X12 844 Product Transfer Account Adjustment

X12 Release 4010

Delimiters

• ~ Segment
• | Element
• > Component

ISA Interchange Control Header

Required · Max use 1

ISA-01 · I01 · Authorization Information Qualifier · Required · Identifier (ID)

• 00: No Authorization Information Present (No Meaningful Information in I02)

ISA-02 · I02 · Authorization Information · Required · String (AN) · Min 10 Max 10

ISA-03 · I03 · Security Information Qualifier · Required · Identifier (ID)

• 00: No Security Information Present (No Meaningful Information in I04)

ISA-04 · I04 · Security Information · Required · String (AN) · Min 10 Max 10

ISA-05 · I05 · Interchange ID Qualifier · Required · Identifier (ID) · Min 2 Max 2

Codes

• 01: Duns (Dun & Bradstreet)
• 02: SCAC (Standard Carrier Alpha Code)
• 03: FMC (Federal Maritime Commission)
• 04: IATA (International Air Transport Association)
• 08: UCC EDI Communications ID (Comm ID)
• 09: X.121 (CCITT)
• 10: Department of Defense (DoD) Activity Address Code
• 11: DEA (Drug Enforcement Administration)
• 12: Phone (Telephone Companies)
• 13: UCS Code (The UCS Code is a Code Used for UCS Transmissions; it includes the Area Code and Telephone Number of a Modem; it Does Not Include Punctuation, Blanks or Access Code)
• 14: Duns Plus Suffix
• 15: Petroleum Accountants Society of Canada Company Code
• 16: Duns Number With 4-Character Suffix
• 17: American Bankers Association (ABA) Transit Routing Number (Including Check Digit, 9 Digit)
• 18: Association of American Railroads (AAR) Standard Distribution Code
• 19: EDI Council of Australia (EDICA) Communications ID Number (COMM ID)
• 20: Health Industry Number (HIN)
• 21: Integrated Postsecondary Education Data System, or (IPEDS)
• 22: Federal Interagency Commission on Education, or FICE
• 23: National Center for Education Statistics Common Core of Data 12-Digit Number for Pre-K-Grade 12 Institutes, or NCES
• 24: The College Board's Admission Testing Program 4-Digit Code of Postsecondary Institutes, or ATP
• 25: American College Testing Program 4-Digit Code of Postsecondary Institutions, or ACT
• 26: Statistics of Canada List of Postsecondary Institutions
• 27: Carrier Identification Number as assigned by Health Care Financing Administration (HCFA)
• 28: Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration (HCFA)
• 29: Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration (HCFA)
• 30: U.S. Federal Tax Identification Number
• 31: Jurisdiction Identification Number Plus 4 as assigned by the International Association of Industrial Accident Boards and Commissions (IAIABC)
• 32: U.S. Federal Employer Identification Number (FEIN)
• 33: National Association of Insurance Commissioners Company Code (NAIC)
• 34: Medicaid Provider and Supplier Identification Number as assigned by individual State Medicaid Agencies in conjunction with Health Care Financing Administration (HCFA)
• 35: Statistics Canada Canadian College Student Information System Institution Codes
• 36: Statistics Canada University Student Information System Institution Codes
• 37: Society of Property Information Compilers and Analysts
• AM: Association Mexicana del Codigo de Producto (AMECOP) Communication ID
• NR: National Retail Merchants Association (NRMA) - Assigned
• SN: Standard Address Number
• ZZ: Mutually Defined

ISA-06 · I06 · Interchange Sender ID · Required · String (AN) · Min 15 Max 15

ISA-07 · I05 · Interchange ID Qualifier · Required · Identifier (ID) · Min 2 Max 2

