AT&T
/
Consolidated Service Invoice/Statement
  • Specification
  • EDI Inspector
Stedi maintains this guide based on public documentation from AT&T. Contact AT&T for official EDI specifications. To report any errors in this guide, please contact us.
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X12 811 Consolidated Service Invoice/Statement

X12 Release 4010
—
Delimiters
  • ~ Segment
  • * Element
  • > Component
EDI samples
  • None included
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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
REF
050
Reference Identification
Max use 1
Optional
ITD
070
Terms of Sale/Deferred Terms of Sale
Max use 5
Optional
DTM
080
Date/Time Reference
Max use 10
Optional
N1 Loop
N1
100
Name
Max use 1
Required
N3
120
Address Information
Max use 2
Optional
N4
130
Geographic Location
Max use 1
Optional
detail
HL Loop
HL
010
Hierarchical Level
Max use 1
Required
LX Loop
LX
020
Assigned Number
Max use 1
Required
PID
040
Product/Item Description
Max use 200
Optional
REF
050
Reference Identification
Max use 1
Optional
QTY Loop
QTY
090
Quantity
Max use 1
Required
HL Loop
HL
010
Hierarchical Level
Max use 1
Required
LX Loop
LX
020
Assigned Number
Max use 1
Required
SI
030
Service Characteristic Identification
Max use 8
Optional
PID
040
Product/Item Description
Max use 200
Optional
AMT
060
Monetary Amount
Max use 5
Optional
DTM
070
Date/Time Reference
Max use 8
Optional
TXI
080
Tax Information
Max use 1
Optional
NM1 Loop
NM1
110
Individual or Organizational Name
Max use 1
Required
REF
150
Reference Identification
Max use 1
Optional
ITA Loop
ITA
180
Allowance, Charge or Service
Max use 1
Required
HL Loop Group
HL
010
Hierarchical Level
Max use 1
Required
IT1 Loop
IT1
210
Baseline Item Data (Invoice)
Max use 1
Required
PID
230
Product/Item Description
Max use 200
Optional
QTY Loop
QTY
290
Quantity
Max use 1
Required
HL Loop
HL
010
Hierarchical Level
Max use 1
Required
SLN Loop
SLN
390
Subline Item Detail
Max use 1
Required
SI
400
Service Characteristic Identification
Max use 2
Optional
PID
410
Product/Item Description
Max use 200
Optional
MEA
415
Measurements
Max use 20
Optional
DTM
480
Date/Time Reference
Max use 10
Optional
AMT
490
Monetary Amount
Max use 15
Optional
MSG
500
Message Text
Max use 1
Optional
QTY Loop
QTY
510
Quantity
Max use 1
Required
HL Loop
HL
010
Hierarchical Level
Max use 1
Required
IT1 Loop
IT1
210
Baseline Item Data (Invoice)
Max use 1
Required
PID
230
Product/Item Description
Max use 200
Optional
QTY Loop
QTY
290
Quantity
Max use 1
Required
TCD Loop
TCD
590
Itemized Call Detail
Max use 1
Required
SI
600
Service Characteristic Identification
Max use 2
Optional
HL Loop Sub Billing Arrangement
HL
010
Hierarchical Level
Max use 1
Required
LX Loop
LX
020
Assigned Number
Max use 1
Required
SI
030
Service Characteristic Identification
Max use 8
Optional
PID
040
Product/Item Description
Max use 200
Optional
REF
050
Reference Identification
Max use 1
Optional
AMT
060
Monetary Amount
Max use 5
Optional
DTM
070
Date/Time Reference
Max use 8
Optional
QTY Loop
QTY
090
Quantity
Max use 1
Required
NM1 Loop
NM1
110
Individual or Organizational Name
Max use 1
Required
N2
120
Additional Name Information
Max use 2
Optional
TXI
170
Tax Information
Max use 1
Optional
ITA Loop
ITA
180
Allowance, Charge or Service
Max use 1
Required
HL Loop
HL
010
Hierarchical Level
Max use 1
Required
IT1 Loop
IT1
210
Baseline Item Data (Invoice)
Max use 1
Required
PID
230
Product/Item Description
Max use 200
Optional
QTY Loop
QTY
290
Quantity
Max use 1
Required
HL Loop
HL
010
Hierarchical Level
Max use 1
Required
SLN Loop
SLN
390
Subline Item Detail
Max use 1
Required
SI
400
Service Characteristic Identification
Max use 2
Optional
PID
410
Product/Item Description
Max use 200
Optional
MEA
415
Measurements
Max use 20
Optional
DTM
480
Date/Time Reference
Max use 10
Optional
AMT
490
Monetary Amount
Max use 15
Optional
MSG
500
Message Text
Max use 1
Optional
QTY Loop
QTY
510
Quantity
Max use 1
Required
HL Loop
HL
010
Hierarchical Level
Max use 1
Required
IT1 Loop
IT1
210
Baseline Item Data (Invoice)
Max use 1
Required
PID
230
Product/Item Description
Max use 200
Optional
QTY Loop
QTY
290
Quantity
Max use 1
Required
TCD Loop
TCD
590
Itemized Call Detail
Max use 1
Required
SI
600
Service Characteristic Identification
Max use 2
Optional
summary
TDS
010
Total Monetary Value Summary
Max use 1
Required
BAL Loop
BAL
040
Balance Detail
Max use 1
Required
CTT
115
Transaction Totals
Max use 1
Optional
SE
120
Transaction Set Trailer
Max use 1
Required
GE
-
Functional Group Trailer
Max use 1
Required
IEA
-
Interchange Control Trailer
Max use 1
Required
ISA

