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The HIPAA Premium Payment Master

Software for the HIPAA 820 Transaction Set, now with support for HIX

The 820 transaction set contains premium and policy payment information. It is another part of the HIPAA stipulted EDI transactions.

Target for the HIPAA 820 transaction, 005010X218A1, set is the communication between a sponsor, i.e. an entity that pays for someone's health care, and an entity that manages health care benefits, such as an insurance. For example a large employer that has a contract with an Insurance company or a TPA (Third Party Administrator) pays its employees' health insurance premiums. This information can either be very detailed and contain some demographic information on each individual that is covered and the premium amount being paid or just contain a summary of the payment for all members.

Health Insurance Exchanges (HIX) use a slightly different version , 005010X306,  to transmit payment information to the carriers. The HIPAA Premium Payment Master supports both versions transparently.

The HIPAA Premium Payment Master processes the information contained in those 820 EDI files. It can display the data in data forms on the screen, save this image to a PDF or TIFF file and print it to paper. The cryptic EDI information is translated and each element in the EDI file is properly displayed. A perfect solution for those with small volumes of 820 files who can use manual entry into their accounting system.

With its database module enabled the HIPAA Premium Payment Master can export the EDI data to any ODBC compliant database, such as Microsoft SQL Server, Oracle or most other databases. Each individual record and element in the EDI file is saved in our staging tables. Ideal for those with larger volumes of 820 EDI files and who will create their own processes to extract and utilize data from our staging tables. The reverse process from SQL to EDI is in the planning stage. Please inquire for more information.

And with the EDI Exchange module enabled, one can create the 999 and TA1 files, handle transport via FTP and ecryption. This makes it the perfect tool for HIX implementations.

The HIPAA Premium Payment Master can:

  • Process Premium Payment information that was submitted in an X12 820 transactions.
  • Display the information for each payment on a form that can be printed.
  • Export 820 data to two staging tables in any ODBC compliant database, such as SQL Server, MySQL and Oracle
  • Integrate with an existing system through the database interface
  • Automate processing through the scheduler and command line arguments


 View the detailed documentationpdficon sm