Insurance
Insurance EDI and API Integration
Policy, premium and claims data that moves reliably between every party to a policy
An insurance policy involves many organizations. Employers send enrollment, agencies and carriers exchange policy data, administrators process claims and banks move premium and claim payments. ECOM integrates those exchanges, in X12, industry XML formats or plain files, with the policy, claims and finance systems you already run.
At a glance
Key documents
- 834 Benefit Enrollment
- 820 Payments and Remittance
- 111 Insurance Policy Information
- 837 Health Care Claims
- 835 Claim Payment Advice
- 148 Injury and Incident Reports
Systems we integrate
- Policy administration
- Claims administration
- Benefits and HR systems
- Finance and banking
PRISM products
- PRISM-EDI
- PRISM-SmartConvert
- PRISM Reconcile360
- PRISM-SCV
- Who we help
- Carriers, third-party administrators, MGAs, agencies, employers and benefits teams, and reinsurers.
- What we connect
- Enrollment, policy, billing, claim and payment files between your policy, claims, benefits and finance systems and each partner's format.
- Problems we solve
- A different companion guide for every carrier, enrollment that drifts out of sync, and files that are not X12.
- Even without EDI
- Many insurance exchanges run as ACORD formats, XML, spreadsheets, PDFs or agreed flat files, or through partner portals. ECOM works with those routes as well as X12.
What is insurance data exchange?
Insurance data exchange is the electronic transfer of policy, enrollment, premium, claim and payment information between carriers, agencies, third-party administrators, employers, reinsurers and banks. Group benefits use ANSI X12 transactions such as the 834 for enrollment and the 820 for premium payment; health claims use the 837 and 835. Property and casualty, life and reinsurance business often use ACORD data or agreed file layouts. ECOM can read and integrate ACORD data; formats and versions are confirmed during scoping. Many exchanges still run as agreed flat files.
Who you connect with
Who an insurance exchange connects
A policy touches many organizations. The mix differs by line, but the exchanges follow the same pattern.
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Employers and benefits systems
Enrollment changes, premium payments
X12 files, portals, spreadsheets -
Agencies and brokers
Policy, billing and commission data
ACORD formats, XML, files -
Carriers and reinsurers
Policy data, claims, bordereaux
ACORD, XML, CSV, fixed-width -
Providers and administrators
Claims and payment advice
X12 837 and 835 -
Banks
Premium receipts, claim disbursements
Bank and remittance files
Lines of business
Group benefits, property and casualty, life and reinsurance each exchange data differently
Pick the line that matches your project. Bank connections come last: they support premium and claim payments but are secondary to the carrier and administrator integrations.
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Health and group benefits
Employers, administrators and carriers moving enrollment, premium and claims.
- How it runs
- Benefits systems send enrollment changes to administrators and carriers, premium is billed and paid with remittance, and claims and payment advice flow between providers, administrators and carriers.
- Documents
- Systems
- Benefits and HR systems, enrollment platforms, claims administration, finance.
- Typical problem
- Every carrier reads the 834 its own way, and missed terminations turn into premium overpayments and denied claims.
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Property and casualty
Agencies, MGAs and carriers exchanging policy, billing and commission data.
- How it runs
- Agency management systems and carrier systems exchange policy, endorsement, billing and commission data in ACORD formats or agreed files, in batches or in real time.
- Systems
- Agency management, rating and quoting, policy administration, billing.
- Typical problem
- Each carrier implements ACORD formats a little differently, and the specifications come through ACORD membership or licensing rather than from a public download.
Source note. ECOM can read and integrate ACORD data. The formats and versions your partners use are confirmed during scoping.
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Life and annuities
Carriers, distributors and administrators exchanging applications, policies and commissions.
- How it runs
- New business, policy and commission data move between distributors, carriers and administrators, often as ACORD data or agreed files.
- Systems
- New business and illustration systems, policy administration, commission systems.
- Typical problem
- Application and policy data must match across several systems before a policy can be issued or paid commission.
Source note. ECOM can read and integrate ACORD data. Formats and versions are confirmed during scoping.
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Reinsurance and large commercial
Brokers, carriers and reinsurers sharing placements, claims and accounting.
- How it runs
- Placing, claims and accounting and settlement data move between brokers and reinsurers, in ACORD data, XML or JSON, and in bordereaux files.
- Systems
- Reinsurance administration, broker platforms, finance.
- Typical problem
- Bordereaux and settlement files vary by treaty and partner and are often reconciled by hand.
Source note. ECOM can read and integrate ACORD data. Formats and versions are confirmed during scoping.
How to read this page: a standard or system named here shows where a requirement is published or what ECOM can connect. It does not mean ECOM has a verified partnership with any named company, and your own contracts and partners define the final requirements.
Who it's for
Different roles, different workflows
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Carriers and reinsurers
You receive enrollment and policy data from employers, agencies and administrators, send policy and billing information back, and exchange claims and bordereaux files with partners.
