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|
|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|
|7||Funding Entity ID||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|
|12||Payer Name||AN||1||35||Y||N102 when N101 = PR|
|13||Payee Last||AN||1||35||Y||N102 when N101 = PE|
|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 payment
SETTLED: Settled payments
CANCELLED: Cancelled, Reissued, or Expired virtual card payments
PENDING FUNDING: Payments that are available for approval in InstaMed Online
SUSPENDED: Suspended payments
PARTIALLY SETTLED: Partially settled payments
VOIDED: Voided payments
EXPIRED: Expired claim payment card payments
STOPPED: A check has been voided or stopped by the bank
|19||Return Code||AN||3||3||S||Populated when Message Status = Returned|
|20||Return Reason||AN||1||100||S||Populated when Message Status = Returned|
|25||Funding Status||AN||1||30||S||Pending Funding
|26||Placeholder Field 6||AN||Reserved for future use|
|27||Placeholder Field 7||AN||Reserved for future use|
|28||Placeholder Field 8||AN||Reserved for future use|
|29||Placeholder Field 9||AN||Reserved for future use|
|30||Placeholder Field 10||AN||Reserved for future use|
|31||Placeholder Field 11||AN||Reserved for future use|
|32||Placeholder Field 12||DEC||Reserved for future use|
|33||Placeholder Field 13||DEC||Reserved for future use|
|34||Placeholder Field 14||DEC||Reserved for future use|
|35||Placeholder Field 15||DEC||Reserved for future use|
Date that print vendor placed item into mailstream; Always populated for CHK and Virtual Card