Interchange Control Header

RequiredMax use 1
—
Example
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 10Max 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 10Max 10
—
ISA-05
I05
Interchange ID Qualifier
Required
Identifier (ID)
Min 2Max 2
—
Codes
ISA-06
I06
Interchange Sender ID
Required
String (AN)
Min 15Max 15
—
ISA-07
I05
Interchange ID Qualifier
Required
Identifier (ID)
Min 2Max 2
—
Codes
ISA-08
I07
Interchange Receiver ID
Required
String (AN)
Min 15Max 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 9Max 9
—
ISA-14
I13
Acknowledgment Requested
Required
Identifier (ID)
Min 1Max 1
—
0
No Acknowledgment Requested
1
Interchange Acknowledgment Requested
ISA-15
I14
Usage Indicator
Required
Identifier (ID)
Min 1Max 1
—
I
Information
P
Production Data
T
Test Data
ISA-16
I15
Component Element Separator
Required
String (AN)
Min 1Max 1
—
>
Component Element Separator
GS

Functional Group Header

RequiredMax use 1
—
Example
GS-01
479
Functional Identifier Code
Required
Identifier (ID)
—
CI
Consolidated Service Invoice/Statement (811)
GS-02
142
Application Sender's Code
Required
String (AN)
Min 2Max 15
—
GS-03
124
Application Receiver's Code
Required
String (AN)
Min 2Max 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 1Max 9
—
GS-07
455
Responsible Agency Code
Required
Identifier (ID)
Min 1Max 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

ST
010
Heading > ST

Transaction Set Header

RequiredMax use 1
—
Example
ST-01
143
Transaction Set Identifier Code
Required
Identifier (ID)
—
811
Consolidated Service Invoice/Statement
ST-02
329
Transaction Set Control Number
Required
Numeric (N)
Min 4Max 9
—
BIG
020
Heading > BIG

Beginning Segment for Invoice

RequiredMax use 1
—
Example
BIG-01
373
Date
Required
Date (DT)
CCYYMMDD format
—
BIG-02
76
Invoice Number
Required
String (AN)
Min 1Max 22
—
BIG-07
640
Transaction Type Code
Optional
Identifier (ID)
Min 2Max 2
—
REF
050
Heading > REF

Reference Identification

OptionalMax use >1
—
Example
REF-01
128
Reference Identification Qualifier
Required
Identifier (ID)
—
IK
Invoice Number
IT
Internal Customer Number
REF-02
127
Reference Identification
Required
String (AN)
Min 1Max 30
—
ITD
070
Heading > ITD

Terms of Sale/Deferred Terms of Sale

OptionalMax use 5
—
Example
ITD-06
446
Terms Net Due Date
Required
Date (DT)
CCYYMMDD format
—
DTM
080
Heading > DTM

Date/Time Reference

OptionalMax use 10
—
Example
DTM-01
374
Date/Time Qualifier
Required
Identifier (ID)
Min 3Max 3
—
DTM-02
373
Date
Optional
Date (DT)
CCYYMMDD format
—
N1 Loop
OptionalMax >1
N1
100
Heading > N1 Loop > N1

Name

RequiredMax use 1
—
Example
N1-01
98
Entity Identifier Code
Required
Identifier (ID)
Min 2Max 3
—
N1-02
93
Name
Optional
String (AN)
Min 1Max 60
—
N3
120
Heading > N1 Loop > N3

Address Information

OptionalMax use 2
—
Example
N3-01
166
Address Information
Required
String (AN)
Min 1Max 55
—
N3-02
166
Address Information
Optional
String (AN)
Min 1Max 55
—
N4
130
Heading > N1 Loop > N4

Geographic Location

OptionalMax use 1
—
Example
N4-01
19
City Name
Optional
String (AN)
Min 2Max 30
—
N4-02
156
State or Province Code
Optional
Identifier (ID)
Min 2Max 2
—
N4-03
116
Postal Code
Optional
Identifier (ID)
Min 3Max 15
—
N4-04
26
Country Code
Optional
Identifier (ID)
Min 2Max 3
—
N1 Loop end
Heading end

Detail

HL Loop
OptionalMax >1
HL
010
Detail > HL Loop > HL

Hierarchical Level

RequiredMax use 1
—
Example
HL-01
628
Hierarchical ID Number
Required
String (AN)
Min 1Max 12
—
HL-03
735
Hierarchical Level Code
Required
Identifier (ID)
—
1
Service/Billing Provider
HL-04
736
Hierarchical Child Code
Optional
Identifier (ID)
—
0
No Subordinate HL Segment in This Hierarchical Structure.
1
Additional Subordinate HL Data Segment in This Hierarchical Structure.
LX Loop
OptionalMax >1
LX
020
Detail > HL Loop > LX Loop > LX

