AmerisourceBergen
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Invoice
  • Specification
  • EDI Inspector
Stedi maintains this guide based on public documentation from AmerisourceBergen. Contact AmerisourceBergen for official EDI specifications. To report any errors in this guide, please contact us.
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X12 810 Invoice

X12 Release 4010

This Draft Standard for Trial Use contains the format and establishes the data contents of the Invoice Transaction Set (810) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set can be used to provide for customary and established business and industry practice relative to the billing for goods and services provided.

Delimiters
  • ~ Segment
  • | Element
  • > Component
EDI sample
  • Sample from AmerisourceBergen
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Overview
ISA
-
Interchange Control Header
Max use 1
Required
GS
-
Functional Group Header
Max use 1
Required
heading
ST
010
Transaction Set Header
Max use 1
Required
BIG
020
Beginning Segment for Invoice
Max use 1
Required
Bill-to-Party
ITD
130
Terms of Sale/Deferred Terms of Sale
Max use 1
Required
detail
IT1 Loop
IT1
010
Baseline Item Data (Invoice)
Max use 1
Required
PID Loop
GE
-
Functional Group Trailer
Max use 1
Required
IEA
-
Interchange Control Trailer
Max use 1
Required
ISA

Interchange Control Header

RequiredMax use 1

To start and identify an interchange of zero or more functional groups and interchange-related control segments

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

Code to identify the type of information in the Authorization Information

00
No Authorization Information Present (No Meaningful Information in I02)
ISA-02
I02
Authorization Information
Required
String (AN)
Min 10Max 10

Information used for additional identification or authorization of the interchange sender or the data in the interchange; the type of information is set by the Authorization Information Qualifier (I01)

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

Code to identify the type of information in the Security Information

00
No Security Information Present (No Meaningful Information in I04)
ISA-04
I04
Security Information
Required
String (AN)
Min 10Max 10

This is used for identifying the security information about the interchange sender or the data in the interchange; the type of information is set by the Security Information Qualifier (I03)

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

Qualifier to designate the system/method of code structure used to designate the sender or receiver ID element being qualified

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

Identification code published by the sender for other parties to use as the receiver ID to route data to them; the sender always codes this value in the sender ID element

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

Qualifier to designate the system/method of code structure used to designate the sender or receiver ID element being qualified

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

Identification code published by the receiver of the data; When sending, it is used by the sender as their sending ID, thus other parties sending to them will use this as a receiving ID to route data to them

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

Date of the interchange

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

Time of the interchange

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

Code to identify the agency responsible for the control standard used by the message that is enclosed by the interchange header and trailer

U
U.S. EDI Community of ASC X12, TDCC, and UCS
ISA-12
I11
Interchange Control Version Number
Required
Identifier (ID)

This version number covers the interchange control segments

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 9Max 9

A control number assigned by the interchange sender

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

Code sent by the sender to request an interchange acknowledgment (TA1)

0
No Acknowledgment Requested
1
Interchange Acknowledgment Requested
ISA-15
I14
Usage Indicator
Required
Identifier (ID)
Min 1Max 1

Code to indicate whether data enclosed by this interchange envelope is test, production or information

I
Information
P
Production Data
T
Test Data
ISA-16
I15
Component Element Separator
Required
String (AN)
Min 1Max 1

Type is not applicable; the component element separator is a delimiter and not a data element; this field provides the delimiter used to separate component data elements within a composite data structure; this value must be different than the data element separator and the segment terminator

>
Component Element Separator

Functional Group Header

RequiredMax use 1

To indicate the beginning of a functional group and to provide control information

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

Code identifying a group of application related transaction sets

IN
Invoice Information (810,819)
GS-02
142
Application Sender's Code
Required
String (AN)
Min 2Max 15

Code identifying party sending transmission; codes agreed to by trading partners

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

Code identifying party receiving transmission. Codes agreed to by trading partners

Required
Date (DT)
CCYYMMDD format

Date expressed as CCYYMMDD

Required
Time (TM)
HHMM, HHMMSS, HHMMSSD, or HHMMSSDD format

Time expressed in 24-hour clock time as follows: HHMM, or HHMMSS, or HHMMSSD, or HHMMSSDD, where H = hours (00-23), M = minutes (00-59), S = integer seconds (00-59) and DD = decimal seconds; decimal seconds are expressed as follows: D = tenths (0-9) and DD = hundredths (00-99)

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

Assigned number originated and maintained by the sender

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

Code used in conjunction with Data Element 480 to identify the issuer of the standard

T
Transportation Data Coordinating Committee (TDCC)
X
Accredited Standards Committee X12
GS-08
480
Version / Release / Industry Identifier Code
Required
String (AN)

