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Back  RFI # 2171: Usage of 820 Transaction

Formal vs. Informal Help Informal Formal

Submitter

Pierce Vicky

Description

Is the usage of the 820 limited to premium payments? We have a situation where we pay a cost settlement to FQHCs and RHCs. This comes out of our Managed Care System even though it is not an actual premium payment.

Submitter Assigned Keywords

820

Response

The 820 transaction can be used for insurance premiums payments and non-covered contributions associated with account based health arrangements including heath saving accounts. See section 1.4 Business Usage for additional information on types of workflows support by this transaction
Payments to Rural Health Clinics (RHC) and Federally Qualified health centers (FQHC) are reported on the 835 Health Care Claim Payment Advice not the 820 Premium Payment. Payments for cost settlements reports are reported using the PLB segment. See section 1.10.2.10 Capitation and Related Payments or Adjustments for additional information on how a managed care organization should report such payments.

Recommendation

The 820 transaction can be used for insurance premiums payments and non-covered contributions associated with account based health arrangements including heath saving accounts. See section 1.4 Business Usage for additional information on types of workflows support by this transaction


Payments to Rural Health Clinics (RHC) and Federally Qualified health centers (FQHC) are reported on the 835 Health Care Claim Payment Advice not the 820 Premium Payment. Payments for cost settlements reports are reported using the PLB segment. See section 1.10.2.10 Capitation and Related Payments or Adjustments for additional information on how a managed care organization should report such payments.
Submission 9/13/2016
Status Date 12/2/2016
Status F - Final
Primary References
Document 005010X218
SectionPurpose