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 Name | Format | Min | Max | Required | Comment/Notes |
|---|---|---|---|---|---|---|
| 1 | Record ID | "IMREP10" | 7 | 7 | Y | |
| 2 | PaymentAmount | DEC | Y | |||
| 3 | PaymentDate | AN | 8 | 8 | S | YYYYMMDD, Available when transaction status is Fulfilled |
| 4 | DisbursementEntity | AN | 10 | 42 | S | TRN03:TRN04 Available when transaction status is Fulfilled |
| 5 | FundingTraceNumber | AN | 1 | 30 | S | From original file -- TRN02 |
| 6 | FundingEntity | AN | 10 | 42 | S | From original file -- TRN03:TRN04 |
| 7 | Payer Name | AN | 1 | 35 | Y | N102 when N101 = PR |
| 8 | Payee Last | AN | 1 | 35 | Y | N102 when N101 = PE |
| 9 | Payee First | AN | 1 | 35 | S | |
| 10 | Payee Primary ID Qualifier | AN | 2 | 2 | Y | N103 when N101 = PE |
| 11 | Payee Primary ID | AN | 1 | 80 | Y | N104 when N101 = PE |
| 12 | Patient Last Name | AN | 1 | 35 | Y | NM103 when NM101 = QC |
| 13 | Patient First Name | AN | 1 | 35 | Y | NM104 when NM101 = QC |
| 14 | Patient Middle Name | AN | 1 | 25 | S | NM105 when NM101 = QC |
| 15 | Patient ID Qualifier | AN | 2 | 2 | Y | NM108 when NM101 = QC |
| 16 | Patient ID | AN | 1 | 80 | Y | NM109 when NM101 = QC |
| 17 | Status | AN | 1 | 20 | Y | FULFILLED: 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 |
| 18 | Provider Adjustments | DEC | S | |||
| 19 | Claim Count | DEC | Y | |||
| 20 | Custom Field 1 | AN | 1 | 100 | O | Placeholders |
| 21 | Custom Field 2 | AN | 1 | 100 | O | Placeholders |
| 22 | Custom Field 3 | AN | 1 | 100 | O | Placeholders |
| 23 | Custom Field 4 | AN | 1 | 100 | O | Placeholders |
| 24 | Custom Field 5 | AN | 1 | 100 | O | Placeholders |
| 25 | Custom Amount 1 | DEC | O | Placeholders | ||
| 26 | Custom Amount 2 | DEC | O | Placeholders | ||
| 27 | Custom Amount 3 | DEC | O | Placeholders | ||
| 28 | Custom Amount 4 | DEC | O | Placeholders | ||
| 29 | Custom Amount 5 | DEC | O | Placeholders | ||
| 30 | Mail Date | AN | 8 | 8 | O | YYYYMMDD Date that print vendor placed item into mailstream; Always populated for CHK |
| 31 | Custom Date 2 | AN | 8 | 8 | O | Placeholders |
| 32 | Custom Date 3 | AN | 8 | 8 | O | Placeholders |
| 33 | Custom Date 4 | AN | 8 | 8 | O | Placeholders |
| 34 | Custom Date 5 | AN | 8 | 8 | O | Placeholders |