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 |