Code indicating the version, release, subrelease, and industry identifier of the EDI standard being used, including the GS and GE segments; if code in DE455 in GS segment is X, then in DE 480 positions 1-3 are the version number; positions 4-6 are the release and subrelease, level of the version; and positions 7-12 are the industry or trade association identifiers (optionally assigned by user); if code in DE455 in GS segment is T, then other formats are allowed

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

Heading

ST
010
Heading > ST

Transaction Set Header

RequiredMax use 1

To indicate the start of a transaction set and to assign a control number

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

Code uniquely identifying a Transaction Set

  • The transaction set identifier (ST01) used by the translation routines of the interchange partners to select the appropriate transaction set definition (e.g., 810 selects the Invoice Transaction Set).
810
Invoice
ST-02
329
Transaction Set Control Number
Required
Numeric (N)
Min 4Max 9

Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set

BIG
020
Heading > BIG

Beginning Segment for Invoice

RequiredMax use 1

To indicate the beginning of an invoice transaction set and transmit identifying numbers and dates

Example
Required
Date (DT)
CCYYMMDD format

Date expressed as CCYYMMDD

  • BIG01 is the invoice issue date.
BIG-02
76
Invoice Number
Required
String (AN)
Min 1Max 22

Identifying number assigned by issuer

Optional
Date (DT)
CCYYMMDD format

Date expressed as CCYYMMDD

  • BIG03 is the date assigned by the purchaser to purchase order.
BIG-04
324
Purchase Order Number
Required
String (AN)
Min 1Max 22

Identifying number for Purchase Order assigned by the orderer/purchaser

Usage notes

The full nine digit Purchase Order Number must be sent

BIG-07
640
Transaction Type Code
Required
Identifier (ID)

Code specifying the type of transaction

  • BIG07 is used only to further define the type of invoice when needed.
Usage notes

A regular trade invoice is assumed if this segment is omitted.

DO
Drop Shipment Invoice
N1 Bill-to-Party
RequiredMax 1
Variants (all may be used)
N1 LoopShip To
N1
070
Heading > Bill-to-Party > N1

Name

RequiredMax use 1

To identify a party by type of organization, name, and code

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

Code identifying an organizational entity, a physical location, property or an individual

BT
Bill-to-Party
N1-03
66
Identification Code Qualifier
Required
Identifier (ID)

Code designating the system/method of code structure used for Identification Code (67)

9
D-U-N-S+4, D-U-N-S Number with Four Character Suffix
11
Drug Enforcement Administration (DEA)
21
Health Industry Number (HIN)
N1-04
67
Identification Code
Required
String (AN)
Min 2Max 80

Code identifying a party or other code

  • This segment, used alone, provides the most efficient method of providing organizational identification. To obtain this efficiency the "ID Code" (N104) must provide a key to the table maintained by the transaction processing party.
Usage notes

The ABC Division DEA Number associated with the Customer.
If not available, use the DEA Number of the Division that is closest to the Customer's Ship-To zip code.

N1 Bill-to-Party end
N1 Loop
RequiredMax 200
Variants (all may be used)
Bill-to-PartyShip To
N1
070
Heading > N1 Loop > N1

Name

RequiredMax use 1

To identify a party by type of organization, name, and code

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

Code identifying an organizational entity, a physical location, property or an individual

RE
Party to receive commercial invoice remittance
SU
Supplier/Manufacturer
Required
String (AN)
Min 1Max 60

Free-form name

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

Code designating the system/method of code structure used for Identification Code (67)

1
D-U-N-S Number, Dun & Bradstreet

Free Form (If Vendor does not have any of the listed, the 1 code should be used).

11
Drug Enforcement Administration (DEA)
21
Health Industry Number (HIN)
N1-04
67
Identification Code
Required
String (AN)
Min 2Max 80

Code identifying a party or other code

  • This segment, used alone, provides the most efficient method of providing organizational identification. To obtain this efficiency the "ID Code" (N104) must provide a key to the table maintained by the transaction processing party.
Usage notes

AmerisourceBergen has a maximum of nine characters for this element.

N1 Loop end
N1 Ship To
RequiredMax 1
Usage notes

This is used for a Drop Ship Order only. This is when the product is NOT shipped to an AmerisourceBergen. The 'BIG07' will be equal to 'DO'.

