X12 849 Response to 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)

• 849: Response to Product Transfer Account Adjustment

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

020 Heading > BRC

BRC Beginning Segment for Response to Product Transfer Account Adjustment

Required · Max use 1

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

• 00: Original
• 15: Re-Submission

BRC-02 · 373 · Date · Required · Date (DT) · CCYYMMDD format

BRC-03 · 128 · Reference Identification Qualifier · Required · Identifier (ID)

• CM: Buyer's Credit Memo

BRC-04 · 127 · Reference Identification · Required · String (AN) · Min 1 Max 30

050 Heading > REF

REF Adjustment Memo (Charge Back)

Required · Max use 1

Variants (all may be used)

REFMutually Defined

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

• AM: Adjustment Memo (Charge Back)

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

050 Heading > REF

REF Mutually Defined

Optional · Max use 12

Variants (all may be used)

REFAdjustment Memo (Charge Back)

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

• ZZ: Mutually Defined

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

N1 Loop Distrubutor Required Max 1

Variants (all may be used)

N1 Loop Supplier/Manufacturer

080 Heading > N1 Loop Distrubutor > N1

N1 Name

Required · Max use 1

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

• DB: Distributor Branch
• DS: Distributor

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 Loop Supplier/Manufacturer Required Max 1

Variants (all may be used)

N1 Loop Distrubutor

080 Heading > N1 Loop Supplier/Manufacturer > N1

N1 Name

Required · Max use 1

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

• MF: Manufacturer of Goods
• SU: Supplier/Manufacturer

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

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

• 1: D-U-N-S Number, Dun & Bradstreet
• 11: Drug Enforcement Administration (DEA)
• 21: Health Industry Number (HIN)

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

030 Detail > CON Loop > REF

REF Reference Identification

Optional · Max use 12

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

• C8: Corrected Contract Number

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

N1 Loop Required Max 50

060 Detail > CON Loop > N1 Loop > N1

N1 Name

Required · Max use 1

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

• ST: Ship To

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

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

• 11: Drug Enforcement Administration (DEA)
• 21: Health Industry Number (HIN)
• PI: Payor Identification
• UL: UCC/EAN Location Code

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

PAD Loop Required Max 1000

120 Detail > CON Loop > PAD Loop > PAD

PAD Product Adjustment Detail

Required · Max use 1

PAD-01 · 350 · Assigned Identification · Required · String (AN) · Min 1 Max 20

130 Detail > CON Loop > PAD Loop > LIN

LIN Item Identification

Required · Max use 1

LIN-01 · 350 · Assigned Identification · Optional · String (AN) · Min 1 Max 20

LIN-02 · 235 · Product/Service ID Qualifier · Required · Identifier (ID)

• N4: National Drug Code in 5-4-2 Format
• ND: National Drug Code (NDC)
• NH: National Health Related Item Code
• UI: U.P.C. Consumer Package Code (1-5-5)

LIN-03 · 234 · Product/Service ID · Required · String (AN) · Min 1 Max 48

140 Detail > CON Loop > PAD Loop > AAA

AAA Request Validation

Optional · Max use 10

AAA-01 · 1073 · Yes/No Condition or Response Code · Required · Identifier (ID)

• N: No

AAA-02 · 559 · Agency Qualifier Code · Required · Identifier (ID)

• DR: National Wholesale Druggists Association

AAA-03 · 901 · Reject Reason Code · Required · Identifier (ID)

• A1: Insufficient Wholesaler Inventory
• A2: Line Item Too Old
• A3: Quantity Invalid - Free Goods
• A4: Rebill Without Offsetting Credit
• A5: Minimum Order Quantity Not Met
• AA: Contract Number Missing
• BB: Contract Number Incorrect
• CC: Contract Expired
• DD: Reject Due to Doors
• EE: Invoice Date Missing or Invalid
• FF: Customer Not Covered
• GG: Customer Expired
• HH: Reject Due to Hand Hold, Ladder, Step, Running Boards, Platforms, etc.
• II: Industrial Interchange
• JJ: Customer DEA Number, Referenced ID, or Address Invalid
• KK: Drug Not Covered
• LL: Drug Expired
• MM: Drug Not Eligible
• NN: Drug Number Missing or Invalid
• OO: Wholesaler Not Covered
• PP: Wholesaler Expired
• QQ: Wholesaler Not Yet Eligible
• RI: Invalid Resubmit Number
• RR: Quantity Invalid or Not Supplied
• SS: Contract Price Missing or Incorrect
• TT: Contract Price Inserted or Corrected
• UU: Unit Cost Missing or Incorrect
• VV: Unit Cost Inserted or Corrected
• WW: Extended Amount Incorrect
• XX: Extended Amount Corrected
• YY: Duplicate Chargeback Request

170 Detail > CON Loop > PAD Loop > UIT

UIT Contract

Required · Max use 1

Variants (all may be used)

UITSubmitted ContractUITSubmitted WholesaleUITWholesale

UIT-01 · 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
• PK: Package
• UN: Unit

UIT-02 · 212 · Unit Price · Required · Decimal number (R) · Min 1 Max 15

UIT-03 · 639 · Basis of Unit Price Code · Required · Identifier (ID)