Codes

• 01: Duns (Dun & Bradstreet)
• 02: SCAC (Standard Carrier Alpha Code)
• 03: FMC (Federal Maritime Commission)
• 04: IATA (International Air Transport Association)
• 08: UCC EDI Communications ID (Comm ID)
• 09: X.121 (CCITT)
• 10: Department of Defense (DoD) Activity Address Code
• 11: DEA (Drug Enforcement Administration)
• 12: Phone (Telephone Companies)
• 13: UCS Code (The UCS Code is a Code Used for UCS Transmissions; it includes the Area Code and Telephone Number of a Modem; it Does Not Include Punctuation, Blanks or Access Code)
• 14: Duns Plus Suffix
• 15: Petroleum Accountants Society of Canada Company Code
• 16: Duns Number With 4-Character Suffix
• 17: American Bankers Association (ABA) Transit Routing Number (Including Check Digit, 9 Digit)
• 18: Association of American Railroads (AAR) Standard Distribution Code
• 19: EDI Council of Australia (EDICA) Communications ID Number (COMM ID)
• 20: Health Industry Number (HIN)
• 21: Integrated Postsecondary Education Data System, or (IPEDS)
• 22: Federal Interagency Commission on Education, or FICE
• 23: National Center for Education Statistics Common Core of Data 12-Digit Number for Pre-K-Grade 12 Institutes, or NCES
• 24: The College Board's Admission Testing Program 4-Digit Code of Postsecondary Institutes, or ATP
• 25: American College Testing Program 4-Digit Code of Postsecondary Institutions, or ACT
• 26: Statistics of Canada List of Postsecondary Institutions
• 27: Carrier Identification Number as assigned by Health Care Financing Administration (HCFA)
• 28: Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration (HCFA)
• 29: Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration (HCFA)
• 30: U.S. Federal Tax Identification Number
• 31: Jurisdiction Identification Number Plus 4 as assigned by the International Association of Industrial Accident Boards and Commissions (IAIABC)
• 32: U.S. Federal Employer Identification Number (FEIN)
• 33: National Association of Insurance Commissioners Company Code (NAIC)
• 34: Medicaid Provider and Supplier Identification Number as assigned by individual State Medicaid Agencies in conjunction with Health Care Financing Administration (HCFA)
• 35: Statistics Canada Canadian College Student Information System Institution Codes
• 36: Statistics Canada University Student Information System Institution Codes
• 37: Society of Property Information Compilers and Analysts
• AM: Association Mexicana del Codigo de Producto (AMECOP) Communication ID
• NR: National Retail Merchants Association (NRMA) - Assigned
• SN: Standard Address Number
• ZZ: Mutually Defined

ISA-08 · I07 · Interchange Receiver ID · Required · String (AN) · Min 15 Max 15

ISA-09 · I08 · Interchange Date · Required · Date (DT) · YYMMDD format

ISA-10 · I09 · Interchange Time · Required · Time (TM) · HHMM format

ISA-11 · I10 · Interchange Control Standards Identifier · Required · Identifier (ID)

• U: U.S. EDI Community of ASC X12, TDCC, and UCS

ISA-12 · I11 · Interchange Control Version Number · Required · Identifier (ID)

• 00401: Draft Standards for Trial Use Approved for Publication by ASC X12 Procedures Review Board through October 1997

ISA-13 · I12 · Interchange Control Number · Required · Numeric (N0) · Min 9 Max 9

ISA-14 · I13 · Acknowledgment Requested · Required · Identifier (ID) · Min 1 Max 1

• 0: No Acknowledgment Requested
• 1: Interchange Acknowledgment Requested

ISA-15 · I14 · Usage Indicator · Required · Identifier (ID) · Min 1 Max 1

• I: Information
• P: Production Data
• T: Test Data

ISA-16 · I15 · Component Element Separator · Required · String (AN) · Min 1 Max 1

• >: Component Element Separator

GS Functional Group Header

Required · Max use 1

GS-01 · 479 · Functional Identifier Code · Required · Identifier (ID)

• CF: Corporate Financial Adjustment Information (844 and 849)

GS-02 · 142 · Application Sender's Code · Required · String (AN) · Min 2 Max 15

GS-03 · 124 · Application Receiver's Code · Required · String (AN) · Min 2 Max 15

GS-04 · 373 · Date · Required · Date (DT) · CCYYMMDD format

GS-05 · 337 · Time · Required · Time (TM) · HHMM, HHMMSS, HHMMSSD, or HHMMSSDD format

GS-06 · 28 · Group Control Number · Required · Numeric (N0) · Min 1 Max 9

GS-07 · 455 · Responsible Agency Code · Required · Identifier (ID) · Min 1 Max 2

• T: Transportation Data Coordinating Committee (TDCC)
• X: Accredited Standards Committee X12

GS-08 · 480 · Version / Release / Industry Identifier Code · Required · String (AN)

• 004010: Draft Standards Approved for Publication by ASC X12 Procedures Review Board through October 1997

Heading

010 Heading > ST

ST Transaction Set Header

Required · Max use 1

ST-01 · 143 · Transaction Set Identifier Code · Required · Identifier (ID)

• 844: Product Transfer Account Adjustment

ST-02 · 329 · Transaction Set Control Number · Required · Numeric (N) · Min 4 Max 9

020 Heading > BAA

BAA Beginning Segment for Product Transfer Account Adjustment

Required · Max use 1

If either Reference Identification Qualifier (BAA-04) or Reference Identification (BAA-05) is present, then the other is required

BAA-01 · 353 · Transaction Set Purpose Code · Required · Identifier (ID)