Use this segment to indicate the Drop Ship Name and optionally the Drop Ship Number

Variants (all may be used)
Bill-to-PartyN1 Loop
N1
070
Heading > Ship To > N1

Name

RequiredMax use 1

To identify a party by type of organization, name, and code

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

Code identifying an organizational entity, a physical location, property or an individual

ST
Ship To
Required
String (AN)
Min 1Max 60

Free-form name

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

Code designating the system/method of code structure used for Identification Code (67)

11
Drug Enforcement Administration (DEA)
21
Health Industry Number (HIN)
91
Assigned by Seller or Seller's Agent

Customers ABC Account Number

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

Code identifying a party or other code

  • This segment, used alone, provides the most efficient method of providing organizational identification. To obtain this efficiency the "ID Code" (N104) must provide a key to the table maintained by the transaction processing party.
N3
090
Heading > Ship To > N3

Address Information

RequiredMax use 1

To specify the location of the named party

Usage notes

This is used only when there are Drop Ships in the invoice. The 'BIG07' will be equal to 'DO'.

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

Address information

N3-02
166
Address Information
Optional
String (AN)
Min 1Max 55

Address information

N4
100
Heading > Ship To > N4

Geographic Location

RequiredMax use 1

To specify the geographic place of the named party

Usage notes

This is used only when there are Drop Ships in the invoice. The 'BIG07' will be equal to 'DO'.

Example
N4-01
19
City Name
Required
String (AN)
Min 2Max 30

Free-form text for city name

  • A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location.
N4-02
156
State or Province Code
Required
Identifier (ID)
Min 2Max 2

Code (Standard State/Province) as defined by appropriate government agency

  • N402 is required only if city name (N401) is in the U.S. or Canada.
N4-03
116
Postal Code
Required
Identifier (ID)
Min 3Max 15

Code defining international postal zone code excluding punctuation and blanks (zip code for United States)

N1 Ship To end
ITD
130
Heading > ITD

Terms of Sale/Deferred Terms of Sale

RequiredMax use >1

To specify terms of sale

Example
ITD-01
336
Terms Type Code
Required
Identifier (ID)

Code identifying type of payment terms

  • If the code in ITD01 is "04", then ITD07 or ITD09 is required and either ITD10 or ITD11 is required; if the code in ITD01 is "05", then ITD06 or ITD07 is required.
01
Basic
02
End of Month (EOM)
03
Fixed Date
07
Extended
08
Basic Discount Offered
ITD-02
333
Terms Basis Date Code
Required
Identifier (ID)

Code identifying the beginning of the terms period

1
Ship Date
2
Delivery Date
3
Invoice Date
5
Invoice Receipt Date
ITD-03
338
Terms Discount Percent
Required
Decimal number (R)
Min 1Max 6

Terms discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date

ITD-04
370
Terms Discount Due Date
Required
Date (DT)
CCYYMMDD format

Date payment is due if discount is to be earned expressed in format CCYYMMDD

ITD-05
351
Terms Discount Days Due
Required
Numeric (N0)
Min 1Max 3

Number of days in the terms discount period by which payment is due if terms discount is earned

ITD-06
446
Terms Net Due Date
Required
Date (DT)
CCYYMMDD format

Date when total invoice amount becomes due expressed in format CCYYMMDD

ITD-07
386
Terms Net Days
Required
Numeric (N0)
Min 1Max 3

Number of days until total invoice amount is due (discount not applicable)

ITD-08
362
Terms Discount Amount
Required
Numeric (N2)
Min 1Max 10

Total amount of terms discount

Heading end

Detail

IT1 Loop
RequiredMax 200000
IT1
010
Detail > IT1 Loop > IT1

Baseline Item Data (Invoice)

RequiredMax use 1

To specify the basic and most frequently used line item data for the invoice and related transactions

Example
If either Product/Service ID Qualifier (IT1-08) or Product/Service ID (IT1-09) is present, then the other is required
IT1-01
350
Assigned Identification
Optional
String (AN)
Min 1Max 20

Alphanumeric characters assigned for differentiation within a transaction set

  • IT101 is the purchase order line item identification.
IT1-02
358
Quantity Invoiced
Required
Decimal number (R)
Min 1Max 10

Number of units invoiced (supplier units)

Usage notes

Please exclude items with zero quantities for AmerisourceBergen.

IT1-03
355
Unit or Basis for Measurement Code
Required
Identifier (ID)

Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken

BX
Box
CA
Case
DE
Deal
DZ
Dozen
EA
Each
GS
Gross
PK
Package
IT1-04
212
Unit Price
Required
Decimal number (R)
Min 1Max 15

Price per unit of product, service, commodity, etc.