Assigned Number

RequiredMax use 1
—
Example
LX-01
554
Assigned Number
Required
Numeric (N0)
Min 1Max 6
—
PID
040
Detail > HL Loop > LX Loop > PID

Product/Item Description

OptionalMax use 200
—
Example
If Product Description Code (PID-04) is present, then Agency Qualifier Code (PID-03) is required
At least one of Product Description Code (PID-04) or Description (PID-05) is required
PID-01
349
Item Description Type
Required
Identifier (ID)
Min 1Max 1
—
PID-02
750
Product/Process Characteristic Code
Optional
Identifier (ID)
Min 2Max 3
—
PID-03
559
Agency Qualifier Code
Optional
Identifier (ID)
Min 2Max 2
—
PID-04
751
Product Description Code
Optional
String (AN)
Min 1Max 12
—
PID-05
352
Description
Optional
String (AN)
Min 1Max 80
—
REF
050
Detail > HL Loop > LX Loop > REF

Reference Identification

OptionalMax use >1
—
Example
REF-01
128
Reference Identification Qualifier
Required
Identifier (ID)
—
ZZ
Mutually Defined
REF-02
127
Reference Identification
Required
String (AN)
Min 1Max 30
—
REF-03
352
Description
Optional
String (AN)
Min 1Max 80
—
QTY Loop
OptionalMax >1
QTY
090
Detail > HL Loop > LX Loop > QTY Loop > QTY

Quantity

RequiredMax use 1
—
Example
QTY-01
673
Quantity Qualifier
Required
Identifier (ID)
Min 2Max 2
—
QTY-02
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
QTY-03
C001
Composite Unit of Measure
OptionalMax 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 2Max 2
—
QTY Loop end
LX Loop end
HL Loop
OptionalMax >1
HL
010
Detail > HL Loop > HL Loop > HL

Hierarchical Level

RequiredMax use 1
—
Example
HL-01
628
Hierarchical ID Number
Required
String (AN)
Min 1Max 12
—
HL-02
734
Hierarchical Parent ID Number
Required
String (AN)
Min 1Max 12
—
HL-03
735
Hierarchical Level Code
Required
Identifier (ID)
—
2
Billing Arrangement
HL-04
736
Hierarchical Child Code
Optional
Identifier (ID)
—
0
No Subordinate HL Segment in This Hierarchical Structure.
1
Additional Subordinate HL Data Segment in This Hierarchical Structure.
LX Loop
OptionalMax >1
LX
020
Detail > HL Loop > HL Loop > LX Loop > LX

Assigned Number

RequiredMax use 1
—
Example
LX-01
554
Assigned Number
Required
Numeric (N0)
Min 1Max 6
—
SI
030
Detail > HL Loop > HL Loop > LX Loop > SI

Service Characteristic Identification

OptionalMax use 8
—
Example
SI-01
559
Agency Qualifier Code
Required
Identifier (ID)
Min 2Max 2
—
SI-02
1000
Service Characteristics Qualifier
Required
String (AN)
Min 2Max 2
—
SI-03
234
Product/Service ID
Required
String (AN)
Min 1Max 48
—
PID
040
Detail > HL Loop > HL Loop > LX Loop > PID

Product/Item Description

OptionalMax use 200
—
Example
If Product Description Code (PID-04) is present, then Agency Qualifier Code (PID-03) is required
At least one of Product Description Code (PID-04) or Description (PID-05) is required
PID-01
349
Item Description Type
Required
Identifier (ID)
Min 1Max 1
—
PID-03
559
Agency Qualifier Code
Optional
Identifier (ID)
Min 2Max 2
—
PID-04
751
Product Description Code
Optional
String (AN)
Min 1Max 12
—
PID-05
352
Description
Optional
String (AN)
Min 1Max 80
—
AMT
060
Detail > HL Loop > HL Loop > LX Loop > AMT

Monetary Amount

OptionalMax use 5
—
Example
AMT-01
522
Amount Qualifier Code
Required
Identifier (ID)
Min 1Max 3
—
AMT-02
782
Monetary Amount
Required
Decimal number (R)
Min 1Max 15
—
DTM
070
Detail > HL Loop > HL Loop > LX Loop > DTM

Date/Time Reference

OptionalMax use 8
—
Example
DTM-01
374
Date/Time Qualifier
Required
Identifier (ID)
Min 3Max 3
—
DTM-02
373
Date
Optional
Date (DT)
CCYYMMDD format
—
TXI
080
Detail > HL Loop > HL Loop > LX Loop > TXI

Tax Information

OptionalMax use >1
—
Example
TXI-01
963
Tax Type Code
Required
Identifier (ID)
Min 2Max 2
—
TXI-02
782
Monetary Amount
Optional
Decimal number (R)
Min 1Max 15
—
TXI-07
662
Relationship Code
Optional
Identifier (ID)
Min 1Max 1
—
LX Loop end
NM1 Loop
OptionalMax >1
NM1
110
Detail > HL Loop > HL Loop > NM1 Loop > NM1

