Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: August 02, 2020

Under HIPAA, HHS adopted standards for electronic transactions, including health plan premium payments.

The health plan premium payment transaction is used to initiate the transfer of payment for health insurance premiums and to provide health plans with information about the transfer of funds, remittance details for individuals for whom premiums are being paid, and payment processing information (e.g., for payroll deductions).

HIPAA Adopted Standard 

In January 2009, HHS adopted Version 5010 of the ASC X12N 820 for health plan premium payments.

This standard applies to all HIPAA covered entities, health plans, health care clearinghouses, and certain health care providers, not just those who work with Medicare or Medicaid.  For more information, see the official ASC X12N website.

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.