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Spotlight PEPPOL BIS Billing 3.0 The EU e-invoicing mandate is here — France Sept 2026, Belgium Jan 2026, Germany 2025.

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X12 820 (HIPAA) — Health Care Premium Payment

The HIPAA 820 carries health-plan premium payments from an employer, sponsor, or TPA to the insurer, with per-employee or per-member breakdown. HIPAA-mandated via Implementation Guide 005010X218.

Purpose

The HIPAA 820 is a specific case of the 820: an employer or sponsor remits to the insurer the premiums covering a group of employees / members and provides the per-member breakdown so the payer can reconcile plan enrollment with the payment. Under HIPAA and the Affordable Care Act, this transaction is the standard exchange instrument between employers and payers, or between exchanges and payers.

The HIPAA 820 may carry the actual settlement (via ACH CCD+/CTX) or just the remittance advice (decoupled from payment). On the payer side it feeds premium reconciliation directly and matches with the 834 (Benefit Enrollment) transactions.

Envelope structure

The HIPAA 820 travels in a functional group RA. GS08 carries 005010X218. Didactic example for an employer payment:

x12 example-820-hipaa.x12 
ISA*00*          *00*          *ZZ*ACMEEMPLOYER  *ZZ*ACMEPAYER     *260514*0800*U*00501*000000820*0*P*>~
GS*RA*ACMEEMPLOYER*ACMEPAYER*20260514*0800*1*X*005010X218~
ST*820*0001*005010X218~
BPR*C*125000.00*C*ACH*CTX*01*ABA123*DA*ACCT0001*1234567890**01*ABA456*DA*ACCT0002*20260514~
TRN*1*PMT-2026-555*1234567890~
DTM*582*20260601~
N1*PE*ACME PAYER PLAN****PI*ACMEPAYER~
N1*PR*ACME EMPLOYER LLC****ID*EIN-1234567890~
ENT*1*2J*ZZ*ACME EMP*EM-001~
RMR*ZZ*MEMBER-001*PI*250.00*250.00~
SE*9*0001*005010X218~
GE*1*1~
IEA*1*000000820~

The BPR carries the total paid, the mode (ACH CTX, CCD+, check, wire), the routing and account, the effective date. TRN is the trace number. The N1 segments name Payee (PE = payer) and Premium Receiver (PR = employer). The ENT loop introduces each member, and RMR (Remittance Advice) carries the per-member allocation.

Common segments

  • Header — ST, BPR (Beginning Segment for Payment Order/Remittance Advice), TRN (Trace), DTM.
  • Parties — N1 (PE = Payer, PR = Premium Receiver).
  • Member / employee — ENT (Entity) loop with NM1, RMR (Remittance Advice), REF (member no., contract no.).
  • Allowance / charge — ADX (Adjustment) for retroactive adjustments.
  • Summary — SE.

Common pitfalls

  • Match with 834: the payer recognizes the member through its NM109 (member ID); it must match exactly the enrollment 834, otherwise reconciliation fails.
  • BPR payment mode: BPR04 distinguishes ACH (CCD+, CTX), check, wire; NACHA CTX carries CTX-formatted addenda so the 820 can ride inside the ACH message.
  • Retroactive adjustments: terminations or new enrollments with retroactive effect require per-member ADX; without them, the gap between expected and received premium cannot be explained.

Documentation

The code 820 and the name Payment Order/Remittance Advice are public and listed on x12.org/products/transaction-sets. The 005010X218 Implementation Guide is distributed by WPC EDI (wpc-edi.com) and is the official HIPAA scheme for Health Plan Premium Payments. CMS references X218 for its Exchanges via cms.gov.