Individual or Organizational Name

RequiredMax use 1
—
Example
If either Identification Code Qualifier (NM1-08) or Identification Code (NM1-09) is present, then the other is required
NM1-01
98
Entity Identifier Code
Required
Identifier (ID)
Min 2Max 3
—
NM1-02
1065
Entity Type Qualifier
Required
Identifier (ID)
Min 1Max 1
—
NM1-03
1035
Name Last or Organization Name
Optional
String (AN)
Min 1Max 35
—
NM1-08
66
Identification Code Qualifier
Optional
Identifier (ID)
Min 1Max 2
—
NM1-09
67
Identification Code
Optional
String (AN)
Min 2Max 80
—
REF
150
Detail > HL Loop > HL Loop > NM1 Loop > REF

Reference Identification

OptionalMax use >1
—
Example
REF-01
128
Reference Identification Qualifier
Required
Identifier (ID)
Min 2Max 3
—
REF-02
127
Reference Identification
Optional
String (AN)
Min 1Max 30
—
NM1 Loop end
ITA Loop
OptionalMax >1
ITA
180
Detail > HL Loop > HL Loop > ITA Loop > ITA

Allowance, Charge or Service

RequiredMax use 1
—
Example
If either Quantity (ITA-10) or Unit or Basis for Measurement Code (ITA-11) is present, then the other is required
ITA-01
248
Allowance or Charge Indicator
Required
Identifier (ID)
Min 1Max 1
—
ITA-02
559
Agency Qualifier Code
Optional
Identifier (ID)
Min 2Max 2
—
ITA-04
331
Allowance or Charge Method of Handling Code
Required
Identifier (ID)
Min 2Max 2
—
ITA-07
360
Allowance or Charge Total Amount
Optional
Numeric (N2)
Min 1Max 15
—
ITA-08
378
Allowance/Charge Percent Qualifier
Optional
Identifier (ID)
Min 1Max 1
—
ITA-10
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
ITA-11
355
Unit or Basis for Measurement Code
Optional
Identifier (ID)
Min 2Max 2
—
ITA-13
352
Description
Optional
String (AN)
Min 1Max 80
—
ITA-14
150
Special Charge or Allowance Code
Optional
Identifier (ID)
Min 3Max 3
—
ITA-16
662
Relationship Code
Optional
Identifier (ID)
Min 1Max 1
—
ITA Loop end
HL Loop Group
OptionalMax >1
Variants (all may be used)
HL Loop Sub Billing Arrangement
HL
010
Detail > HL Loop > HL Loop > HL Loop Group > HL

Hierarchical Level

RequiredMax use 1
—
Example
HL-01
628
Hierarchical ID Number
Required
String (AN)
Min 1Max 12
—
HL-02
734
Hierarchical Parent ID Number
Required
String (AN)
Min 1Max 12
—
HL-03
735
Hierarchical Level Code
Required
Identifier (ID)
—
4
Group
HL-04
736
Hierarchical Child Code
Optional
Identifier (ID)
—
0
No Subordinate HL Segment in This Hierarchical Structure.
1
Additional Subordinate HL Data Segment in This Hierarchical Structure.
IT1 Loop
OptionalMax >1
IT1
210
Detail > HL Loop > HL Loop > HL Loop Group > IT1 Loop > IT1

Baseline Item Data (Invoice)

RequiredMax use 1
—
Example
If either Quantity Invoiced (IT1-02), Unit or Basis for Measurement Code (IT1-03) or Unit Price (IT1-04) are present, then the others are required
If either Product/Service ID Qualifier (IT1-06) or Product/Service ID (IT1-07) is present, then the other is required
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
—
IT1-02
358
Quantity Invoiced
Optional
Decimal number (R)
Min 1Max 10
—
IT1-03
355
Unit or Basis for Measurement Code
Optional
Identifier (ID)
Min 2Max 2
—
IT1-04
212
Unit Price
Optional
Decimal number (R)
Min 1Max 15
—
IT1-06
235
Product/Service ID Qualifier
Optional
Identifier (ID)
Min 2Max 2
—
IT1-07
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
IT1-08
235
Product/Service ID Qualifier
Optional
Identifier (ID)
Min 2Max 2
—
IT1-09
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
PID
230
Detail > HL Loop > HL Loop > HL Loop Group > IT1 Loop > PID

Product/Item Description

OptionalMax use 200
—
Example
If Product Description Code (PID-04) is present, then Agency Qualifier Code (PID-03) is required
At least one of Product Description Code (PID-04) or Description (PID-05) is required
PID-01
349
Item Description Type
Required
Identifier (ID)
Min 1Max 1
—
PID-03
559
Agency Qualifier Code
Optional
Identifier (ID)
Min 2Max 2
—
PID-04
751
Product Description Code
Optional
String (AN)
Min 1Max 12
—
PID-05
352
Description
Optional
String (AN)
Min 1Max 80
—
QTY Loop
OptionalMax >1
QTY
290
Detail > HL Loop > HL Loop > HL Loop Group > IT1 Loop > QTY Loop > QTY

Quantity

RequiredMax use 1
—
Example
QTY-01
673
Quantity Qualifier
Required
Identifier (ID)
Min 2Max 2
—
QTY-02
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
QTY-03
C001
Composite Unit of Measure
OptionalMax 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 2Max 2
—
QTY Loop end
IT1 Loop end
HL Loop
OptionalMax >1
HL
010
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > HL