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Third-party administrators and MGAs
You sit between employers or agents and carriers, so the same member, policy and claim data arrives in one format and must leave in each carrier's format.
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Employers and benefits teams
Your HR or benefits system sends enrollment changes to every carrier and administrator, and premium payments follow each invoice cycle.
How the workflow runs
Enrollment, premium and claims across the parties to a group policy
Group benefits show the pattern most clearly. The employer's changes reach the carrier, premium is billed and paid, and claims flow from providers to the administrator and back as payments.
- Employer→Administrator 834 Enrollment changes New hires, terminations and coverage changes.
- Administrator→Carrier 834 Enrollment to the carrier In each carrier's companion-guide format.
- Carrier→Employer Premium bill Often a list bill or an agreed file.
- Employer→Carrier 820 Premium payment Payment with remittance by member or group.
- Provider→Administrator 837 Claim For health coverage administered by the TPA.
- Administrator→Provider 835 Claim payment advice What was paid, adjusted or denied.
- 01
Capture enrollment changes
Benefits system changes are sent as 834 files on an agreed schedule, as full files or changes only, to each carrier or administrator.
- 02
Translate per carrier
Each carrier publishes its own companion guide, so the same employee change is mapped and validated differently for each destination.
- 03
Bill and pay premium
Premium invoices are reconciled against enrollment, and payment is sent with an 820 remittance that ties amounts to groups or members.
- 04
Exchange claims and payments
Claims, claim status and payment advice move between providers, administrators and carriers, with acknowledgments for every file.
- 05
Reconcile and correct
Rejected records, enrollment discrepancies and unmatched payments are returned as exceptions to the team that owns them.
Beyond EDI
Every form insurance data takes, mapped to your systems
One employer change may need an X12 file for one carrier, an XML message for another and a spreadsheet for a third. ECOM maps each to the same source record.
How it arrives
- EDI834 enrollment, 820 premium, 837 and 835 claims
- XMLACORD data and agency XML messages
- Flat fileCarrier-specific and bordereaux layouts
- SpreadsheetCensus and premium spreadsheets
- PortalCarrier and administrator portals
- PDF or emailStatements and bills converted to data
ECOM
- Validate every file or message
- Map to each partner's rules
- Deliver, acknowledge and monitor
Where it goes
- Policy admin
- Claims system
- Finance ledger
- Partner reports
Challenges
Integration challenges in insurance
A companion guide per carrier
Every carrier interprets the 834 its own way, and an employer or administrator may send to dozens of them.
Enrollment that drifts out of sync
Missed terminations and late additions turn into premium overpayments, denied claims and manual reconciliation.
Formats beyond X12
Agency, bordereaux, reinsurance and payment files arrive as XML, CSV or fixed-width layouts that each need their own mapping.
Sensitive personal data
Member and claim data must travel over encrypted, logged connections with clear ownership of every file.
How we help
How ECOM supports insurance companies
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Enrollment file integration
834 files built from benefits and HR systems, or loaded into policy administration, mapped to each partner's companion guide.
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Premium and payment matching
820 remittance and bank files matched to invoices, groups and members for reconciliation.
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Claims file exchange
Claim, claim status and payment advice files exchanged and acknowledged between providers, administrators and carriers.
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Non-X12 formats
XML, CSV and fixed-width files, including partner-specific layouts, transformed to and from your systems.
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Secure, audited transfer
Encrypted connections over AS2, SFTP or HTTPS, with every file logged and acknowledgments tracked.
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Monitoring
Missing files, rejected records and unacknowledged transfers shown as exceptions before a partner reports them.
PRISM products
Which PRISM products apply
Each partner connects in the way it can support. These products cover the connections and visibility this industry needs most.
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PRISM-EDI
Exchange of 834, 820, 837 and 835 files and other agreed formats with each carrier, administrator and employer.
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PRISM-SmartConvert
Bills, statements and forms that arrive as PDFs or emails converted into structured data.
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PRISM Reconcile360
Automated cash application and reconciliation of incoming payments and remittance against open items.
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PRISM-SCV
Monitoring of file transfers, acknowledgments and exceptions across insurance partners.
Systems integration
What insurance integration connects to
Insurance exchanges touch systems on both sides of every relationship.
From
- Benefits systems
- Agency systems
- Claims files
- Bank files
ECOM · Insurance exchange
- Validate each file
- Map per partner
- Secure delivery
To
- Policy admin
- Claims system
- Finance ledger
- Partner reports
| System | What flows | What to plan for |
|---|---|---|
| Policy administration | Enrollment, policy and endorsement data in; policy and billing data out. | Member and policy identifiers must stay consistent across every partner file. |
| Claims administration | Claims, claim status, payments and adjustments. | Health claims follow the X12 transactions adopted under HIPAA; other lines use agreed formats. |
| Benefits and HR systems | Employee enrollment and changes to carriers. | Decide full-file or change-only delivery with each carrier. |
| Finance and banking | Premium receipts, claim disbursements and remittance. | Remittance detail is what makes payments matchable. |
Lines of business
Different lines, different exchanges
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Group benefits
Enrollment, premium and claims between employers, administrators and carriers, mostly in X12.
