Payment Type Codes
These codes identify the type and purpose for a payment amount.
Exchange Payment Type codes are transmitted in 005010X306, loop 2300, RMR02. They identify the type and purpose for the payment amount transmitted in ASC X12 005010X306, loop 2300, RMR04.
Note:
- Catastrophic is included in Individual Market and Merged is Individual and Small Group Markets combined.
- All markets include both on and off exchange issuers.
- Exchange markets include Individual/Small Group/Catastrophic/Merged.
- Specific transaction detail may be provided in the Document Control Number in the payment reports effective July 2017.
3/1/2021
Code List Filters
| ADM | Administrative Fees used for a debt owed by the payee. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. The Administrative Fee is $15. Negative Amounts Only Start: 11/01/2015 | Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets |
| APTC | Advance Payment of Premium Tax Credit. RMR04 will be positive. Start: 10/01/2013 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| APTCADJ | Advance Payment of Premium Tax Credit Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| APTCMADJ | APTC Manual Adjustment. Used to show APTC manual adjustment when enrollment group level information is not applicable. RMR04 will be positive or negative and may be reversed in the future. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Start: 10/01/2013 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| BAL | When an AR invoice is split between multiple HIX 820 reports, this adjustment balances the reports. Negative Amounts & Positive Amounts Start: 10/01/2013 | Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets |
| CSR | Advance Payment of Cost Sharing Reduction. RMR04 will be positive. Start: 10/01/2013 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| CSRADJ | Advance Payment of Cost Sharing Reduction Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| CSRMADJ | CSR Manual Adjustment. Used to show CSR manual adjustment when enrollment group level information is not provided. RMR04 will be positive or negative and may be reversed in the future. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Start: 10/01/2013 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| CSRN | Cost Sharing Reduction Reconciliation. Negative Amounts & Positive Amounts Start: 01/01/2015 | Last Modified: 05/01/2017 Notes: CMS Exchange Markets |
| CSRNADJ | Cost Sharing Reduction Reconciliation Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| DDVC | Default Data Validation Charge or Allocation Payment. If DDVC is the Payment Type Code, a corresponding Report Type Code of DDVCRPT will also be included. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017). Negative Amounts & Positive Amounts
Start: 02/01/2021 Notes: All Markets |
| DEBTADJ | Payee's debt amount covered by an affiliate's payment. RMR04 will be positive. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. When used to report that a prior debt was covered, RMR04 with the payment type code of BAL will also be used. Start: 10/01/2013 | Last Modified: 11/01/2014 | Stop: 05/01/2015 Notes: CMS |
| DEPENDENTPREM | Dependent responsible premium amount. RMR04 will be positive. Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| DEPENDENTPREMADJCANCEL | Dependent premium amount adjustment due to cancellation. RMR04 will positive or negative Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| DEPENDENTPREMADJNSF | Dependent responsible premium amount due to non-sufficient funds. RMR04 will be positive or negative. Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| DEPENDENTPREMADJTERMINATE | Dependent responsible premium amount due to the termination of a policy. RMR04 will be positive or negative. Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| EMPLOYEEPREM | Employee responsible premium amount. RMR04 will be positive. Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| EMPLOYEEPREMADJCANCEL | Employee responsible premium amount adjustment due to cancellation. RMR04 will be positive or negative Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| EMPLOYEEPREMADJNSF | Employee responsible premium amount adjustment due to non-sufficient funds. RMR04 will be positive or negative. Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| EMPLOYEEPREMADJTERMINATE | Employee responsible premium amount adjustment due to the termination of a policy. RMR04 will be positive or negative. Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| EMPLOYERPREM | Employer responsible premium amount. RMR04 will be positive. Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| EMPLOYERPREMADJCANCEL | Employer responsible premium amount adjustment due to cancellation. RMR04 will be positive or negative Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| EMPLOYERPREMADJNSF | Employer responsible premium amount adjustment due to non-sufficient funds. RMR04 will be positive or negative. Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| EMPLOYERPREMADJTERMINATE | Employer responsible premium amount adjustment due to the termination of a policy. RMR04 will be positive or negative. Start: 11/01/2014 | Last Modified: 11/01/2015 Notes: CMS SHOP Market Only |
| EXTLOAN | Payment Offsets For Co-op Loan. Negative Amounts Only Start: 10/18/2016 Notes: CMS Co-ops Only |
| HCRPC | High Cost Risk Pool Contribution Amount. Negative Amounts & Positive Amounts Start: 08/01/2019 Notes: All Markets |
| HCRPP | High Cost Risk Pool Payment Amount. Negative Amounts & Positive Amounts Start: 08/01/2019 Notes: All Markets |
| HCRPPYREF | High Cost Risk Pool Refund For Prior Fiscal Years. Positive Amounts Only Start: 08/01/2019 Notes: All Markets |
| HCRPADMIN | High Cost Risk Pool Refund of Admin Charge. Positive Amounts Only Start: 08/01/2019 Notes: All Markets |
| HCRPINT | High Cost Risk Pool Refund of Interest Charge. Positive Amounts Only Start: 08/01/2019 Notes: All Markets |
| INT | Interest charges for a debt owed by the payee. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. The Secretary of Treasury certifies and updates an interest rate on a quarterly basis. Negative Amounts Only Start: 11/01/2015 | Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets |
| INVOICE | Used to show a total amount that will be billed or otherwise collected. Only used when BPR02 would otherwise be negative. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Negative Amounts Only Start: 10/01/2013 | Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets |
| PEN | Penalty charges for a debt owed by the payee. The Treasury will add additional administrative fees of up to 30 percent and accrue the required penalty charge of 6 percent per year on any amount outstanding. Interest will continue to accrue. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Negative Amounts Only Start: 11/01/2015 | Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets |
| RA | Risk Adjustment Charge or Payment. If RA is the Payment Type Code, a corresponding Report Type Code of RARPT will also be included. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017).
Negative Amounts & Positive Amounts Start: 01/01/2015 | Last Modified: 03/01/2021 Notes: All Markets |
| RAADJ | Risk Adjustment Payment or Charge Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| RAAR | Risk Adjustment Administration Fee Refund. A Risk Adjustment Admin Fee is only charged if an Issuer does not pay their RA Charges within 30 days. Positive Amounts Only Start: 10/01/2015 | Last Modified: 05/01/2017 Notes: All Markets |
| RACR | Risk Adjustment Refund For Prior Fiscal Years. Positive Amounts Only Start: 05/01/2015 Notes: All Markets |
| RAD | Risk Adjustment Default Charge or Allocation Payment. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017). Negative Amounts & Positive Amounts
Start: 05/01/2015 | Last Modified: 03/01/2021 Notes: All Markets |
| RADV | Risk Adjustment Data Validation Adjustment Charge or Payment. If RADV is the Payment Type Code, a corresponding Report Type Code of RADVRPT will also be included. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017).