Hierarchical Level

RequiredMax use 1
—
Example
HL-01
628
Hierarchical ID Number
Required
String (AN)
Min 1Max 12
—
HL-02
734
Hierarchical Parent ID Number
Required
String (AN)
Min 1Max 12
—
HL-03
735
Hierarchical Level Code
Required
Identifier (ID)
—
8
Charge Detail
HL-04
736
Hierarchical Child Code
Optional
Identifier (ID)
—
0
No Subordinate HL Segment in This Hierarchical Structure.
1
Additional Subordinate HL Data Segment in This Hierarchical Structure.
SLN Loop
OptionalMax >1
SLN
390
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > SLN Loop > SLN

Subline Item Detail

RequiredMax use 1
—
Example
If Relationship Code (SLN-08) is present, then Unit Price (SLN-06) is required
If either Product/Service ID Qualifier (SLN-09) or Product/Service ID (SLN-10) is present, then the other is required
SLN-01
350
Assigned Identification
Required
String (AN)
Min 1Max 20
—
SLN-03
662
Relationship Code
Required
Identifier (ID)
Min 1Max 1
—
SLN-04
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
SLN-05
C001
Composite Unit of Measure
OptionalMax 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 2Max 2
—
SLN-06
212
Unit Price
Optional
Decimal number (R)
Min 1Max 15
—
SLN-08
662
Relationship Code
Optional
Identifier (ID)
Min 1Max 1
—
SLN-09
235
Product/Service ID Qualifier
Optional
Identifier (ID)
Min 2Max 2
—
SLN-10
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
SI
400
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > SLN Loop > SI

Service Characteristic Identification

OptionalMax use 2
—
Example
SI-01
559
Agency Qualifier Code
Required
Identifier (ID)
Min 2Max 2
—
SI-02
1000
Service Characteristics Qualifier
Required
String (AN)
Min 2Max 2
—
SI-03
234
Product/Service ID
Required
String (AN)
Min 1Max 48
—
PID
410
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > SLN Loop > PID

Product/Item Description

OptionalMax use 200
—
Example
If Product Description Code (PID-04) is present, then Agency Qualifier Code (PID-03) is required
At least one of Product Description Code (PID-04) or Description (PID-05) is required
PID-01
349
Item Description Type
Required
Identifier (ID)
Min 1Max 1
—
PID-03
559
Agency Qualifier Code
Optional
Identifier (ID)
Min 2Max 2
—
PID-04
751
Product Description Code
Optional
String (AN)
Min 1Max 12
—
PID-05
352
Description
Optional
String (AN)
Min 1Max 80
—
MEA
415
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > SLN Loop > MEA

Measurements

OptionalMax use 20
—
Example
MEA-02
738
Measurement Qualifier
Optional
Identifier (ID)
Min 1Max 3
—
MEA-03
739
Measurement Value
Optional
Decimal number (R)
Min 1Max 15
—
DTM
480
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > SLN Loop > DTM

Date/Time Reference

OptionalMax use 10
—
Example
DTM-01
374
Date/Time Qualifier
Required
Identifier (ID)
Min 3Max 3
—
DTM-02
373
Date
Optional
Date (DT)
CCYYMMDD format
—
AMT
490
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > SLN Loop > AMT

Monetary Amount

OptionalMax use 15
—
Example
AMT-01
522
Amount Qualifier Code
Required
Identifier (ID)
Min 1Max 3
—
AMT-02
782
Monetary Amount
Required
Decimal number (R)
Min 1Max 15
—
MSG
500
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > SLN Loop > MSG

Message Text

OptionalMax use >1
—
Example
MSG-01
933
Free-Form Message Text
Required
String (AN)
Min 1Max 264
—
QTY Loop
OptionalMax >1
QTY
510
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > SLN Loop > QTY Loop > QTY

Quantity

RequiredMax use 1
—
Example
QTY-01
673
Quantity Qualifier
Required
Identifier (ID)
Min 2Max 2
—
QTY-02
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
QTY-03
C001
Composite Unit of Measure
OptionalMax 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 2Max 2
—
QTY Loop end
SLN Loop end
HL Loop
OptionalMax >1
HL
010
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > HL Loop > HL

Hierarchical Level

RequiredMax use 1
—
Example
HL-01
628
Hierarchical ID Number
Required
String (AN)
Min 1Max 12
—
HL-02
734
Hierarchical Parent ID Number
Required
String (AN)
Min 1Max 12
—
HL-03
735
Hierarchical Level Code
Required
Identifier (ID)
—
9
Line Detail
HL-04
736
Hierarchical Child Code
Optional
Identifier (ID)
—
0
No Subordinate HL Segment in This Hierarchical Structure.
IT1 Loop
OptionalMax >1
IT1
210
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > HL Loop > IT1 Loop > IT1

Baseline Item Data (Invoice)

