Appendix D. Change Summary

This Implementation Guide (007030X345) defines the X12 requirements for the Health Insurance Exchange Related Payments. It is based on version/release/subrelease 007030 of the ASC X12 standards.

LocationX345 | Health Insurance Exchange Related Payments
1.4 Business Usage
ActionModify Chapter 1
Section 1.4.3.1.2 Row 1, Column 5, changed to:

Required when the enrollment is from a SHOP exchange and an exchange assigned employer group identifier was provided in the 834 enrollment transaction and all enrollees within this transaction apply to a single employer group. If not required by this implementation guide, do not send.
CR 1363The Exchange Assigned Employer Group Identifier segments (positions 0500 and 0600) have a similar business use and should have a similar situational rule.
LocationX345 | Health Insurance Exchange Related Payments
1.4 Business Usage
ActionModify Chapter 1
Section 1.4.3.1.2 Row 3, column 2.

From:
2000

To:
2100
CR 1363The Exchange Assigned Employer Group Identifier segments (positions 0500 and 0600) have a similar business use and should have a similar situational rule.
LocationX345 | Health Insurance Exchange Related Payments
1.4 Business Usage
ActionModify Chapter 1
Section 1.4.3.1.2 Row 4, Column 3,

From:
2000

To:
2100
CR 1363The Exchange Assigned Employer Group Identifier segments (positions 0500 and 0600) have a similar business use and should have a similar situational rule.
LocationX345 | Health Insurance Exchange Related Payments
1.4 Business Usage
ActionModify Chapter 1
Modify Front Matter Section 1.4.3.1.2 (Employer Group Identifier) Table- Row 3 (Enrollee Level), Column 4 (Usage)

To:
Required when the enrollment is from a SHOP exchange and an exchange assigned employer group identifier was provided in the 834 enrollment transaction and the Header REF (Exchange Assigned Employer Group Identifier )is not used. If not required by this implementation guide, do not send.
CR 1363The Exchange Assigned Employer Group Identifier segments (positions 0500 and 0600) have a similar business use and should have a similar situational rule.
LocationX345 | Health Insurance Exchange Related Payments
1.10 Data Overview
ActionAdd Chapter 1
Add to section 1.10.1.1, 2nd paragraph.

One 820 transaction set reflects a single payment device. For example, one 820 transaction corresponds to one check or one EFT payment. Multiple premium amounts can be referenced within a single 820 transaction.
CR 1443Revise the front matter to address reassociation challenges by specifying one 820 corresponds to one EFT or check.
LocationX345 | Health Insurance Exchange Related Payments | 820 | 0100
ST - 820 Header
ActionAdd Data Element Note
Header/ST02 Transaction Set Control Number

The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). For example, start with the number 0001 and increment from there. The number also aids in error resolution research.
CR 999Revise the ST02 notes across the TR3's to make them consistent.
LocationX345 | Health Insurance Exchange Related Payments | 820 | 0200
BPR - Financial Information
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX345 | Health Insurance Exchange Related Payments | 820 | 0500
REF - Exchange Assigned Employer Group Identifier
ActionModify Segment Situational Rule
Required when the enrollment is from a SHOP exchange and an exchange assigned employer group identifier was provided in the 834 enrollment transaction and all enrollees within this transaction apply to a single employer group. If not required by this implementation guide, do not send.
CR 1363The Exchange Assigned Employer Group Identifier segments (positions 0500 and 0600) have a similar business use and should have a similar situational rule.
LocationX345 | Health Insurance Exchange Related Payments | 820 | 0600 | 2100
REF - Exchange Assigned Employer Group Identifier
ActionModify Segment Situational Rule
Required when the enrollment is from a SHOP exchange and an exchange assigned employer group identifier was provided in the 834 enrollment transaction Header REF (Exchange Assigned Employer Group Identifier) is not used. If not required by this implementation guide, do not send.
CR 1363The Exchange Assigned Employer Group Identifier segments (positions 0500 and 0600) have a similar business use and should have a similar situational rule.
LocationX345 | Health Insurance Exchange Related Payments | 820 | 1500 | 2300
RMR - Remittance Detail
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX345 | Health Insurance Exchange Related Payments | 820 | 0100
SE - Transaction Set Trailer
ActionAdd Data Element Note
Transaction Set Trailer/SE02 Transaction Set Control Number

The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). For example, start with the number 0001 and increment from there. The number also aids in error resolution research.
CR 999Revise the ST02 notes across the TR3's to make them consistent.