• 00: Original

BAA-02 · 640 · Transaction Type Code · Required · Identifier (ID)

• RA: Request for Credit

BAA-03 · 373 · Date · Required · Date (DT) · CCYYMMDD format

BAA-04 · 128 · Reference Identification Qualifier · Optional · Identifier (ID)

• AM: Adjustment Memo (Charge Back)

BAA-05 · 127 · Reference Identification · Optional · String (AN) · Min 1 Max 30

N1 Distributor Branch Optional Max 1

Variants (all may be used)

Supplier/Manufacturer

070 Heading > Distributor Branch > N1

N1 Name

Required · Max use 1

N1-01 · 98 · Entity Identifier Code · Required · Identifier (ID)

• DB: Distributor Branch

N1-02 · 93 · Name · Optional · String (AN) · Min 1 Max 60

N1-03 · 66 · Identification Code Qualifier · Required · Identifier (ID)

• 11: Drug Enforcement Administration (DEA)

N1-04 · 67 · Identification Code · Required · String (AN) · Min 2 Max 80

N1 Supplier/Manufacturer Optional Max 1

Variants (all may be used)

Distributor Branch

070 Heading > Supplier/Manufacturer > N1

N1 Name

Required · Max use 1

N1-01 · 98 · Entity Identifier Code · Required · Identifier (ID)

• SU: Supplier/Manufacturer

N1-03 · 66 · Identification Code Qualifier · Required · Identifier (ID)

• 11: Drug Enforcement Administration (DEA)

N1-04 · 67 · Identification Code · Required · String (AN) · Min 2 Max 80

Detail

CON Loop Required Max 10000

010 Detail > CON Loop > CON

CON Contract Number Detail

Required · Max use 1

CON-01 · 128 · Reference Identification Qualifier · Required · Identifier (ID)

• VC: Vendor Contract Number

CON-02 · 127 · Reference Identification · Required · String (AN) · Min 1 Max 30

CON-03 · 846 · Contract Status Code · Required · Identifier (ID)

• VA: Valid Open Contract

N1 Loop Optional Max 50

050 Detail > CON Loop > N1 Loop > N1

N1 Name

Required · Max use 1

At least one of Name (N1-02) or Identification Code Qualifier (N1-03) is required

If either Identification Code Qualifier (N1-03) or Identification Code (N1-04) is present, then the other is required

N1-01 · 98 · Entity Identifier Code · Required · Identifier (ID)

• ST: Ship To

N1-02 · 93 · Name · Optional · String (AN) · Min 1 Max 60

N1-03 · 66 · Identification Code Qualifier · Optional · Identifier (ID)

• 11: Drug Enforcement Administration (DEA)
• UL: UCC/EAN Location Code

N1-04 · 67 · Identification Code · Optional · String (AN) · Min 2 Max 80

070 Detail > CON Loop > N1 Loop > N3

N3 Address Information

Optional · Max use 2

N3-01 · 166 · Address Information · Required · String (AN) · Min 1 Max 55

080 Detail > CON Loop > N1 Loop > N4

N4 Geographic Location

Optional · Max use 1

N4-01 · 19 · City Name · Optional · String (AN) · Min 2 Max 30

N4-02 · 156 · State or Province Code · Optional · Identifier (ID) · Min 2 Max 2

N4-03 · 116 · Postal Code · Optional · Identifier (ID) · Min 3 Max 15

090 Detail > CON Loop > N1 Loop > REF

REF Health Industry Number (HIN)

Optional · Max use 1

Variants (all may be used)

REFPayer Identification Number

REF-01 · 128 · Reference Identification Qualifier · Required · Identifier (ID)

• HI: Health Industry Number (HIN)

REF-02 · 127 · Reference Identification · Required · String (AN) · Min 1 Max 30

090 Detail > CON Loop > N1 Loop > REF

REF Payer Identification Number

Optional · Max use 1

Variants (all may be used)

REFHealth Industry Number (HIN)

REF-01 · 128 · Reference Identification Qualifier · Required · Identifier (ID)

• 2U: Payer Identification Number

REF-02 · 127 · Reference Identification · Required · String (AN) · Min 1 Max 30

SII Loop Optional Max >1

105 Detail > CON Loop > N1 Loop > SII Loop > SII

SII Sales Item Information

Required · Max use 1

SII-01 · 235 · Product/Service ID Qualifier · Required · Identifier (ID)

• ND: National Drug Code (NDC)
• NH: National Health Related Item Code
• UP: U.P.C. Consumer Package Code (1-5-5-1)

SII-02 · 234 · Product/Service ID · Required · String (AN) · Min 1 Max 48

SII-03 · 380 · Quantity · Required · Decimal number (R) · Min 1 Max 15

SII-04 · C001 · Composite Unit of Measure · Required Max use 1 · To identify a composite unit of measure (See Figures Appendix for examples of use)

