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 NameFormatMinMaxRequiredComment/Notes
1Record ID"IMRPA10"77Y
2DisbursementTraceNumberAN130STRN02 Disbursed check/trace number to provider; Available when transaction status is Paid
3DisbursementEntityAN1042STRN03:TRN04 Available when transaction status is Paid
4OriginalTraceNumberAN130SFrom original file TRN02
5OriginalDisbursedPaymentTraceNumberAN130SCPC Re-Issues
6ReissuedPaymentTraceNumberAN130SCPC Re-Issues
7FundingEntityAN1042SFrom original file TRN03:TRN04
8PaymentDateAN88SYYYYMMDD, Available when transaction status is Paid
9PaymentMethodAN130SACH, CHK, NON, Virtual Card
12Payer NameAN135YN102 when N101 = PR
13Payee LastAN135YN102 when N101 = PE
14Payee FirstAN135S
15Payee Primary ID QualifierAN22YN103 when N101 = PE
16Payee Primary IDAN180YN104 when N101 = PE
17Tax IDAN180SREF*TJ segment
18StatusAN120YPAID: 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
19Return CodeAN33SPopulated when Message Status = Returned
20Return ReasonAN1100SPopulated when Message Status = Returned
21Provider AdjustmentsDECS
22Claim CountNUMY
23Funding DateAN88S
25Funding StatusAN130SAvailable 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)
26Custom Field 1AN1100OReserved for future use
27Custom Field 2AN1100OReserved for future use
28Custom Field 3AN1100OReserved for future use
29Custom Field 4AN1100OReserved for future use
30Custom Field 5AN1100OReserved for future use
31Custom Amount 1DECOReserved for future use
32Custom Amount 2DECOReserved for future use
33Custom Amount 3DECOReserved for future use
34Custom Amount 4DECOReserved for future use
35Custom Amount 5DECOReserved for future use
Date that print vendor placed item into mailstream; Always populated for CHK and Virtual Card
37Custom Date 2AN88OReserved for future use
38Custom Date 3AN88OReserved for future use
39Custom Date 4AN88OReserved for future use
40Custom Date 5AN88OReserved for future use