It appears the big question is whether an ODFI that is processing payments (including health care payments) is considered a HIPAA entity. If it is then we will need to convert the 820's we use for our EFT process from 4010 to 5010.
Thanks to all, the discussion has been very informative. From: Rachel Foerster [mailto:[email protected]] Sent: Tuesday, May 14, 2013 9:22 PM To: 'Kevin Baloue'; Mitchell, Christopher (DTMB) Cc: '[email protected]' Subject: RE: [EDI-L] Financial EDI question Kevin, I think you're a bit mistaken about the X12 v5010X306 TR3 and its intended purpose. This particular TR3 has not been adopted under HIPAA TR3 is specifically identified by OESS to be the standard adopted under HIPAA to be used for health plan premium payments. HIPAA has adopted the X218 TR3 for the payment of health plan premiums. The OESS had adopted the NACHA CCD+TRN Segment of the associated 835 to be the HIPAA mandated transaction for electronic payments of health care claims. This final rule requires health plans to use the CCD+TRN to instruct its financial institution (the ODFI) to originate an EFT CCD+ transaction via the ACH to the provider's financial institution (the RDFI). The requirement to use any specific X12 TR3 for transactions through the HIXs is determined by CCIO. These transactions are not HIPAA mandated transactions, but rather, are implementation specifications for certain base X12 transaction set standards to support the HIXs and were developed by a Special Action Committee (SAC) of the ASC X12N Insurance Subcommittee. It will be confusing for many in the industry to understand the differences and distinctions between the various TR3 implementation specifications adopted and mandated under HIPAA and the other TR3 implementation specifications to support certain information exchanges via HIXs. Which TR3 implementation specification and corresponding CAQH CORE Operating Rules are applicable will be driven by whether than entity is a HIPAA covered entity to which the HIPAA law and regulations apply or another entity (which could also be a HIPAA covered entity) which is attempting to operate through a HIX and comply with the CCIO requirements applicable thereto. Anyone interested in learning more about the CAQH CORE HIPAA/ACA adopted operating rules can find a wealth of information at caqh.org. All of the CORE operating rules and other implementation resources, etc. can be downloaded free from the CAQH web site. The X306 TR3 is specifically for the use of payments for Health Insurance Exchange (HIX) payments. See below from the WPC Registry list. Health Insurance Exchange Related Payments Purpose The Health Insurance Exchange Related Payment Technical Report Type 3 describes the use of the ASC X12 Payment Order/Remittance Advice (820) transaction set for: - the payment of premium - the advance payment of premium tax credits and cost-sharing reduction amount - annual reconciliations Primary Trading Partners Trading partners may include but are not limited to: - Issuers - Health Insurance Exchanges -- State or designee -- Federal or designee Exceptions/Limitations Only to be used for Exchange related payments Rachel Foerster, CEO Rachel Foerster & Associates Ltd. Senior CAQH/CORE Consultant Boundary Information Group 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 www.rfa-edi.com<http://www.rfa-edi.com> [RFA Ltd Framed New Logo] From: Kevin Baloue [mailto:[email protected]] Sent: Tuesday, May 14, 2013 12:25 PM To: Mitchell, Christopher (DTMB); [email protected]<mailto:[email protected]> Cc: [email protected]<mailto:[email protected]> Subject: RE: [EDI-L] Financial EDI question Hi Rachel, You should look at the 820 Health Insurance Exchange Related Payments, ASC X12N/005010X306 TR3. This version was created specifically for the reassociation of payment and remittance information that have been separated. That is the 820 version that several of the State Based Exchanges are using to capture the CCD+ addenda (CCD+) (ACH) The TRN in this document is titled "Reassociation Trace Number". Kevin Baloue EDI Consultant CGI, Technologies and Solutions Cell: 773-914-1242 ________________________________ To: [email protected]<mailto:[email protected]> CC: [email protected]<mailto:[email protected]> From: [email protected]<mailto:[email protected]> Date: Mon, 13 May 2013 13:52:38 +0000 Subject: RE: [EDI-L] Financial EDI question Rachel - Yes, this question is being driven by the mandatory changes required to go into place on 1/1/2014 by the Affordable Care Act. We are definitely getting familiar with the EFT/ERA requirements. Our project to add the TRN addenda record