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

Issue Date: September 11, 2015

Program Area: Vendor Management, Payments, and Collections (VMPC)

Question: How many HIX 820 transactions will health insurance companies receive per Heath Insurance Oversight System (HIOS) ID?

Answer: Issuers will receive one (1) PPR and one (1) HIX 820 transaction per Payee ID unless they receive payments in excess of 100 million dollars, or if the HIX 820 transaction exceeds one million lines. For example, If an Issuer receives a payment over 100 million dollars, that Issuer will receive one (1) PPR and two (2) HIX 820 transactions for that Payee Group.

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.

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.