• 26: Statistics of Canada List of Postsecondary Institutions
• 27: Carrier Identification Number as assigned by Health Care Financing Administration (HCFA)
• 28: Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration (HCFA)
• 29: Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration (HCFA)
• 30: U.S. Federal Tax Identification Number
• 31: Jurisdiction Identification Number Plus 4 as assigned by the International Association of Industrial Accident Boards and Commissions (IAIABC)
• 32: U.S. Federal Employer Identification Number (FEIN)
• 33: National Association of Insurance Commissioners Company Code (NAIC)
• 34: Medicaid Provider and Supplier Identification Number as assigned by individual State Medicaid Agencies in conjunction with Health Care Financing Administration (HCFA)
• 35: Statistics Canada Canadian College Student Information System Institution Codes
• 36: Statistics Canada University Student Information System Institution Codes
• 37: Society of Property Information Compilers and Analysts
• 38: The College Board and ACT, Inc. 6-Digit Code List of Secondary Institutions
• AM: Association Mexicana del Codigo de Producto (AMECOP) Communication ID
• NR: National Retail Merchants Association (NRMA) - Assigned
• SA: User Identification Number as assigned by the Safety and Fitness Electronic Records (SAFER) System
• SN: Standard Address Number
• ZZ: Mutually Defined

ISA-08 · I07 · Interchange Receiver ID · Required · String (AN) · Min 15 Max 15

ISA-09 · I08 · Interchange Date · Required · Date (DT) · YYMMDD format

ISA-10 · I09 · Interchange Time · Required · Time (TM) · HHMM format

ISA-11 · I65 · Repetition Separator · Required · String (AN) · Min 1 Max 1

• ^: Repetition Separator

ISA-12 · I11 · Interchange Control Version Number · Required · Identifier (ID)

• 00501: Standards Approved for Publication by ASC X12 Procedures Review Board through October 2003

ISA-13 · I12 · Interchange Control Number · Required · Numeric (N0) · Min 9 Max 9

ISA-14 · I13 · Acknowledgment Requested · Required · Identifier (ID) · Min 1 Max 1

• 0: No Interchange Acknowledgment Requested
• 1: Interchange Acknowledgment Requested (TA1)

ISA-15 · I14 · Interchange Usage Indicator · Required · Identifier (ID) · Min 1 Max 1

• I: Information
• P: Production Data
• T: Test Data

ISA-16 · I15 · Component Element Separator · Required · String (AN) · Min 1 Max 1

• >: Component Element Separator

GS Functional Group Header

Required · Max use 1

GS-01 · 479 · Functional Identifier Code · Required · Identifier (ID)

• RA: Payment Order/Remittance Advice (820)

GS-02 · 142 · Application Sender's Code · Required · String (AN) · Min 2 Max 15

GS-03 · 124 · Application Receiver's Code · Required · String (AN) · Min 2 Max 15

GS-04 · 373 · Date · Required · Date (DT) · CCYYMMDD format

GS-05 · 337 · Time · Required · Time (TM) · HHMM, HHMMSS, HHMMSSD, or HHMMSSDD format

GS-06 · 28 · Group Control Number · Required · Numeric (N0) · Min 1 Max 9

GS-07 · 455 · Responsible Agency Code · Required · Identifier (ID) · Min 1 Max 2

• T: Transportation Data Coordinating Committee (TDCC)
• X: Accredited Standards Committee X12

GS-08 · 480 · Version / Release / Industry Identifier Code · Required · String (AN)

005010X306

Heading

0100 Heading > ST

ST 820 Header

Required · Max use 1

ST-01 · 143 · Transaction Set Identifier Code · Required · Identifier (ID)

• 820: Payment Order/Remittance Advice

ST-02 · 329 · Transaction Set Control Number · Required · Numeric (N) · Min 4 Max 9

ST-03 · 1705 · Implementation Convention Reference · Required · String (AN)

005010X306

0200 Heading > BPR

BPR Financial Information

Required · Max use 1

If either Depository Financial Institution (DFI) Identification Number Qualifier (BPR-12) or Receiving Depository Financial Institution (DFI) Identifier (BPR-13) is present, then the other is required

If Account Number Qualifier (BPR-14) is present, then Receiver Bank Account Number (BPR-15) is required

BPR-01 · 305 · Transaction Handling Code · Required · Identifier (ID)

• I: Remittance Information Only

BPR-02 · 782 · Total Payment Amount · Required · Decimal number (R) · Min 1 Max 15

BPR-03 · 478 · Credit or Debit Flag Code · Required · Identifier (ID)

• C: Credit

BPR-04 · 591 · Payment Method Code · Required · Identifier (ID)

• ACH: Automated Clearing House (ACH)
• CHK: Check
• FWT: Federal Reserve Funds/Wire Transfer - Nonrepetitive
• NON: Non-Payment Data

BPR-05 · 812 · Payment Format Code · Optional · Identifier (ID)

