Section title: External Code Lists
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Report Type Codes

These codes provide exchange-related report type codes. They define the type of report being described.

Exchange-related Report Type codes are transmitted in 005010X306, loop 2300, REF02.

Note:

  • Catastrophic is included in Individual Market and Merged is Individual and Small Group Markets combined.

  • All markets include both on and off exchange issuers.

  • Exchange markets include Individual/Small Group/Catastrophic/Merged.

4/26/2024

Code List Filters

AFFRPTReferences an affiliate payee ID and HIX 820 EFT Trace Number (TRN02) that will allow the payee to identify the affiliate related to the Exchange Payment Type Code in the 2300 Loop.
Start: 10/01/2013 | Last Modified: 11/01/2015 | Stop: 05/01/2015
Notes: CMS Individual Market Only
BALRPTThe report type code that corresponds to BAL Payment Type code to provide additional details for the transaction.
Start: 11/01/2015
Notes: CMS All Programs and Relevant Markets
DDVCRPT Provides a CMS Invoice Number associated with the DDVC Charge or Payment. The Invoice Number will be 16 or 17 digits and below provides the necessary key to identify the Benefit Year, Issuer ID, State, and Market associated to the DDVC Charge or Payment.

Default Data Validation Charge/Payment Invoice Logic:

Invoice Number Example: 214VA160112345001
Digit 1: Program and Market Designator (2)
Digits 2-3: Program Year (14)
Digits 4-5: State Code (VA)
Digits 6-9: Year and Month (1601)
Digits 10-14: Issuer ID (12345)
Digits 15-17: Transaction Sequential Counter (001)

Program and Market Designator (Digit 1) Key:
Default Data Validation Individual - 2
Default Data Validation Small Group - 3
Default Data Validation Catastrophic - 4
Default Data Validation Merged - 5

Start: 02/01/2021
Notes: All Markets
HCRPCRPTProvides a CMS Invoice Number associated with the HCRP Contribution/Collection (negative or positive). The Invoice Number will be 16 or 17 digits and below provides the necessary key to identify the Program Year, Payee ID, and Market associated to the HCRP Contribution/Collection.

HCRP Contribution/Collection Invoice Logic:

Invoice Number Example: X222311A12345601
Digit 1: Program and Market Designator (X)
Digits 2-3: Program Year (22)
Digits 4-7: Year and Month (2311)
Digits 8-14 (or 8-15): Payee ID (A123456)
Digits 15-16 (or 16-17): Transaction Sequential Counter (01)

Program and Market Designator (Digit 1) Key:
High Cost Risk Pool Individual - X
High Cost Risk Pool Small Group - Y
Start: 5/1/2024
Notes: CMS Individual and Small Group Markets Only
HCRPPRPTProvides a CMS Invoice Number associated with the HCRP Payment (negative or positive). The Invoice Number will be 16 or 17 digits and below provides the necessary key to identify the Program Year, Payee ID, and Market associated to the HCRP Payment.

HCRP Payment Invoice Logic:

Invoice Number Example: X222311A12345601
Digit 1: Program and Market Designator (X)
Digits 2-3: Program Year (22)
Digits 4-7: Year and Month (2311)
Digits 8-14 (or 8-15): Payee ID (A123456)
Digits 15-16 (or 16-17): Transaction Sequential Counter (01)