is underway. My original question was to see if anyone understood the mechanism the ODFI uses to determine which addenda record to pick up. Your comment about 5010 raises another question: Currently we send payments in X12 820 format to the ODFI using EDI version 4010. The ODFI then converts the 820 transactions into the ACH format and then routes them through the ACH network to the RDFI. Although it is clear that 835's are being required to use EDI version 5010 AND the ODFI must use CCD+ to transmit to the ACH network, it is unclear whether we need to convert our 820's to version 5010. Can anyone clarify? Our TRN02 should not go beyond 30 characters. Christopher Mitchell DTMB Agency Services, Application Services Phone: (517) 335-1613 E-mail: [email protected]<mailto:mitchellc2%40michigan.gov><mailto:[email protected]<mailto:mitchellc2%40michigan.gov>> From: [email protected]<mailto:EDI-L%40yahoogroups.com> [mailto:[email protected]<mailto:EDI-L%40yahoogroups.com>] On Behalf Of Rachel Foerster Sent: Friday, May 10, 2013 5:07 PM To: Mitchell, Christopher (DTMB); 'Sergey Sudakov' Cc: [email protected]<mailto:EDI-L%40yahoogroups.com> Subject: RE: [EDI-L] Financial EDI question If you are using the 820 to instruct the ODFI to generate the CCD+ for health plan premium payments then you should get familiar with the HIPAA-adopted v5010 X12 820 TR3. The 820 includes the TRN segment for tracking and reassociating the EFT payment transaction with the corresponding 820. Rachel Foerster 847-872-8070 From: [email protected]<mailto:EDI-L%40yahoogroups.com><mailto:EDI-L%40yahoogroups.com> [mailto:[email protected]<mailto:EDI-L%40yahoogroups.com><mailto:EDI-L%40yahoogroups.com>] On Behalf Of Mitchell, Christopher (DTMB) Sent: Friday, May 10, 2013 11:38 AM To: Sergey Sudakov Cc: [email protected]<mailto:EDI-L%40yahoogroups.com><mailto:EDI-L%40yahoogroups.com> Subject: RE: [EDI-L] Financial EDI question I am currently working with the ODFI on our particular case. I was just wondering if there were general rules anyone was aware of. I have not found anything through my research yet. -----Original Message----- From: [email protected]<mailto:EDI-L%40yahoogroups.com><mailto:EDI-L%40yahoogroups.com> <mailto:EDI-L%40yahoogroups.com> [mailto:[email protected]<mailto:EDI-L%40yahoogroups.com><mailto:EDI-L%40yahoogroups.com> <mailto:EDI-L%40yahoogroups.com> ] On Behalf Of Sergey Sudakov Sent: Friday, May 10, 2013 12:11 PM To: Mitchell, Christopher (DTMB) Cc: [email protected]<mailto:EDI-L%40yahoogroups.com><mailto:EDI-L%40yahoogroups.com> <mailto:EDI-L%40yahoogroups.com> Subject: Re: [EDI-L] Financial EDI question Could it be the RMR segment? Do you have contact info at the Originating Depository Financial Institution where you can call and ask? Thanks, Sergey Sudakov EDI Project Manager Beacon EDI, Inc [email protected]<mailto:sergey.sudakov%40beaconedi.com><mailto:sergey.sudakov%40beaconedi.com> <mailto:sergey.sudakov%40beaconedi.com> 4445 Eastgate Mall Suite 200 San Diego, CA 92121 800-334-6127 x2 https://beaconedi.com/ EDI Blog: https://beaconedi.com/edi-blog On Fri, May 10, 2013 at 8:30 AM, Christopher <[email protected]<mailto:mitchellc2%40michigan.gov><mailto:mitchellc2%40michigan.gov> <mailto:mitchellc2%40michigan.gov> >wrote: > ** > > > We currently send 820 payments to our ODFI which converts them to ACH > format and then transmits them into the ACH network. When processing a > CCD+ payment, how does the ODFI know which segment to pick up and send > as the addenda record? For example, for Healthcare payments, the TRN > segment needs to be sent as addenda. For Tax payments, the TXP segment > needs to be captured. If anyone has knowledge about how this works let > me know. Google searches are not returning anything. > > > [Non-text portions of this message have been removed] ------------------------------------ ... Please use the following Message Identifiers as your subject prefix: <SALES>, <JOBS>, <LIST>, <TECH>, <MISC>, <EVENT>, <OFF-TOPIC> Job postings are welcome, but for job postings or requests for work: <JOBS> IS REQUIRED in the subject line as a prefix.Yahoo! Groups Links [Non-text portions of this message have been removed] [Non-text portions of this message have been removed] [Non-text portions of this message have been removed] ------------------------------------ ... Please use the following Message Identifiers as your subject prefix: <SALES>, <JOBS>, <LIST>, <TECH>, <MISC>, <EVENT>, <OFF-TOPIC> Job postings are welcome, but for job postings or requests for work: <JOBS> IS REQUIRED in the subject line as a prefix.Yahoo! 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