RMR

Individual Premium Remittance Detail

Pos: 150

Max: 1

Detail - Optional

Loop: 2300B

Elements: 5

	Ref	Id	Element Name	Req	Type	Min/Max	Usage
	RMR01	128	Reference Identification Qualifier Description: Code qualifying the Reference Identification	C	ID	2/3	Required

Code

Name

Account Number

Pension Contract

Health Insurance Policy Number

For HIPAA Health Premium Payments this code is REQUIRED when an invoice has not been received from the Health Plan.

Life Insurance Policy Number

Contract Number

Insurance Certificate Number

Insurance Policy Number

Invoice Number

For HIPAA Health Premium Payments this code is REQUIRED when an invoice has been received from the Health Plan.

Certification

	RMR02	127	Reference Identification Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Health Care Industry: Insurance Remittance Reference Number	C	AN	1/30	Required
	RMR03	482	Payment Action Code Description: Code specifying the accounts receivable open item(s), if any, to be included in the cash application. This is required when the sender needs to inform the receiver how to apply the payment. For HIPAA Health Premium Payments this segment is NOT USED.	O	ID	2/2	Situational

	Code	Name
	PI	Pay Item
	PP	Partial Payment

	RMR04	782	Monetary Amount Description: Monetary amount Health Care Industry: Detail Premium Payment Amount This is the amount being paid on this remittance item.	O	R	1/18	Required
	RMR05	782	Monetary Amount Description: Monetary amount Health Care Industry: Billed Premium Amount This is required when the paid amount is different than the amount billed.	O	R	1/18	Situational

1.	If RMR03 is present, it specifies how the cash is to be applied.
2.	RMR04 is the amount paid.
3.	RMR05 is the amount of invoice (including charges, less allowance) before terms discount (if discount is applicable) or debit amount or credit amount of referenced items.
4.	RMR06 is the amount of discount taken.
5.	RMR08, if present, represents an interest penalty payment, amount late interest paid, or amount anticipation.

1.	Parties using this segment should agree on the content of RMR01 and RMR02 prior to initiating communication.
2.	If RMR03 is not present, this is a payment for an open item. If paying an open item, RMR02 must be present. If not paying a specific open item, RMR04 must be present.
3.	RMR05 may be needed by some payees to distinguish between duplicate reference numbers.

Notes:

1. Used to relay detailed remittance information related to an employee or member of a group plan.
2. For HIPAA Health Premium Payments this segment is REQUIRED.

Example:

RMR*B7*123456789*PI*250.00~

1.	P0102 - If either RMR01,RMR02 is present, then all are required
2.	P0708 - If either RMR07,RMR08 is present, then all are required