Program and Market Designator (Digit 1) Key:
High Cost Risk Pool Individual - X
High Cost Risk Pool Small Group - Y
Start: 5/1/2024
Notes: CMS Individual and Small Group Markets Only
INFORPTThe report type code that corresponds to any Payment Type code to provide additional details for the transaction.
Start: 10/18/2016
Notes: CMS All Programs and Relevant Markets
INVOICERPTReferences an Invoice number related to the Exchange Payment Type Code in the 2300 Loop
Start: 10/01/2013 | Last Modified: 11/01/2015
Notes: CMS Individual Market Only
ISSUERIDRPTReferences an Issuer (5-digit) HIOS ID number related to the Exchange Payment Type Code in the 2300 Loop
Start: 11/01/2015
Notes: CMS Individual Market Only
MADJRPTThe number included in the document control number references a unique trace number that may be included on a future HIX 820 if the manual adjustment is reversible.
Start: 10/01/2013 | Last Modified: 11/01/2015 | Stop: 11/01/2015
Notes: CMS Individual Market Only
PAYMENTTRANSACTIONIDThis will be the Payment Transaction ID for the initial payment ID if this is an initial payment.
Start: 11/01/2014 | Last Modified: 11/01/2015
Notes: CMS SHOP Market Only
RARPTProvides a CMS Invoice Number associated with the RA Charge or Payment. The Invoice Number will be 16 or 17 digits and below provides the necessary key to identify the Benefit Year, Issuer ID, State, and Market associated to the RA Charge or Payment.

Risk Adjustment Program Charge/Payment Invoice Logic:

Invoice Number Example: I14VA160112345001
Digit 1: Program and Market Designator (I)
Digits 2-3: Program Year (14)
Digits 4-5: State Code (VA)
Digits 6-9: Year and Month (1601)
Digits 10-14: Issuer ID (12345)
Digits 15-17: Transaction Sequential Counter (001)

Program and Market Designator (Digit 1) Key:
Risk Adjustment Individual - I
Risk Adjustment Small Group - L
Risk Adjustment Catastrophic - T
Risk Adjustment Merged - M
Start: 11/01/2015 | Last Modified: 10/25/2017
Notes: All Markets
RADRPTProvides a CMS Invoice Number associated with the RAD Charge or Payment. The Invoice Number will be 16 or 17 digits and below provides the necessary key to identify the Benefit Year, Issuer ID, State, and Market associated to the RAD Charge or Payment.

Risk Adjustment Default Charge/Payment Invoice Logic:

Invoice Number Example: N14VA160112345001
Digit 1: Program and Market Designator (N)
Digits 2-3: Program Year (14)
Digits 4-5: State Code (VA)
Digits 6-9: Year and Month (1601)
Digits 10-14: Issuer ID (12345)
Digits 15-17: Transaction Sequential Counter (001)

Program and Market Designator (Digit 1) Key:
Risk Adjustment Default Charge/Payment Individual - N
Risk Adjustment Default Charge/Payment Small Group - O
Risk Adjustment Default Charge/Payment Catastrophic - H
Risk Adjustment Default Charge/Payment Merged - B
Start: 11/01/2015 | Last Modified: 03/01/2021
Notes: All Markets
RADVRPTProvides a CMS Invoice Number associated with the RADV Charge or Payment. The Invoice Number will be 16 or 17 digits and below provides the necessary key to identify the Benefit Year, Issuer ID, State, and Market associated to the RADV Charge or Payment.

Risk Adjustment Data Validation Charge/Payment Invoice Logic:

Invoice Number Example: 614VA160112345001
Digit 1: Program and Market Designator (6)
Digits 2-3: Program Year (14)
Digits 4-5: State Code (VA)
Digits 6-9: Year and Month (1601)
Digits 10-14: Issuer ID (12345)
Digits 15-17: Transaction Sequential Counter (001)

Program and Market Designator (Digit 1) Key:
Risk Adjustment Data Validation Individual - 6
Risk Adjustment Data Validation Small Group - 7
Risk Adjustment Data Validation Catastrophic - 8
Risk Adjustment Data Validation Merged - 9
Start: 02/01/2021
Notes: All Markets
REVMADJRPTThe number included in the document control number references a unique trace number from a prior month HIX 820 where the manual adjustment first occurred.
Start: 10/01/2013 | Last Modified: 11/01/2015 | Stop: 11/01/2015
Notes: CMS Individual Market Only
SHOPUFRPTThe number included in the document control number references a unique trace number (TRN02) from a corresponding SHOP HIX 820 transaction.
Start: 11/01/2015
Notes: CMS Individual Market Only