Usage notes

5 Places to the right of the Decimal places

IT1-06
235
Product/Service ID Qualifier
Required
Identifier (ID)

Code identifying the type/source of the descriptive number used in Product/Service ID (234)

  • IT106 through IT125 provide for ten different product/service IDs for each item. For example: Case, Color, Drawing No., U.P.C. No., ISBN No., Model No., or SKU.
Usage notes

Qualifiers must match Product ID and conform to the format examples identified below, by unique qualifier.

IN
Buyer's Item Number
MF
Manufacturer

Manufacturer Part Number

N1
National Drug Code in 4-4-2 Format
N2
National Drug Code in 5-3-2 Format
N3
National Drug Code in 5-4-1 Format
N4
National Drug Code in 5-4-2 Format
N5
National Health Related Item Code in 5-5 Format
N6
National Health Related Item Code in 4-6 Format
ND
National Drug Code (NDC)

This has 10 digits only

NH
National Health Related Item Code
UA
U.P.C./EAN Case Code (2-5-5)
UI
U.P.C. Consumer Package Code (1-5-5)
UP
U.P.C. Consumer Package Code (1-5-5-1)
UX
Universal Product Number
VC
Vendor's (Seller's) Catalog Number
IT1-07
234
Product/Service ID
Required
String (AN)
Min 1Max 48

Identifying number for a product or service

Usage notes

The ID number(s) used to identify the product or service in the invoice should be the same ID number(s) used in the purchase order.
This value must conform to the corresponding qualifier used in IT106.

IT1-08
235
Product/Service ID Qualifier
Optional
Identifier (ID)

Code identifying the type/source of the descriptive number used in Product/Service ID (234)

LT
Lot Number
IT1-09
234
Product/Service ID
Optional
String (AN)
Min 1Max 48

Identifying number for a product or service

PID Loop
OptionalMax 1000
PID
060
Detail > IT1 Loop > PID Loop > PID

Product/Item Description

RequiredMax use 1

To describe a product or process in coded or free-form format

Example
PID-01
349
Item Description Type
Required
Identifier (ID)

Code indicating the format of a description

  • If PID01 equals "F", then PID05 is used. If PID01 equals "S", then PID04 is used. If PID01 equals "X", then both PID04 and PID05 are used.
F
Free-form
PID-05
352
Description
Required
String (AN)
Min 1Max 80

A free-form description to clarify the related data elements and their content

PID Loop end
SAC Loop
OptionalMax 25
SAC
180
Detail > IT1 Loop > SAC Loop > SAC

Service, Promotion, Allowance, or Charge Information

RequiredMax use 1

To request or identify a service, promotion, allowance, or charge; to specify the amount or percentage for the service, promotion, allowance, or charge

Example
SAC-01
248
Allowance or Charge Indicator
Required
Identifier (ID)

Code which indicates an allowance or charge for the service specified

  • If SAC01 is "A" or "C", then at least one of SAC05, SAC07, or SAC08 is required.
A
Allowance
C
Charge
SAC-02
1300
Service, Promotion, Allowance, or Charge Code
Required
Identifier (ID)

Code identifying the service, promotion, allowance, or charge

A250
Advances
A260
Advertising Allowance
A400
Allowance Non-performance
B010
Cents Off
B240
COD Charges
B660
Contract Allowance
B720
Cooperative Advertising/Merchandising Allowance (Performance)
C000
Defective Allowance
C030
Delivery Surcharge
C040
Delivery
C227
C310
Discount
C540
Early Buy Allowance
C870
Expediting Fee
C880
Expediting Premium
D200
Freight Charges to Destination
D240
Freight
D500
Handling
D820
Inside Delivery
D980
Insurance
E730
New Item Allowance
F050
Other (See related description)
F180
Pallet
F210
Parish/County Sales Tax (only)
F290
Performance Award
F340
Pick/Up
F800
Promotional Allowance
F810
Promotional Discount
F910
Quantity Discount
F970
Rebate
G330
Rental Charge
G400
Repair
G470
Restocking Charge
G830
Shipping and Handling
H000
Special Allowance
H010
Special Buy
H090
Special Handling
H630
Tax - City Sales Tax (Only)
H660
Tax - Federal Excise Tax, FET
H700
Tax - Local Tax
H750
Tax - Sales Tax (State and Local)
H770
Tax - State Tax
H790
Tax - Use Tax
H850
Tax
I070
Tobacco Products Report Charge
I170
Trade Discount
I250
Transportation Charge (Minimum Rate)
I410
Unsaleable Merchandise Allowance
I530
Volume Discount
SAC-05
610
Amount
Required
Numeric (N2)
Min 1Max 15

Monetary amount

  • SAC05 is the total amount for the service, promotion, allowance, or charge.
  • If SAC05 is present with SAC07 or SAC08, then SAC05 takes precedence.
SAC Loop end
IT1 Loop end
Detail end

Summary

TDS
010
Summary > TDS

Total Monetary Value Summary

RequiredMax use 1

To specify the total invoice discounts and amounts

Example
TDS-01
610
Amount
Required
Numeric (N2)
Min 1Max 15

Monetary amount

  • TDS01 is the total amount of invoice (including charges, less allowances) before terms discount (if discount is applicable).
Usage notes

This is the total amount of the invoice (including charges, less allowances) before terms discount (if discount is applicable).
Do not send zero dollar invoices to AmerisourceBergen.