• CT: Contract

170 Detail > CON Loop > PAD Loop > UIT

UIT Submitted Contract

Required · Max use 1

Variants (all may be used)

UITContractUITSubmitted WholesaleUITWholesale

UIT-01 · 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
• PK: Package
• UN: Unit

UIT-02 · 212 · Unit Price · Required · Decimal number (R) · Min 1 Max 15

UIT-03 · 639 · Basis of Unit Price Code · Required · Identifier (ID)

• SC: Submitted Contract

170 Detail > CON Loop > PAD Loop > UIT

UIT Submitted Wholesale

Required · Max use 1

Variants (all may be used)

UITContractUITSubmitted ContractUITWholesale

UIT-01 · 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
• PK: Package
• UN: Unit

UIT-02 · 212 · Unit Price · Required · Decimal number (R) · Min 1 Max 15

UIT-03 · 639 · Basis of Unit Price Code · Required · Identifier (ID)

• SW: Submitted Wholesale

170 Detail > CON Loop > PAD Loop > UIT

UIT Wholesale

Required · Max use 1

Variants (all may be used)

UITContractUITSubmitted ContractUITSubmitted Wholesale

UIT-01 · 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
• PK: Package
• UN: Unit

UIT-02 · 212 · Unit Price · Required · Decimal number (R) · Min 1 Max 15

UIT-03 · 639 · Basis of Unit Price Code · Required · Identifier (ID)

• WH: Wholesale

180 Detail > CON Loop > PAD Loop > QTY

QTY Quantity

Required · Max use 1

Variants (all may be used)

QTYQuantity

QTY-01 · 673 · Quantity Qualifier · Required · Identifier (ID)

• 32: Quantity Sold
• 76: Returns

QTY-02 · 380 · Quantity · Required · Decimal number (R) · Min 1 Max 15

QTY-03 · C001 · Composite Unit of Measure · Optional 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) · Min 2 Max 2

180 Detail > CON Loop > PAD Loop > QTY

QTY Quantity

Required · Max use 5

Variants (all may be used)

QTYQuantity

QTY-01 · 673 · Quantity Qualifier · Required · Identifier (ID)

• 83: Submitted Quantity Sold
• 84: Submitted Quantity Returned

QTY-02 · 380 · Quantity · Required · Decimal number (R) · Min 1 Max 15

QTY-03 · C001 · Composite Unit of Measure · Optional 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) · Min 2 Max 2

190 Detail > CON Loop > PAD Loop > AMT

AMT Monetary Amount

Required · Max use 1

Variants (all may be used)

AMTMonetary Amount

AMT-01 · 522 · Amount Qualifier Code · Required · Identifier (ID)

• A: Adjusted Chargeback Claim Amount

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

190 Detail > CON Loop > PAD Loop > AMT

AMT Monetary Amount

Required · Max use 2

Variants (all may be used)

AMTMonetary Amount

AMT-01 · 522 · Amount Qualifier Code · Required · Identifier (ID)

• S: Submitted Chargeback Claim Amount

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

210 Detail > CON Loop > PAD Loop > REF

REF Reference Identification

Required · Max use 12

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

• DI: Distributor Invoice Number
• L1: Letters or Notes
• RX: Resubmit number

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

220 Detail > CON Loop > PAD Loop > DTM

DTM Date/Time Reference

Required · Max use 10

DTM-01 · 374 · Date/Time Qualifier · Required · Identifier (ID)

• 003: Invoice

DTM-02 · 373 · Date · Required · Date (DT) · CCYYMMDD format

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

Required · Max use 1

Variants (all may be used)

AMTMonetary AmountAMTMonetary Amount

AMT-01 · 522 · Amount Qualifier Code · Required · Identifier (ID)

• A: Adjusted Chargeback Claim Amount

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

020 Summary > AMT

AMT Monetary Amount

Optional · Max use 5

Variants (all may be used)

AMTMonetary AmountAMTMonetary Amount

AMT-01 · 522 · Amount Qualifier Code · Required · Identifier (ID)

• NA: Net Adjustment

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

020 Summary > AMT

AMT Monetary Amount

Required · Max use 1

Variants (all may be used)

AMTMonetary AmountAMTMonetary Amount

AMT-01 · 522 · Amount Qualifier Code · Required · Identifier (ID)

• S: Submitted Chargeback Claim Amount

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|849|2006~
BRC|00|20110415|CM|98765432~
REF|AM|61111234567~
REF|ZZ|25~
N1|DB||11|RA0210409~
N1|SU|VENDOR NAME|11|BB1234567~
CON|VC|ABCD1|VA~
N1|ST|SAMPLE CUSTOMER|11|AA1235852~
PAD|1~
LIN||ND|00551970803~
AAA|N|DR|YY~
UIT|UN|2606|CT~
UIT|UN|2553.88|SC~
UIT|UN|2606|SW~
UIT|UN|2606|WH~
QTY|83|11~
QTY|32|11~
AMT|S|573.32~
AMT|A|0~
REF|DI|046123456~
REF|RX|602888S18~
DTM|003|20110401~
CTT|1~
AMT|S|73965.54~
AMT|NA|573.32~
AMT|A|73392.22~
SE|27|2006