Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
F.1 820 Format Payment Advice Data File
The 820 Format Payment Advice data file is a Health Insurance Portability & Accountability Act
(HIPAA)-compliant version of the Plan Payment Report, which is also known as the Automated
Plan Payment System (APPS) Payment Letter. The data file itemizes the final monthly payment to
the Plan. It is produced by APPS when final payments are calculated, and is available to Plans as
part of the month-end processing. This file is not available through Medicare Advantage and
Prescription Drug System (MARx).
The following records are included in this file:
Header Record (numbers 1-6 below)
Detail Record (numbers 7-10 below)
Summary Record (number 11 below)
The segments are listed in a required order:
1. ST, 820 Header
2. BPR, Financial Information
3. TRN, Re-association Key
4. DTM, Coverage Period
5. N1, Premium Receiver’s Name
6. N1, Premium Payer’s Name
7. RMR, Organization Summary Remittance Detail
8. IT1, Summary Line Item
9. SLN, Member Count
10. ADX, Organization Summary Remittance Level Adjustment
11. SE, 820 Trailer
The physical layout of a segment is:
Segment Identifier, an alphanumeric code, followed by
Each selected field (data element) preceded by a data element separator (“*”)
And terminated by a segment terminator (“~”).
Fields are mostly variable in length and do not contain leading/trailing spaces. If fields are empty,
they are skipped by inserting contiguous data element separators (“*”) unless they are at the end of
the segment. Fields that are not selected are represented in the same way as fields that are selected,
but as this particular iteration of the transaction set contain no data, they are skipped.
For example, in fictitious segment XXX, fields 2, 3, and 5 (the last field) are skipped:
BALANCING REQUIREMENTS 1
XXX*field 1 content***field 4 content~
1 See pp.16 in National EDI Transaction Set Implementation Guide for 820, ASCX12N, 820 (004010X061), dated
May 2000
December 28, 2012 F-3 820 Format Payment
Advice Data File