Negative Amounts & Positive Amounts
Start: 02/01/2021 Notes: All Markets |
| RAIR | Risk Adjustment Interest Charge Refund. A Risk Adjustment Interest Charge is only assessed if an Issuer does not pay their RA Charges within 30 days. Negative Amounts & Positive Amounts Start: 10/01/2015 | Last Modified: 05/01/2017 Notes: All Markets |
| RAREF | Risk Adjustment Refund For Current Fiscal Year. Positive Amounts Only Start: 05/01/2015 Notes: All Markets |
| RAUF | Risk Adjustment User Fee. Negative Amounts Only Start: 01/01/2015 | Last Modified: 05/01/2017 Notes: All Markets |
| RAUFADJ | Risk Adjustment User Fee Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| RAUFAR | Risk Adjustment User Fee Refund of admin charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets |
| RAUFIR | Risk Adjustment User Fee Refund of interest charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets |
| RAUFR | Risk Adjustment User Fee Refund. Positive Amounts Only Start: 05/01/2015 Notes: All Markets |
| RAUFR2PY | Risk Adjustment User Fee Refund. Positive Amounts Only Start: 10/18/2016 | Last Modified: 08/01/2018 | Stop: 09/30/2018 Notes: All Markets |
| RAUFREF | Risk Adjustment User Fee refund for current fiscal year. Positive Amounts Only Start: 05/01/2015 Notes: All Markets |
| RAUFRN | Risk Adjustment User Fee Refund. Positive Amounts Only Start: 05/01/2015 | Last Modified: 08/01/2018 | Stop: 09/30/2018 Notes: All Markets |
| RC | Risk Corridor Program payment or charge amount. Negative Amounts & Positive Amounts Start: 01/01/2015 | Last Modified: 05/01/2017 Notes: CMS Exchange Markets |
| RC15 | Risk Corridors Charges. Negative Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets |
| RCADJ | Risk Corridor Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| RCAR | Risk Corridors Refund Of Admin Charge. Positive Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets |
| RCCR15 | Risk Corridors Refund For Prior Fiscal Years. Positive Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets |
| RCCR16 | Risk Corridors Refund For Current Fiscal Year. Positive Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets |
| RCIR | Risk Corridors Refund Of Interest Charge. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets |
| RCREF | Risk Corridors Refund For Current Fiscal Year. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets |
| REDUCED | Payment reduced to cover a debt owed by the payee. RMR04 will be negative. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Negative Amounts Only Start: 10/01/2013 | Last Modified: 05/01/2017 Notes: CMS Exchange Markets |
| RIC | Reinsurance Contribution Amount. Negative Amounts & Positive Amounts Start: 06/01/2014 | Last Modified: 05/01/2017 Notes: All Markets |
| RICADJ | Reinsurance Contribution Adjustment. RMR04 will be positive or negative. Start: 06/01/2014 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| RICAR | Reinsurance Contribution Refund Of Admin Charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets |
| RICIR | Reinsurance Contribution Refund Of Interest Charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets |
| RICR | Reinsurance Contribution Refund For Prior Fiscal Years. Positive Amounts Only Start: 05/01/2015 Notes: All Markets |
| RICREF | Reinsurance Contribution Refund For Current Fiscal Year. Positive Amounts Only Start: 05/01/2015 Notes: All Markets |
| RIP | Reinsurance Payment Amount. Negative Amounts & Positive Amounts Start: 06/01/2014 | Last Modified: 05/01/2017 Notes: CMS Individual Market Only |
| RIPADJ | Reinsurance Payment Adjustment. RMR04 will be positive or negative. Start: 06/01/2014 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| SHOPUF | Federally-facilitated Marketplace User Fee for SHOP plans. (SHOP HIX 820 Trace Number may be provided in the Document Control Number in the payment reports). Negative Amounts & Positive Amounts Start: 10/01/2013 | Last Modified: 05/01/2017 Notes: CMS SHOP Market |
| SHOPUFADJ | Federally-facilitated Marketplace User Fee Adjustment for SHOP plans. RMR04 will be positive or negative. This code will not be used. Start: 10/01/2013 | Last Modified: 11/01/2015 | Stop: 11/01/2015 Notes: CMS Individual Market Only |
| SHOPUFMADJ | Federally-facilitated Marketplace User Fee Manual Adjustment for SHOP Plans. Start: 10/01/2013 | Last Modified: 11/01/2015 | Stop: 11/01/2015 Notes: CMS Individual Market Only |
| UF | Federally-facilitated Marketplace User Fee. RMR04 will be negative. Start: 10/01/2013 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| UFADJ | Federally-facilitated Marketplace User Fee Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| UFAR | FFM User Fee refund of admin charges. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets |
| UFIR | FFM User Fee Refund of interest charges. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets |
| UFMADJ | Federally-facilitated Marketplace User Fee Manual Adjustment. Used to show user fee manual adjustment when enrollment group level information is not provided. RMR04 will be positive or negative and may be reversed in the future. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Start: 10/01/2013 | Last Modified: 11/01/2015 Notes: CMS Individual Market Only |
| UFR | Federally-facilitated Marketplace User Fee Adjustment related to providing contraceptive care coverage. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Positive Amounts Only Start: 11/01/2015 | Last Modified: 05/01/2017 Notes: CMS Exchange Markets |
| UFR2PY | FFM User Fee Refund. Positive Amounts Only Start: 10/18/2016 | Last Modified: 08/01/2018 | Stop: 09/30/2018 Notes: CMS Exchange Markets |
| UFRP | FFM User Fee Refund. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets |
| UFRPN | FFM User Fee Refund. Positive Amounts Only Start: 05/01/2015 | Last Modified: 08/01/2018 | Stop: 09/30/2018 Notes: CMS Exchange Markets |
| COMM | Any commissions withheld by the Exchange. RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only |
| COMMADJ | Any commissions adjustment. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only |
| DEDUCT | Deductible amount due to the Payer. RMR04 will be positive or negative. Start: 10/01/2015 Notes: SBM Only |
| INTPREM | Initial premium payment received by the Exchange from the customer. This amount will be the gross premium received from the customer. RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only |
| MDCAID | State Medicaid Subsidy. RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only |
| MDCAIDADJ | State Medicaid Subsidy Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only |
| MISC | Used to indicate miscellaneous amounts (i.e. write-offs, etc.) RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only |
| MRF | Marketplace-Related Fee. This is the amount that is being paid not attributable to an individual coverage but at a plan or carrier level. If negative, the fee was withheld from carrier payments. If positive, the fee was paid to the carrier. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only |
| MRFADJ | Adjustments to a previously sent MRF. The MRFADJ is not attributable to an individual coverage level but at a plan or carrier level. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only |
| NONPAYADJ | Code use to indicate an adjustment is being made due to a NSF or stop payment. Amount will always be negative. Start: 10/01/2013 Notes: SBM Only |
| OPMUF | OPM Multi-State Plan user fee. RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only |
| OPMUFADJ | OPM Multi-State Plan user fee manual adjustment. Used to show user fee manual adjustment when enrollment group level information is not provided. RMR04 will be positive or negative and may be reversed in the future. Start: 10/01/2013 Notes: SBM Only |
| PREM | Premium payment amount received for the enrollment group for coverage (excluding APTC and Exchange-Related Fees). RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only |
| PREMADJ | Adjustments to premium payment amount received for the enrollment group for coverage (excluding APTC and Marketplace-Related Fees). RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only |
| PREMALL | Premium payment amount received for the enrollment group for coverage (including APTC and Marketplace-Related Fees). RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only |
| PREMALLADJ | Adjustments to premium payment amount received for the enrollment group for coverage (including APTC and Marketplace-Related Fees). RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only |
| REFUND | Total refunded amount sent back to the customer. RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only |
| RETURN | Total returned payment (i.e. returned due to non-sufficient funds). RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only |
| SBMUF | State Based Marketplace User Fee. RMR04 will be negative. Start: 05/01/2015 Notes: SBM Only |
| SBMUFADJ | State Based Marketplace User Fee Adjustment. RMR04 will be positive or negative. Start: 05/01/2015 Notes: SBM Only |
| SMAND | State Mandate Benefit Subsidy. RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only |
| SMANDADJ | State Mandate Benefit Subsidy Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only |
| TPP | Money paid by a third party payer as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only |
| TPPADJ | Adjustments to Money paid by a third party payer as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only |
| TRIBE | Money paid by a registered Tribe as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only |
| TRIBEADJ | Adjustments to Money paid by a registered Tribe as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only |
| WRITEOFF | Write off amount Start: 06/01/2014 Notes: SBM Only |