Examples

Providing implementers with examples that clarify the use of ASC X12 transaction sets.

 

Health Insurance Exchange Related Payments Examples

> Different Types of Payment Made by the HIX
> ASC X12 Version: 005010 | Transaction Set: 820 | TR3 ID: 005010X306

> Payments Exceed Charges
> CMS Example | Initial Payment (Optional) | Payment Type Code: BAL

> Payments Exceed Charges
> CMS Example | Final Payment | Payment Type Code: BAL

> Charges Exceed Payments (SHOP)
> CMS Example | Initial Payment (Optional) | Payment Type Code: INVOICE

> Charges Exceed Payments (SHOP)
> CMS Example | Final Payment | Payment Type Code: INVOICE

> APTC Adjustments
> CMS Example | Initial (Optional) Payment Type Code: APTCADJ

> APTC Adjustments
> CMS Example | Final Payment Type Code: APTCADJ

> Outstanding Debt Owed by the Payee or their Affiliates
> CMS Example | Initial (Optional) Payment Type Code: REDUCED

> Outstanding Debt Owed by the Payee or their Affiliates
> CMS Example | Final Payment Type Code: REDUCED

> Debt Amount Covered by an Affiliate’s Payment
> CMS Example | Initial (Optional) Payment Type Code: DEBTADJ

> Current Month Debt Amount Covered by an Affiliate’s Payment
> CMS Example | Final Payment Type Code: DEBTADJ

> CSR Manual Adjustment
> CMS Example | Optional Payment Type Code: CSRMADJ

> CSR Manual Adjustment
> CMS Example | Final Payment Type Code: CSRMADJ

> Replace CSR Manual Adjustment with Retroactive CSR Adjustment
> CMS Example | Initial (Optional) Payment Type Code: CSRMADJ/CSRADJ

> Replace CSR Manual Adjustment with Retroactive CSR Adjustment
> CMS Example | Final Payment Type Code: CSRMADJ/CSRADJ

> CMS sends HIX 820 to State Based Marketplace
> CMS Example | Payment Type Code: APTC/CSR