Extracting Premium Payment Data for HIPAA

Benefits Administration provides a method for extracting benefit premium data into ASC X12N 820, the file format required by the Department of Health and Human Services in compliance with HIPAA requirements.

Before you extract premium data, define a plan sponsor ID in the HIPAA section of Benefit Company (BN00.1).

Note: Coordination between the Benefits and Accounts Payable departments are required to produce a complete HIPAA 820 transaction set. Since electronic payment can be sent separately from the supporting detail, re-association keys and/or EFT payment details will be needed for the premium receiver to put the actual payment and supporting data together after transmission.

BN320 will create a single HIPAA 820 file, so you may need to run the program separately for each Health Plan.

Note: You determine what process/method you use to format the data into the EDI standard format. Data may need to be extracted from your AP application (whether using Lawson AP or other vendor) and merged with the data from BN320 to produce the complete HIPAA 820 transaction set.

To extract premium payment data

  1. Access Premium Report (BN320).
  2. Access the Report tab. Use the following guidelines to enter field values:
    File Option

    Select whether to create a file that contains the HIPAA 820 data.

    Premium Receiver

    If you select Create File in the File Option field, select the insurer to whom the premium will be paid.

  3. Access the HIPAA File tab. Use the following guidelines to enter field values:
    Company Contact

    If you are creating a HIPAA 820 file, select whether or not the company contact person is an employee.

    Employee Number

    If you are creating a HIPAA 820 file, select the employee who serves as the contact person for the benefit information to be sent.

    Remittance Only

    Required. Select whether to include the payment in the EDI transaction, or if remittance detail is being sent separately. This information is required in the HIPAA 820 file.

    Payment Date

    Type the date payment is made for the premium; for example, the check issue date or EFT effective date.

    Trace Number

    Type a trace number for the payment. This is used to reassociate the payment with the remittance detail when transmitted separately.

    Invoice Number

    Type an optional invoice number to include in the HIPAA 820 file.

    Invoice Amount

    Type an optional invoice amount to include in the HIPAA 820 file.

    Adjustment Amount

    Type an adjustment amount if the premium paid will vary from the total amount identified in the BN320 report.

    Adjustment Reason

    Select a reason for any discrepancy between the reported or invoiced premium amount and amount paid. This information will be included in the HIPAA 820 file. If no adjustment amount or invoice amount is entered, leave this field blank.

  4. Run the report.

    A file called Hipaa820 will be placed in your current directory.