• CCP: Cash Concentration/Disbursement plus Addenda (CCD+) (ACH)

BPR-12 · 506 · Depository Financial Institution (DFI) Identification Number Qualifier · Optional · Identifier (ID)

• 01: ABA Transit Routing Number Including Check Digits (9 digits)
• 02: Swift Identification (8 or 11 characters)

BPR-13 · 507 · Receiving Depository Financial Institution (DFI) Identifier · Optional · String (AN) · Min 3 Max 12

BPR-14 · 569 · Account Number Qualifier · Optional · Identifier (ID)

• DA: Demand Deposit

BPR-15 · 508 · Receiver Bank Account Number · Optional · String (AN) · Min 1 Max 35

BPR-16 · 373 · Check Issue or EFT Effective Date · Required · Date (DT) · CCYYMMDD format

0350 Heading > TRN

TRN Reassociation Trace Number

Required · Max use 1

TRN-01 · 481 · Trace Type Code · Required · Identifier (ID)

• 3: Financial Reassociation Trace Number

TRN-02 · 127 · Check or EFT Trace Number · Required · String (AN) · Min 1 Max 50

1000A Payee Name Loop Required Max 1

Variants (all may be used)

Payer's Name Loop

0700 Heading > Payee Name Loop > N1

N1 Payee Name

Required · Max use 1

N1-01 · 98 · Entity Identifier Code · Required · Identifier (ID)

• PE: Payee

N1-02 · 93 · Payee Organization Name · Required · String (AN) · Min 1 Max 60

N1-03 · 66 · Identification Code Qualifier · Required · Identifier (ID)

• FI: Federal Taxpayer's Identification Number

N1-04 · 67 · Payee's Tax Identification Number · Required · String (AN) · Min 2 Max 80

1000B Payer's Name Loop Required Max 1

Variants (all may be used)

Payee Name Loop

0700 Heading > Payer's Name Loop > N1

N1 Payer's Name

Required · Max use 1

N1-01 · 98 · Entity Identifier Code · Required · Identifier (ID)

• RM: Party that remits payment

N1-02 · 93 · Payer Name · Required · String (AN) · Min 1 Max 60

N1-03 · 66 · Identification Code Qualifier · Required · Identifier (ID)

• 58: Originating Company Number

N1-04 · 67 · Payer Identifier · Required · String (AN) · Min 2 Max 80

Detail

2000 Remittance Information Loop Required Max >1

0100 Detail > Remittance Information Loop > ENT

ENT Remittance Information

Required · Max use 1

ENT-01 · 554 · Assigned Number · Required · Numeric (N0) · Min 1 Max 6

2100 Individual Name Loop Required Max 1

0200 Detail > Remittance Information Loop > Individual Name Loop > NM1

NM1 Individual Name

Required · Max use 1

NM1-01 · 98 · Entity Identifier Code · Required · Identifier (ID)

• IL: Insured or Subscriber

NM1-02 · 1065 · Entity Type Qualifier · Required · Identifier (ID)

• 1: Person

NM1-03 · 1035 · Individual Last Name · Required · String (AN) · Min 1 Max 60

NM1-04 · 1036 · Individual First Name · Required · String (AN) · Min 1 Max 35

NM1-05 · 1037 · Individual Middle Name · Optional · String (AN) · Min 1 Max 25

NM1-06 · 1038 · Individual Name Prefix · Optional · String (AN) · Min 1 Max 10

NM1-07 · 1039 · Individual Name Suffix · Optional · String (AN) · Min 1 Max 10

NM1-08 · 66 · Identification Code Qualifier · Required · Identifier (ID)

• C1: Insured or Subscriber

NM1-09 · 67 · Exchange Assigned Subscriber Identifier · Required · String (AN) · Min 2 Max 80

0600 Detail > Remittance Information Loop > Individual Name Loop > REF

REF Exchange Assigned Qualified Health Plan Identifier

Optional · Max use 1

Variants (all may be used)

REFExchange Assigned Policy IdentifierREFIssuer Assigned Policy IdentifierREFIssuer Assigned Subscriber Identifier

REF-01 · 128 · Reference Identification Qualifier · Required · Identifier (ID)

• 38: Master Policy Number

REF-02 · 127 · Exchange Assigned Qualified Health Plan Identifier · Required · String (AN) · Min 1 Max 50

0600 Detail > Remittance Information Loop > Individual Name Loop > REF

REF Exchange Assigned Policy Identifier

Required · Max use 1

Variants (all may be used)

REFExchange Assigned Qualified Health Plan IdentifierREFIssuer Assigned Policy IdentifierREFIssuer Assigned Subscriber Identifier

REF-01 · 128 · Reference Identification Qualifier · Required · Identifier (ID)

• POL: Policy Number

REF-02 · 127 · Exchange Assigned Policy Identifier · Required · String (AN) · Min 1 Max 50

0600 Detail > Remittance Information Loop > Individual Name Loop > REF

REF Issuer Assigned Policy Identifier

Required · Max use 1

Variants (all may be used)