RequiredMax use 1
—
Example
If either Quantity Invoiced (IT1-02), Unit or Basis for Measurement Code (IT1-03) or Unit Price (IT1-04) are present, then the others are required
If either Product/Service ID Qualifier (IT1-06) or Product/Service ID (IT1-07) is present, then the other is required
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
—
IT1-02
358
Quantity Invoiced
Optional
Decimal number (R)
Min 1Max 10
—
IT1-03
355
Unit or Basis for Measurement Code
Optional
Identifier (ID)
Min 2Max 2
—
IT1-04
212
Unit Price
Optional
Decimal number (R)
Min 1Max 15
—
IT1-06
235
Product/Service ID Qualifier
Optional
Identifier (ID)
Min 2Max 2
—
IT1-07
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
IT1-08
235
Product/Service ID Qualifier
Optional
Identifier (ID)
Min 2Max 2
—
IT1-09
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
PID
230
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > HL Loop > IT1 Loop > PID

Product/Item Description

OptionalMax use 200
—
Example
If Product Description Code (PID-04) is present, then Agency Qualifier Code (PID-03) is required
At least one of Product Description Code (PID-04) or Description (PID-05) is required
PID-01
349
Item Description Type
Required
Identifier (ID)
Min 1Max 1
—
PID-03
559
Agency Qualifier Code
Optional
Identifier (ID)
Min 2Max 2
—
PID-04
751
Product Description Code
Optional
String (AN)
Min 1Max 12
—
PID-05
352
Description
Optional
String (AN)
Min 1Max 80
—
QTY Loop
OptionalMax >1
QTY
290
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > HL Loop > IT1 Loop > QTY Loop > QTY

Quantity

RequiredMax use 1
—
Example
QTY-01
673
Quantity Qualifier
Required
Identifier (ID)
Min 2Max 2
—
QTY-02
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
QTY-03
C001
Composite Unit of Measure
OptionalMax 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 2Max 2
—
QTY Loop end
IT1 Loop end
TCD Loop
OptionalMax >1
TCD
590
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > HL Loop > TCD Loop > TCD

Itemized Call Detail

RequiredMax use 1
—
Example
If either Location Qualifier (TCD-04) or Location Identifier (TCD-05) is present, then the other is required
TCD-01
350
Assigned Identification
Optional
String (AN)
Min 1Max 20
—
TCD-02
373
Date
Optional
Date (DT)
CCYYMMDD format
—
TCD-03
337
Time
Optional
Time (TM)
HHMM, HHMMSS, HHMMSSD, or HHMMSSDD format
—
TCD-04
309
Location Qualifier
Optional
Identifier (ID)
Min 1Max 2
—
TCD-05
310
Location Identifier
Optional
String (AN)
Min 1Max 30
—
TCD-10
739
Measurement Value
Optional
Decimal number (R)
Min 1Max 15
—
TCD-11
739
Measurement Value
Optional
Decimal number (R)
Min 1Max 15
—
TCD-12
782
Monetary Amount
Optional
Decimal number (R)
Min 1Max 15
—
TCD-13
782
Monetary Amount
Optional
Decimal number (R)
Min 1Max 15
—
TCD-14
782
Monetary Amount
Optional
Decimal number (R)
Min 1Max 15
—
TCD-15
782
Monetary Amount
Optional
Decimal number (R)
Min 1Max 15
—
TCD-16
662
Relationship Code
Optional
Identifier (ID)
Min 1Max 1
—
SI
600
Detail > HL Loop > HL Loop > HL Loop Group > HL Loop > HL Loop > TCD Loop > SI

Service Characteristic Identification

OptionalMax use 2
—
Example
If either Service Characteristics Qualifier (SI-04) or Product/Service ID (SI-05) is present, then the other is required
If either Service Characteristics Qualifier (SI-06) or Product/Service ID (SI-07) is present, then the other is required
If either Service Characteristics Qualifier (SI-08) or Product/Service ID (SI-09) is present, then the other is required
If either Service Characteristics Qualifier (SI-10) or Product/Service ID (SI-11) is present, then the other is required
SI-01
559
Agency Qualifier Code
Required
Identifier (ID)
Min 2Max 2
—
SI-02
1000
Service Characteristics Qualifier
Required
String (AN)
Min 2Max 2
—
SI-03
234
Product/Service ID
Required
String (AN)
Min 1Max 48
—
SI-04
1000
Service Characteristics Qualifier
Optional
String (AN)
Min 2Max 2
—
SI-05
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
SI-06
1000
Service Characteristics Qualifier
Optional
String (AN)
Min 2Max 2
—
SI-07
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
SI-08
1000
Service Characteristics Qualifier
Optional
String (AN)
Min 2Max 2
—
SI-09
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
SI-10
1000
Service Characteristics Qualifier
Optional
String (AN)
Min 2Max 2
—
SI-11
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
TCD Loop end
HL Loop end
HL Loop end
HL Loop Group end
HL Loop Sub Billing Arrangement
OptionalMax >1
Variants (all may be used)
HL Loop Group
HL
010
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL

Hierarchical Level

RequiredMax use 1
—
Example
HL-01
628
Hierarchical ID Number
Required
String (AN)
Min 1Max 12
—
HL-02
734
Hierarchical Parent ID Number
Required
String (AN)
Min 1Max 12
—
HL-03
735
Hierarchical Level Code
Required
Identifier (ID)
—
3
Sub-Billing Arrangement
HL-04
736
Hierarchical Child Code
Optional
Identifier (ID)
—
0
No Subordinate HL Segment in This Hierarchical Structure.
1
Additional Subordinate HL Data Segment in This Hierarchical Structure.
LX Loop
OptionalMax >1
LX
020
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > LX Loop > LX