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Property and casualty
Policy, billing and claims data between agencies and carriers, often in ACORD formats or agreed files.
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Life and annuities
Application, policy and commission data between carriers, distributors and administrators.
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Health claims
Claims and payment advice follow the HIPAA-adopted X12 transactions described on the healthcare page.
Health claims in detail
Trading partners
Guides for the banks behind premium and claim payments
Premium receipts and claim disbursements run through bank connections and payment files.
All financial guides-
JPMorgan Chase
Bank; the guide covers payment and remittance file exchange.
JPMorgan Chase in detail -
Wells Fargo
Bank; the guide covers payment and remittance file exchange.
Wells Fargo in detail -
Bank of America
Bank; the guide covers payment and remittance file exchange.
Bank of America in detail
Implementation
What to plan for in an insurance integration project
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Collect every companion guide
Each carrier or administrator documents its own rules. Start with the guides for the partners you must go live with first.
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Agree file timing and type
Full files, change files and cut-off times all affect how quickly coverage changes take effect.
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Define data ownership
Agree who corrects a rejected record and how corrections are resent, before production.
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Review security with your team
Encryption, key management, retention and access are documented for your security and compliance teams during evaluation.
Documents and standards
Common transactions
Examples of X12 transactions used in insurance and benefits. Many property and casualty, life and reinsurance exchanges use ACORD data or agreed file layouts instead. ECOM can read and integrate ACORD data; the formats and versions are confirmed during scoping, using the layout your partner or your own ACORD access provides.
| Code | Document | What it does |
|---|---|---|
| 834 | Benefit EnrollmentX12 name: Benefit Enrollment and Maintenance | Sends enrollment and coverage changes. |
| 820 | Payments and RemittanceX12 name: Payment Order/Remittance Advice | Pays premium with remittance detail. |
| 111 | Insurance Policy InformationX12 name: Individual Insurance Policy and Client Information | Shares policy and client data. |
| 837 | Health Care Claims | Submits health claims. |
| 835 | Claim Payment AdviceX12 name: Health Care Claim Payment/Advice | Explains claim payment. |
| 148 | Injury and Incident ReportsX12 name: Report of Injury, Illness or Incident | Reports an injury or incident. |
Scenarios
Typical integration scenarios
Administrator onboarding carriers
Send enrollment to each new carrier in its own format from one internal source.
Carrier receiving employer files
Validate and load 834 files from many employers, with errors returned quickly.
Premium reconciliation
Match premium payments and remittance to invoices and members.
Frequently asked questions
Does ECOM work with ACORD formats?
Yes. ECOM can read and integrate ACORD data. The specific formats and versions your carriers, agencies or reinsurers use are confirmed during scoping, and the work follows the layout your partner or your own ACORD access provides. This is a statement about reading and integrating the data, not about ACORD membership or certification.
Which EDI transactions are used in insurance?
Group benefits commonly use the X12 834 for enrollment and the 820 for premium payment, and health claims use the 837 and 835. Other lines of business often use ACORD standards or agreed file layouts.
Does ECOM provide a policy administration or claims system?
No. ECOM integrates the data exchanges with the policy, claims, benefits and finance systems you already run.
Can ECOM handle formats other than X12?
Yes. XML, CSV, fixed-width and partner-specific layouts are transformed to and from your systems alongside X12.
How is member data protected in transit?
Files travel over encrypted connections, access is controlled by role, and transfers are logged. Specific controls are documented for your security team during evaluation.
Does a working EDI connection mean regulatory compliance?
No. A tested connection confirms that the data exchange works. Regulatory and contractual compliance remains with each party.
How to get started
Tell us who you trade with and what you run
- Send the basics. Your trading partners, the documents they require, your ERP or other systems, and any deadline.
- We review the requirements. An ECOM specialist looks at the partner programs, document formats and connections involved.
- You decide how to proceed. We outline the options, including managed services or software, for you to compare.
Helpful to share, but not required
You do not need an implementation guide or a finished requirements list to contact us. If you have these, they speed things up:
- Your line of business: group benefits, property and casualty, life, reinsurance or a mix.
- Which partners you must connect first, and their companion guides or file layouts if you have them; if not, we can help gather them.
- The system each file comes from or goes to: benefits, policy admin, claims or finance.
- Delivery timing (full or change files) and any rejected-record problem you want fixed first.
See how ECOM works with customers: case studies ERP integrations compare delivery options (software, managed or team-based)
Connect your next carrier or administrator
Share the partner's companion guide and the system the data comes from. An ECOM specialist will outline mapping, testing and timing.