REFExchange Assigned Qualified Health Plan IdentifierREFExchange Assigned Policy IdentifierREFIssuer Assigned Subscriber Identifier

REF-01 · 128 · Reference Identification Qualifier · Required · Identifier (ID)

• AZ: Health Insurance Policy Number

REF-02 · 127 · Issuer Assigned Policy Identifier · Required · String (AN) · Min 1 Max 50

0600 Detail > Remittance Information Loop > Individual Name Loop > REF

REF Issuer Assigned Subscriber Identifier

Required · Max use 1

Variants (all may be used)

REFExchange Assigned Qualified Health Plan IdentifierREFExchange Assigned Policy IdentifierREFIssuer Assigned Policy Identifier

REF-01 · 128 · Reference Identification Qualifier · Required · Identifier (ID)

• 0F: Subscriber Number

REF-02 · 127 · Issuer Assigned Subscriber Identifier · Required · String (AN) · Min 1 Max 50

2300 Remittance Detail Loop Required Max >1

1500 Detail > Remittance Information Loop > Remittance Detail Loop > RMR

RMR Remittance Detail

Required · Max use 1

RMR-01 · 128 · Reference Identification Qualifier · Required · Identifier (ID)

• ZZ: Mutually Defined

RMR-02 · 127 · Exchange Payment Type · Required · String (AN)

• APTC: Advance Payment of Premium Tax Credit
• CSR: Advance Payment of Cost Sharing Reduction
• DEPENDENTPREM: Dependent responsible premium amount
• EMPLOYEEPREM: Employee responsible premium amount
• EMPLOYERPREM: Employer responsible premium amount
• INTPREM: Initial premium payment received by the Exchange from the customer
• PREM: Premium payment amount received for the enrollment group for coverage (excluding APTC and Exchange-Related Fees)
• UF: Federally-facilitated Marketplace User Fee

RMR-04 · 782 · Payment Amount · Required · Decimal number (R) · Min 1 Max 15

1800 Detail > Remittance Information Loop > Remittance Detail Loop > DTM

DTM Individual Coverage Period

Required · Max use 1

DTM-01 · 374 · Date Time Qualifier · Required · Identifier (ID)

• 582: Report Period

DTM-05 · 1250 · Date Time Period Format Qualifier · Required · Identifier (ID)

• RD8: Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

DTM-06 · 1251 · Coverage Period · Required · String (AN) · Min 1 Max 35

Summary

0100 Summary > SE

SE Transaction Set Trailer

Required · Max use 1

SE-01 · 96 · Transaction Segment Count · Required · Numeric (N0) · Min 1 Max 10

SE-02 · 329 · Transaction Set Control Number · Required · Numeric (N) · Min 4 Max 9

GE Functional Group Trailer

Required · Max use 1

GE-01 · 97 · Number of Transaction Sets Included · Required · Numeric (N0) · Min 1 Max 6

GE-02 · 28 · Group Control Number · Required · Numeric (N0) · Min 1 Max 9

IEA Interchange Control Trailer

Required · Max use 1

IEA-01 · I16 · Number of Included Functional Groups · Required · Numeric (N0) · Min 1 Max 5

IEA-02 · I12 · Interchange Control Number · Required · Numeric (N0) · Min 9 Max 9

EDI Samples

Batch payments sample

ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *240221*1259*^*00501*000000001*0*T*>~
GS*RA*SENDER*RECEIVER*20240701*125918*000000001*X*005010X306~
ST*820*0001*005010X306~
BPR*I*1100*C*ACH*CCP*******01*199999999*DA*987654321*20240701~
TRN*3*78905~
N1*PE*Oscar*FI*11111111~
N1*RM*Thatch*58*22222222~
ENT*1~
NM1*IL*1*Doe*John****C1*mbr_01hwnmmb6qk1dhj10yaevkcb4k~
REF*POL*enrlmt_01hwnmmb6qk1dhj10yaevkcb4k~
REF*AZ*111111222222~
REF*0F*333333444444~
RMR*ZZ*APTC**600~
DTM*582****RD8*20240701-20240731~
RMR*ZZ*CSR**100~
DTM*582****RD8*20240701-20240731~
RMR*ZZ*UF**-25~
DTM*582****RD8*20240701-20240731~
ENT*2~
NM1*IL*1*Dough*Jane****C1*mbr_63u5rozdwe2725w16j0zoq24~
REF*POL*enrlmt_1iyehp8mhbsgvsrdaft1tbvv~
REF*AZ*555555666666~
REF*0F*777777888888~
RMR*ZZ*APTC**400~
DTM*582****RD8*20240701-20240731~
RMR*ZZ*CSR**50~
DTM*582****RD8*20240701-20240731~
RMR*ZZ*UF**-25~
DTM*582****RD8*20240701-20240731~
SE*28*0001~
GE*1*000000001~
IEA*1*000000001~