Member Payment Level File

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 NameFormatMinMaxRequiredComment/Notes
1Record ID"IMREP10"77Y
3PaymentDateAN88SYYYYMMDD, Available when transaction status is Fulfilled
4DisbursementEntityAN1042STRN03:TRN04 Available when transaction status is Fulfilled
5FundingTraceNumberAN130SFrom original file -- TRN02
6FundingEntityAN1042SFrom original file -- TRN03:TRN04
7Payer NameAN135YN102 when N101 = PR
8Payee LastAN135YN102 when N101 = PE
9Payee FirstAN135S
10Payee Primary ID QualifierAN22YN103 when N101 = PE
11Payee Primary IDAN180YN104 when N101 = PE
12Patient Last NameAN135YNM103 when NM101 = QC
13Patient First NameAN135YNM104 when NM101 = QC
14Patient Middle NameAN125SNM105 when NM101 = QC
15Patient ID QualifierAN22YNM108 when NM101 = QC
16Patient IDAN180YNM109 when NM101 = QC
17StatusAN120YFULFILLED: Disbursed payments
SUSPENDED: Suspended payments
SETTLED: Settled payments
PENDING APPROVAL: Payments that are available for approval in InstaMed Online
VOIDED: Payments were voided by client via their bank
RETURNED: Returned payments
STOPPED: Payments were stopped by client via their bank
REMOVED: Payments was removed from Pending Approval
18Provider AdjustmentsDECS
19Claim CountDECY
20Custom Field 1AN1100OPlaceholders
21Custom Field 2AN1100OPlaceholders
22Custom Field 3AN1100OPlaceholders
23Custom Field 4AN1100OPlaceholders
24Custom Field 5AN1100OPlaceholders
25Custom Amount 1DECOPlaceholders
26Custom Amount 2DECOPlaceholders
27Custom Amount 3DECOPlaceholders
28Custom Amount 4DECOPlaceholders
29Custom Amount 5DECOPlaceholders
Date that print vendor placed item into mailstream; Always populated for CHK
31Custom Date 2AN88OPlaceholders
32Custom Date 3AN88OPlaceholders
33Custom Date 4AN88OPlaceholders
34Custom Date 5AN88OPlaceholders