Section title: X12 EDI Examples
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ASC X12 Version: 005010 | Transaction Set: 820 | TR3 ID: 005010X218

Example 1: Summary Bill Payment

Scenario One depicts a summary bill payment. This example shows a premium payer submitting an 820 transaction set to pay a group major medical and disability bill (Invoiced). The plan covers 80 employees. Seventy-five of the 80 employees have family coverage costing $220 per employee. Twenty-five of the 80 employees have disability coverage costing $100 for each employee. The total bill is $19,000. This is a summary bill payment because the premium receiver does not require the payment detail to list each individual employee in order to properly apply the payment.

The premium receiver has provided the premium payer with a plan number (12345), a group major medical invoice number of 970501001, and a disability invoice number of 970501002. The premium payment will be delivered using the ACH network. The 820 remittance detail will accompany the funds transfer.

Transmission Explanation

Table 1

ST*820*0001*005010X218~

Beginning of an 820 transaction set, Control number = 0001.

BPR*C*19000*C*ACH*CTX*01*999999992*DA*12345678*1030449999**01*199999999*DA*98765*20070516~

Financial institution to include the remittance information with the payment of $19000 using a credit ACH CTX formatted payment. The premium payer's bank transit routing number is 999999992 and their bank account is 12345678. The premium payer's Tax ID with a leading 1 is 1030449999. The premium receiver's bank transit routing number is 199999999 and their bank account is 98765. The payment effective date is May 16, 2007.

TRN*1*12345*1030449999~

Reassociation Key provides a sender unique trace number "12345", and the sender's Tax ID number preceded by a 1. This Key is included in case the sending trace number is duplicated by another sender.

REF*14*12345~

The master account number is 12345.

N1*PE*DEF HEALTH CARE INC.*FI*012222222~

The premium receiver's name (DEF HEALTH CARE INC) and federal Tax ID number (012222222).

N1*PR*ABC PLASTICS*FI*123456789~

The premium payer's name (ABC PLASTICS) and federal tax ID number (123456789).

Table 2

ENT*1*2L*FI*123456789~

Start of detail loop. Identifies this is a corporate entity item (summary bill payment). The premium payer's federal tax ID number (123456789).

RMR*IK*970501001*PI*16500~

The invoice being paid 970501001 (major medical).The amount being paid to this invoice ($16500).

IT1*1~

Start of required member counts under a summary RMR item.

SLN*1**O*5*IE~

Five of the 80 employees have individual coverage.

SLN*2**O*75*10~

Seventy-five of the 80 employees have family coverage.

RMR*IK*970501002*PI*250~

The invoice being paid 970501002 (disability). The amount being paid to this invoice ($2500).

IT1*1~

Start of required member counts under a summary RMR item.

SLN*1**O*25*IE~

Twenty-five employees have disability coverage.

Table 3

SE*15*0001~

Transaction Set Trailer with segment count (15) and Control Number (0001).