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

Example 2: List Bill Payment

Scenario Two demonstrates a List Bill payment. This example shows a premium payer submitting an 820 transaction set to pay a group employee life insurance premium bill (Invoice). The plan covers 4 employees. Two of the employees have only one policy, two of the employees have two policies each. This is a list bill payment because the premium receiver requires the payment detail to list each individual employee and each of the policy numbers and payment amounts that are being paid in this remittance.

The premium receiver has provided the premium payer with a plan number (0011001). The premium payment will be delivered using the (ACH) network. The 820 remittance detail will accompany the fund transfer. The total payment is for $255.

Transmission Explanation

Table 1

ST*820*0001*005010X218~

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

BPR*C*255*C*ACH*CTX*01*999999992*DA*12345678*1345678901**01*199999999*DA*98765*20071103~

Financial institution to include the remittance information with the payment of $255 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 receiver's bank transit routing number is 199999999 and their bank account is 98765. The payment effective date is November 3, 2007.

TRN*1*78905*1345678901~

Reassociation Key provides a sender unique trace number "78905" the sender's Tax ID number preceded by a 1 is included in case the sending trace number is duplicated by another sender.

REF*14*0011001~

The master account number is 0011001.

N1*PE*BATA INSURANCE CO.*FI*012222222~

The premium receiver's name (BATA INSURANCE CO.) and Federal Tax ID number (012222222).

N1*PR*ALFA MEDAL CO*FI*123456789~

The premium payer's name (ALFA MEDAL CO) and federal tax ID number (123456789).

Table 2

ENT*1*2J*34*030440099~

Start of detail loop for first individual. Identifying this is an individual John Doe's remittance items (list bill payment). The individual's Social Security Number (030440099).

NM1*EY*1*DOE*JOHN****EI*777222~

The individual's name (JOHN DOE) and employee's identification number (777222).

RMR*IG*555666**30~

The first policy being paid (555666) for JOHN DOE.The amount being paid to this invoice ($30).

RMR*IG*555667**35~

The second policy being paid (555667) for JOHN DOE. The amount being paid to this invoice ($35).

ENT*2*2J*34*029500563~

Start of detail loop second individual. Identifying this is an individual Emily Firstones's remittance items (list bill payment).The individual's Social Security Number (029500563).

NM1*EY*1*FIRSTONE*EMILY****EI*777333~

The individual's name (EMILY FIRSTONE) and employee's identification number (777333).

RMR*IG*555777**45~

The policy being paid (555777) for EMILY FIRSTONE. The amount being paid to this invoice ($45).

ENT*3*2J*34*029480664~

Start of detail loop third Individual. Identifying this is a individual Julie Middleone's remittance items (List bill payment).The individual's Social Security Number (029480664).

NM1*EY*1*MIDDLEONE*JULIE****EI*777444~

The individual's name (JULIE MIDDLEONE) and employee's identification number (777444).

RMR*IG*544477**50~

The policy being paid (544477) for JULIE MIDDLEONE. The amount being paid to this invoice ($50).

ENT*4*2J*34*030498099~

Start of detail loop fourth individual. Identifying this is a individual Kelly Newone's remittance items (list bill payment).The individual's Social Security Number (030498099).

NM1*EY*1*NEWONE*KELLY****EI*777111~

The individual's name (KELLY NEWONE) and employee's identification number (777111).

RMR*IG*551166**45~

The first policy being paid (551166) for KELLY NEWONE. The amount being paid to this invoice ($45).

RMR*IG*558766**50~

The second policy being paid (558766) for KELLY NEWONE. The amount being paid to this invoice ($50).

Table 3

SE*21*0001~

Transaction Set Trailer with segment count (21) and Control Number (0001).