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Segment
in
X12 Release 003040

FSA Flexible Spending Account

To supply flexible spending account information
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
875
Maintenance Type Code
Identifier (ID)
Mandatory
3
3
-
Code identifying the specific type of item maintenance.
Codes (41)
02
Flexible Spending Account Selection Code
Identifier (ID)
Optional
1
1
-
Code indicating selection of a type of Flexible Spending Account.
Codes (5)
03
Maintenance Reason Code
Identifier (ID)
Optional
2
3
-
Code identifying the reason for the maintenance change.
Codes (56)
04
Account Number
String (AN)
Optional
1
35
-
Account number assigned.
FSA04 is Flexible Spending Account (FSA) Policy Number.
05
Frequency Code
Identifier (ID)
Optional
1
1
-
Code indicating frequency or type of payment.
FSA05 specifies the frequency of contribution.
Codes (12)
06
Plan Coverage Description
String (AN)
Optional
1
50
-
A description or number that identifies the plan or coverage.
07
Product Option Code
Identifier (ID)
Optional
1
2
-
Code indicating an option chosen for the product
Codes (8)
08
Product Option Code
Identifier (ID)
Optional
1
2
-
Code indicating an option chosen for the product
Codes (8)
09
Product Option Code
Identifier (ID)
Optional
1
2
-
Code indicating an option chosen for the product
Codes (8)
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.