InstaMed supports the ability to send payments (and denials) to members (Explanation of Benefits or EOB). These outbound payments consist of claims adjudicated by a health plan and owed to a member.
In order to properly reflect the disposition of an adjudicated claim, issued via the InstaMed Disbursement Hub solution, InstaMed supports the generation of payment-level batch files.
For example, if a check payment is issued for $1,000, a single record would be reported in the batch file with a ‘Paid’ status regardless of how many claims are applicable to the check payment. InstaMed will output another batch file in the future when the check is deposited to change the status of the check payment from ‘Paid’ to ‘Settled’.
The specification below is used to report on the status of specific payments issued by InstaMed as part of a payment/835 transaction.
Files are output in a pipe delimited format and uploaded to client-specific SFTP directories.
|Field #||Field Name||Format||Min||Max||Required||Comment|
|3||PaymentDate||AN||8||8||S||YYYYMMDD, Available when transaction status is Paid|
|4||DisbursementEntity||AN||10||42||S||TRN03:TRN04 Available when transaction status is Paid|
|6||Funding Entity ID||AN||10||42||S|
|7||Payer Name||AN||1||35||Y||N102 when N101 = PR|
|8||Payee Last||AN||1||35||Y||N102 when N101 = PE|
|10||Payee Primary ID Qualifier||AN||2||2||Y||N103 when N101 = PE|
|11||Payee Primary ID||AN||1||80||Y||N104 when N101 = PE|
|12||Patient Last Name||AN||1||35||Y|
|13||Patient First Name||AN||1||35||Y|
|14||Patient Middle Name||AN||1||25||S|
|15||Patient ID Qualifier||AN||2||2||Y|
|17||Status||AN||1||20||Y||FULFILLED: Disbursed payments
RETURNED: Returned payment
SETTLED: Settled payments
PENDING FUNDING: Payments that are available for approval in InstaMed Online
SUSPENDED: Suspended payments
VOIDED: Voided payments
|20||Placeholder Field 2||AN||Reserved for future use|
|21||Placeholder Field 3||AN||Reserved for future use|
|22||Placeholder Field 4||AN||Reserved for future use|
|23||Placeholder Field 5||AN||Reserved for future use|
|24||Placeholder Field 6||AN||Reserved for future use|
|25||Placeholder Field 7||AN||Reserved for future use|
|26||Placeholder Field 8||AN||Reserved for future use|
|27||Placeholder Field 9||AN||Reserved for future use|
|28||Placeholder Field 10||AN||Reserved for future use|
|29||Placeholder Field 11||AN||Reserved for future use|
Date that print vendor placed item into mailstream; Always populated for CHK
|31||Placeholder Field 12||DEC||Reserved for future use|
|32||Placeholder Field 13||DEC||Reserved for future use|
|33||Placeholder Field 14||DEC||Reserved for future use|
|34||Placeholder Field 15||DEC||Reserved for future use|