Assigned Number

RequiredMax use 1
—
Example
LX-01
554
Assigned Number
Required
Numeric (N0)
Min 1Max 6
—
SI
030
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > LX Loop > SI

Service Characteristic Identification

OptionalMax use 8
—
Example
SI-01
559
Agency Qualifier Code
Required
Identifier (ID)
Min 2Max 2
—
SI-02
1000
Service Characteristics Qualifier
Required
String (AN)
Min 2Max 2
—
SI-03
234
Product/Service ID
Required
String (AN)
Min 1Max 48
—
PID
040
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > LX Loop > PID

Product/Item Description

OptionalMax use 200
—
Example
If Product Description Code (PID-04) is present, then Agency Qualifier Code (PID-03) is required
At least one of Product Description Code (PID-04) or Description (PID-05) is required
PID-01
349
Item Description Type
Required
Identifier (ID)
Min 1Max 1
—
PID-03
559
Agency Qualifier Code
Optional
Identifier (ID)
Min 2Max 2
—
PID-04
751
Product Description Code
Optional
String (AN)
Min 1Max 12
—
PID-05
352
Description
Optional
String (AN)
Min 1Max 80
—
REF
050
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > LX Loop > REF

Reference Identification

OptionalMax use >1
—
Example
At least one of Reference Identification (REF-02) or Description (REF-03) is required
REF-01
128
Reference Identification Qualifier
Required
Identifier (ID)
Min 2Max 3
—
REF-02
127
Reference Identification
Optional
String (AN)
Min 1Max 30
—
REF-03
352
Description
Optional
String (AN)
Min 1Max 80
—
REF-04
C040
Reference Identifier
OptionalMax use 1
To identify one or more reference numbers or identification numbers as specified by the Reference Qualifier
C040-01
128
Reference Identification Qualifier
Required
Identifier (ID)
Min 2Max 3
—
C040-02
127
Reference Identification
Required
String (AN)
Min 1Max 30
—
AMT
060
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > LX Loop > AMT

Monetary Amount

OptionalMax use 5
—
Example
AMT-01
522
Amount Qualifier Code
Required
Identifier (ID)
Min 1Max 3
—
AMT-02
782
Monetary Amount
Required
Decimal number (R)
Min 1Max 15
—
DTM
070
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > LX Loop > DTM

Date/Time Reference

OptionalMax use 8
—
Example
DTM-01
374
Date/Time Qualifier
Required
Identifier (ID)
Min 3Max 3
—
DTM-02
373
Date
Optional
Date (DT)
CCYYMMDD format
—
QTY Loop
OptionalMax >1
QTY
090
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > LX Loop > QTY Loop > QTY

Quantity

RequiredMax use 1
—
Example
QTY-01
673
Quantity Qualifier
Required
Identifier (ID)
Min 2Max 2
—
QTY-02
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
QTY-03
C001
Composite Unit of Measure
OptionalMax 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 2Max 2
—
QTY Loop end
LX Loop end
NM1 Loop
OptionalMax >1
NM1
110
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > NM1 Loop > NM1

Individual or Organizational Name

RequiredMax use 1
—
Example
If either Identification Code Qualifier (NM1-08) or Identification Code (NM1-09) is present, then the other is required
NM1-01
98
Entity Identifier Code
Required
Identifier (ID)
Min 2Max 3
—
NM1-02
1065
Entity Type Qualifier
Required
Identifier (ID)
Min 1Max 1
—
NM1-03
1035
Name Last or Organization Name
Optional
String (AN)
Min 1Max 35
—
NM1-08
66
Identification Code Qualifier
Optional
Identifier (ID)
Min 1Max 2
—
NM1-09
67
Identification Code
Optional
String (AN)
Min 2Max 80
—
N2
120
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > NM1 Loop > N2

Additional Name Information

OptionalMax use 2
—
Example
N2-01
93
Name
Required
String (AN)
Min 1Max 60
—
N2-02
93
Name
Optional
String (AN)
Min 1Max 60
—
TXI
170
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > NM1 Loop > TXI

Tax Information

OptionalMax use >1
—
Example
TXI-01
963
Tax Type Code
Required
Identifier (ID)
Min 2Max 2
—
TXI-02
782
Monetary Amount
Optional
Decimal number (R)
Min 1Max 15
—
TXI-07
662
Relationship Code
Optional
Identifier (ID)
Min 1Max 1
—
NM1 Loop end
ITA Loop
OptionalMax >1
ITA
180
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > ITA Loop > ITA

Allowance, Charge or Service

RequiredMax use 1
—
Example
If either Quantity (ITA-10) or Unit or Basis for Measurement Code (ITA-11) is present, then the other is required
ITA-01
248
Allowance or Charge Indicator
Required
Identifier (ID)
Min 1Max 1
—
ITA-02
559
Agency Qualifier Code
Optional
Identifier (ID)
Min 2Max 2
—
ITA-04
331
Allowance or Charge Method of Handling Code
Required
Identifier (ID)
Min 2Max 2
—
ITA-07
360
Allowance or Charge Total Amount
Optional
Numeric (N2)
Min 1Max 15
—
ITA-10
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
ITA-11
355
Unit or Basis for Measurement Code
Optional
Identifier (ID)
Min 2Max 2
—
ITA-13
352
Description
Optional
String (AN)
Min 1Max 80
—
ITA-14
150
Special Charge or Allowance Code
Optional
Identifier (ID)
Min 3Max 3
—
ITA-16
662
Relationship Code
Optional
Identifier (ID)
Min 1Max 1
—
ITA Loop end
HL Loop
OptionalMax >1
HL
010
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL

