820HIX Health Insurance Exchange Related Payments (005010X306)
Health insurance exchanges and issuers use this 820 (005010X306) to report premium payments and adjustments for exchange enrollees. This is the standard X12 HIPAA 005010 spec, with 5 loops and 28 segment positions, as OpenEDI JSON, an ediFabric C# template and an ediFabric Native model. To change it for a trading partner, customize it in the EDI Spec Builder.
Use the 820HIX spec in your code
ediFabric .NET
Add the C# template and its common files to your project, or reference the template NuGet package, and read 820HIX files into TS820HIX objects. See ediFabric .NET.
ediFabric Native
Map version 005010X306 to the Native model with set_map, then parse 820HIX files to JSON from Python, Java, C or C#. See Convert between EDI and JSON.
OpenEDI
Select Customize in Spec Builder to copy the spec under your own name, change it for your partner, and parse files against it in EdiNation, ediFabric Native or ediFabric Cloud. Read about OpenEDI.
Generate 820HIX classes in Python, Java, Node.js, Go, Rust or C
ediFabric Native returns each 820HIX as JSON, with the property names of the OpenEDI schema. To work with that JSON as typed objects, generate classes from the OpenEDI file in your language and deserialize the JSON into TS820HIX. Serialize the objects back to JSON to build EDI with ediFabric Native. The classes keep the loops, segments, lengths and code lists, but not the EDI data formats, so validate files with ediFabric Native. Read more in Generate a class from OpenEDI.
Python: datamodel-code-generator. Node.js: openapi-typescript. Java, Go, Rust and C: OpenAPI Generator.
820HIX structure
Loops and segments of the standard 820HIX, with their usage and maximum repeats.
| ID | Name | Usage | Max use |
|---|---|---|---|
| ST | Transaction Set Header | Optional | 1 |
| BPR | Financial Information | Mandatory | 1 |
| TRN | Reassociation Trace Number | Mandatory | 1 |
| REF | Exchange Assigned Qualified Health Plan Identifier | Optional | 1 |
| REF | Issuer Assigned Qualified Health Plan Identifier | Optional | 1 |
| REF | Exchange Assigned Employer Group Identifier | Optional | 1 |
| REF | Issuer Assigned Employer Group Identifier | Optional | 1 |
| Loop 1000A | Payee Name | Mandatory | 1 |
| N1 | Payee Name | Mandatory | 1 |
| REF | Unique Health Plan Identifier | Optional | 1 |
| Loop 1000B | Payers Name | Mandatory | 1 |
| N1 | Payers Name | Mandatory | 1 |
| PER | Payers Administrative Contact Information | Optional | >1 |
| Loop 2000 | Remittance Information | Mandatory | >1 |
| ENT | Remittance Information | Mandatory | 1 |
| Loop 2100 | Individual Name | Optional | 1 |
| NM1 | Individual Name | Mandatory | 1 |
| REF | Exchange Assigned Qualified Health Plan Identifier | Optional | 1 |
| REF | Issuer Assigned Qualified Health Plan Identifier | Optional | 1 |
| REF | Exchange Assigned Employer Group Identifier | Optional | 1 |
| REF | Issuer Assigned Employer Group Identifier | Optional | 1 |
| REF | Exchange Assigned Policy Identifier | Mandatory | 1 |
| REF | Issuer Assigned Policy Identifier | Optional | 1 |
| REF | Exchange Assigned APTC Contributor Tax Payer Identifier | Optional | 1 |
| REF | Issuer Assigned APTC Contributor Tax Payer Identifier | Optional | 1 |
| REF | Exchange Assigned Dependent Identifier | Optional | 1 |
| REF | Issuer Assigned Dependent Identifier | Optional | 1 |
| REF | Issuer Assigned Subscriber Identifier | Optional | 1 |
| Loop 2300 | Remittance Detail | Mandatory | >1 |
| RMR | Remittance Detail | Mandatory | 1 |
| REF | Exchange Report Document Control Number | Optional | >1 |
| DTM | Individual Coverage Period | Mandatory | 1 |
| SE | Transaction Set Trailer | Optional | 1 |