SAC Loop
OptionalMax 25
SAC
040
Summary > SAC Loop > SAC

Service, Promotion, Allowance, or Charge Information

RequiredMax use 1

To request or identify a service, promotion, allowance, or charge; to specify the amount or percentage for the service, promotion, allowance, or charge

Example
SAC-01
248
Allowance or Charge Indicator
Required
Identifier (ID)

Code which indicates an allowance or charge for the service specified

  • If SAC01 is "A" or "C", then at least one of SAC05, SAC07, or SAC08 is required.
A
Allowance
C
Charge
SAC-02
1300
Service, Promotion, Allowance, or Charge Code
Required
Identifier (ID)

Code identifying the service, promotion, allowance, or charge

A250
Advances
A260
Advertising Allowance
A400
Allowance Non-performance
B010
Cents Off
B240
COD Charges
B660
Contract Allowance
B720
Cooperative Advertising/Merchandising Allowance (Performance)
C000
Defective Allowance
C040
Delivery
C310
Discount
C540
Early Buy Allowance
C880
Expediting Premium
D200
Freight Charges to Destination
D240
Freight
D500
Handling
D820
Inside Delivery
D980
Insurance
E730
New Item Allowance
F180
Pallet
F210
Parish/County Sales Tax (only)
F290
Performance Award
F340
Pick/Up
F800
Promotional Allowance
F810
Promotional Discount
F910
Quantity Discount
F970
Rebate
G330
Rental Charge
G400
Repair
G470
Restocking Charge
H000
Special Allowance
H010
Special Buy
H090
Special Handling
H630
Tax - City Sales Tax (Only)
H700
Tax - Local Tax
H750
Tax - Sales Tax (State and Local)
H790
Tax - Use Tax
H850
Tax
I070
Tobacco Products Report Charge
I250
Transportation Charge (Minimum Rate)
I410
Unsaleable Merchandise Allowance
I530
Volume Discount
SAC-05
610
Amount
Required
Numeric (N2)
Min 1Max 15

Monetary amount

  • SAC05 is the total amount for the service, promotion, allowance, or charge.
  • If SAC05 is present with SAC07 or SAC08, then SAC05 takes precedence.
SAC Loop end
CTT
070
Summary > CTT

Transaction Totals

RequiredMax use 1

To transmit a hash total for a specific element in the transaction set

  • Number of line items (CTT01) is the accumulation of the number of IT1 segments.
    If used, hash total (CTT02) is the sum of the value of quantities invoiced (IT102) for each IT1 segment.
Example
CTT-01
354
Number of Line Items
Required
Numeric (N0)
Min 1Max 6

Total number of line items in the transaction set

Usage notes

This is the total number of IT1 segments.

SE
080
Summary > SE

Transaction Set Trailer

RequiredMax use 1

To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)

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

Total number of segments included in a transaction set including ST and SE segments

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

Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set

Summary end

Functional Group Trailer

RequiredMax use 1

To indicate the end of a functional group and to provide control information

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

Total number of transaction sets included in the functional group or interchange (transmission) group terminated by the trailer containing this data element

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

Assigned number originated and maintained by the sender

Interchange Control Trailer

RequiredMax use 1

To define the end of an interchange of zero or more functional groups and interchange-related control segments

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

A count of the number of functional groups included in an interchange

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

A control number assigned by the interchange sender

EDI Samples

Sample from AmerisourceBergen

ST|810|0001~
BIG|20021028|75543325||96954|||DO~
N1|SU|VENDOR NAME|21|K22LM1234~
N1|BT||21|J81TK1600~
N1|ST|GENERAL HOSPITAL|21|4DY2VT210~
N3|600 MOON RIVER DRIVE|ATTN PHARMACY~
N4|MID AMERICA|TN|55555~
ITD|01|3|2|20021127|30|20021128|31|107~
IT1|1|1|EA|37.1||N4|00006484300~
IT1|2|4|EA|4.10||N4|00006484301~
TDS|5350~
CTT|2~
SE|13|0001~

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