C001-01 · 355 · Unit or Basis for Measurement Code · Required · Identifier (ID)

• EA: Each

SII-05 · 212 · Unit Price · Required · Decimal number (R) · Min 1 Max 15

SII-06 · 212 · Unit Price · Required · Decimal number (R) · Min 1 Max 15

SII-07 · 782 · Monetary Amount · Required · Decimal number (R) · Min 1 Max 15

107 Detail > CON Loop > N1 Loop > SII Loop > N9

N9 Reference Identification

Optional · Max use 1

N9-01 · 128 · Reference Identification Qualifier · Required · Identifier (ID)

• DI: Distributor Invoice Number

N9-02 · 127 · Reference Identification · Optional · String (AN) · Min 1 Max 30

N9-04 · 373 · Date · Optional · Date (DT) · CCYYMMDD format

N9-06 · 623 · Time Code · Optional · Identifier (ID)

• L1: Unique Line Item Identifier

N9-07 · C040 · Reference Identifier · Optional Max use 1 · To identify one or more reference numbers or identification numbers as specified by the Reference Qualifier · If either Reference Identification Qualifier (C040 - 03) or Reference Identification (C040 - 04) is present, then the other is required

C040-01 · 128 · Reference Identification Qualifier · Required · Identifier (ID) · Min 2 Max 3

C040-02 · 127 · Reference Identification · Required · String (AN) · Min 1 Max 30

C040-03 · 128 · Reference Identification Qualifier · Optional · Identifier (ID)

• 8X: Transaction Category or Type

C040-04 · 127 · Reference Identification · Optional · String (AN)

• 00: for original
• 18: for credit/rebill with original
• 41: for credit/rebill with no original

Summary

010 Summary > CTT

CTT Transaction Totals

Required · Max use 1

CTT-01 · 354 · Number of Line Items · Required · Numeric (N0) · Min 1 Max 6

020 Summary > AMT

AMT Monetary Amount

Optional · Max use 5

AMT-01 · 522 · Amount Qualifier Code · Required · Identifier (ID) · Min 1 Max 3

AMT-02 · 782 · Monetary Amount · Required · Decimal number (R) · Min 1 Max 15

030 Summary > SE

SE Transaction Set Trailer

Required · Max use 1

SE-01 · 96 · Number of Included Segments · Required · Numeric (N0) · Min 1 Max 10

SE-02 · 329 · Transaction Set Control Number · Required · Numeric (N) · Min 4 Max 9

GE Functional Group Trailer

Required · Max use 1

GE-01 · 97 · Number of Transaction Sets Included · Required · Numeric (N0) · Min 1 Max 6

GE-02 · 28 · Group Control Number · Required · Numeric (N0) · Min 1 Max 9

IEA Interchange Control Trailer

Required · Max use 1

IEA-01 · I16 · Number of Included Functional Groups · Required · Numeric (N0) · Min 1 Max 5

IEA-02 · I12 · Interchange Control Number · Required · Numeric (N0) · Min 9 Max 9

EDI Samples

Sample from AmerisourceBergen

ST|844|100001757~
BAA|00|RA|20210220|AM|6192955447~
N1|DB|ABC DC SACRAMENTO|11|RA0310603~
N1|SU||11|043569607~
CON|VC|V797D70168|VA~
N1|ST|CSDC TRAVIS-TRAVIS AFB CA ROOM 136|11|RC0351849~
N3|106 BODIN CIRCLE, BUILDING 791~
N4|TRAVIS AFB|CA|94535~
SII|ND|54738054803|1|EA|6.53|5.94|.59~
N9|DI|0987543262||20210216|||L1>4187818169000020~
CON|VC|V797D70168|VA~
N1|ST|MISAWA AB MARK FOR MEDICAL MATERIEL|11|PM0059661~
N3|UNIT 5024, BLDG. 99~
N4|APO|AP|96319~
SII|ND|54738054803|11|EA|6.53|5.94|6.49~
N9|DI|0987637270||20210217|||L1>4188602230000160~
CON|VC|V797D70168|VA~
N1|ST|US NAVAL HOSP OKINAWA - HT0720 ATTN SUPPLY OFFICER N68470|11|PM0059661~
N3|PSC 482 BLDG 966 TARAWA RD CAMP FOS~
N4|FPO|AP|96362~
SII|ND|54738054803|4|EA|6.53|5.94|2.36~
N9|DI|0987637769||20210217|||L1>4188603101000380~
CTT|3~
AMT|CC|9.44~
SE|25|100001757~