820 Transaction Set Guides (OKMMIS)
The 820 Transaction Set is the HIPAA-compliant financial transaction used to transmit care coordination payments. The 820 Transaction Set is generated by the Oklahoma OKMMIS and is distributed to primary care providers/case managers (PCP/CMs) who request electronic capitation reports and participate in the SoonerCare Choice program. The 820 Care Coordination Payment is combined with the last financial cycle of the month. This transaction is used for the Premium Payment Remittance Information (PPRI). Total payment amount noted in the BPR02 segment of the 820 Transaction may or may not equal the actual payment amount. This is due to the integration of the premium payment with fee-for-service claims payment in the same weekly financial cycle. The 820 Transaction is only available by download via the Web or RAS. The PCP/CMs must contact Gainwell to make other arrangements if other media is required.
To learn more about HIPAA EDI Transactions and become a certified EDI Professional, please visit our course schedule page.