Provider Payment Level File

InstaMed supports the ability to send payments (and denials) to providers (Explanation of Payment or EOP). These outbound payments consist of claims adjudicated by a health plan and owed to a provider.

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 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/Notes
1	Record ID	"IMRPA10"	7	7	Y
2	DisbursementTraceNumber	AN	1	30	S	TRN02 Disbursed check/trace number to provider; Available when transaction status is Paid
3	DisbursementEntity	AN	10	42	S	TRN03:TRN04 Available when transaction status is Paid
4	OriginalTraceNumber	AN	1	30	S	From original file TRN02
5	OriginalDisbursedPaymentTraceNumber	AN	1	30	S	CPC Re-Issues
6	ReissuedPaymentTraceNumber	AN	1	30	S	CPC Re-Issues
7	FundingEntity	AN	10	42	S	From original file TRN03:TRN04
8	PaymentDate	AN	8	8	S	YYYYMMDD, Available when transaction status is Paid
9	PaymentMethod	AN	1	30	S	ACH, CHK, NON, Virtual Card
10	PaymentAmount	DEC			Y
11	SettlementAmount	DEC			S
12	Payer Name	AN	1	35	Y	N102 when N101 = PR
13	Payee Last	AN	1	35	Y	N102 when N101 = PE
14	Payee First	AN	1	35	S
15	Payee Primary ID Qualifier	AN	2	2	Y	N103 when N101 = PE
16	Payee Primary ID	AN	1	80	Y	N104 when N101 = PE
17	Tax ID	AN	1	80	S	REF*TJ segment
18	Status	AN	1	20	Y	PAID: Payment was disbursed to provider RETURNED: Returned payments SETTLED: Settled payments CANCELLED: Cancelled and Reissued card payments PENDING APPROVAL: Payments that are available for approval in InstaMed Online SUSPENDED: Suspended payments PARTIALLY SETTLED: Partially settled payments VOIDED: Payments were voided by client via their bank EXPIRED: Expired claim payment card payments STOPPED: Payments were stopped by client via their bank REMOVED: Payments was removed from Pending Approval
19	Return Code	AN	3	3	S	Populated when Message Status = Returned
20	Return Reason	AN	1	100	S	Populated when Message Status = Returned
21	Provider Adjustments	DEC			S
22	Claim Count	NUM			Y
23	Funding Date	AN	8	8	S
24	FundingTraceNumber	AN	1	30	S
25	Funding Status	AN	1	30	S	Available with select funding models Notified: Email issued to Funding Entity (e.g. employer group) requesting funding Ready for Funding: Transactions have been "settled" and funds are set to be collected (status is used with Presentment model) Funded: NACHA Debit created to pull funding (funds to subaccount) Ready for Replenishment: Transactions have been "settled" and funds are set to be collected (status is used with Issuance and Target Balance models) Replenished: NACHA Debit created to pull funding (funds to disbursing account)
26	Custom Field 1	AN	1	100	O	Reserved for future use
27	Custom Field 2	AN	1	100	O	Reserved for future use
28	Custom Field 3	AN	1	100	O	Reserved for future use
29	Custom Field 4	AN	1	100	O	Reserved for future use
30	Custom Field 5	AN	1	100	O	Reserved for future use
31	Custom Amount 1	DEC			O	Reserved for future use
32	Custom Amount 2	DEC			O	Reserved for future use
33	Custom Amount 3	DEC			O	Reserved for future use
34	Custom Amount 4	DEC			O	Reserved for future use
35	Custom Amount 5	DEC			O	Reserved for future use
36	Mail Date	AN	8	8	S	YYYYMMDD Date that print vendor placed item into mailstream; Always populated for CHK and Virtual Card
37	Custom Date 2	AN	8	8	O	Reserved for future use
38	Custom Date 3	AN	8	8	O	Reserved for future use
39	Custom Date 4	AN	8	8	O	Reserved for future use
40	Custom Date 5	AN	8	8	O	Reserved for future use