Hierarchical Level

RequiredMax use 1
—
Example
HL-01
628
Hierarchical ID Number
Required
String (AN)
Min 1Max 12
—
HL-02
734
Hierarchical Parent ID Number
Required
String (AN)
Min 1Max 12
—
HL-03
735
Hierarchical Level Code
Required
Identifier (ID)
—
4
Group
HL-04
736
Hierarchical Child Code
Optional
Identifier (ID)
—
0
No Subordinate HL Segment in This Hierarchical Structure.
1
Additional Subordinate HL Data Segment in This Hierarchical Structure.
IT1 Loop
OptionalMax >1
IT1
210
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > IT1 Loop > IT1

Baseline Item Data (Invoice)

RequiredMax use 1
—
Example
If either Quantity Invoiced (IT1-02), Unit or Basis for Measurement Code (IT1-03) or Unit Price (IT1-04) are present, then the others are required
If either Product/Service ID Qualifier (IT1-06) or Product/Service ID (IT1-07) is present, then the other is required
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
—
IT1-02
358
Quantity Invoiced
Optional
Decimal number (R)
Min 1Max 10
—
IT1-03
355
Unit or Basis for Measurement Code
Optional
Identifier (ID)
Min 2Max 2
—
IT1-04
212
Unit Price
Optional
Decimal number (R)
Min 1Max 15
—
IT1-06
235
Product/Service ID Qualifier
Optional
Identifier (ID)
Min 2Max 2
—
IT1-07
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
IT1-08
235
Product/Service ID Qualifier
Optional
Identifier (ID)
Min 2Max 2
—
IT1-09
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
PID
230
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > IT1 Loop > PID

Product/Item Description

OptionalMax use 200
—
Example
If Product Description Code (PID-04) is present, then Agency Qualifier Code (PID-03) is required
At least one of Product Description Code (PID-04) or Description (PID-05) is required
PID-01
349
Item Description Type
Required
Identifier (ID)
Min 1Max 1
—
PID-03
559
Agency Qualifier Code
Optional
Identifier (ID)
Min 2Max 2
—
PID-04
751
Product Description Code
Optional
String (AN)
Min 1Max 12
—
PID-05
352
Description
Optional
String (AN)
Min 1Max 80
—
QTY Loop
OptionalMax >1
QTY
290
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > IT1 Loop > QTY Loop > QTY

Quantity

RequiredMax use 1
—
Example
QTY-01
673
Quantity Qualifier
Required
Identifier (ID)
Min 2Max 2
—
QTY-02
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
QTY-03
C001
Composite Unit of Measure
OptionalMax 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 2Max 2
—
QTY Loop end
IT1 Loop end
HL Loop
OptionalMax >1
HL
010
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > HL

Hierarchical Level

RequiredMax use 1
—
Example
HL-01
628
Hierarchical ID Number
Required
String (AN)
Min 1Max 12
—
HL-02
734
Hierarchical Parent ID Number
Required
String (AN)
Min 1Max 12
—
HL-03
735
Hierarchical Level Code
Required
Identifier (ID)
—
8
Charge Detail
HL-04
736
Hierarchical Child Code
Optional
Identifier (ID)
—
0
No Subordinate HL Segment in This Hierarchical Structure.
1
Additional Subordinate HL Data Segment in This Hierarchical Structure.
SLN Loop
OptionalMax >1
SLN
390
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > SLN Loop > SLN

Subline Item Detail

RequiredMax use 1
—
Example
If Relationship Code (SLN-08) is present, then Unit Price (SLN-06) is required
If either Product/Service ID Qualifier (SLN-09) or Product/Service ID (SLN-10) is present, then the other is required
SLN-01
350
Assigned Identification
Required
String (AN)
Min 1Max 20
—
SLN-03
662
Relationship Code
Required
Identifier (ID)
Min 1Max 1
—
SLN-04
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
SLN-05
C001
Composite Unit of Measure
OptionalMax 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 2Max 2
—
SLN-06
212
Unit Price
Optional
Decimal number (R)
Min 1Max 15
—
SLN-08
662
Relationship Code
Optional
Identifier (ID)
Min 1Max 1
—
SLN-09
235
Product/Service ID Qualifier
Optional
Identifier (ID)
Min 2Max 2
—
SLN-10
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
SI
400
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > SLN Loop > SI

Service Characteristic Identification

OptionalMax use 2
—
Example
SI-01
559
Agency Qualifier Code
Required
Identifier (ID)
Min 2Max 2
—
SI-02
1000
Service Characteristics Qualifier
Required
String (AN)
Min 2Max 2
—
SI-03
234
Product/Service ID
Required
String (AN)
Min 1Max 48
—
PID
410
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > SLN Loop > PID

Product/Item Description

OptionalMax use 200
—
Example
If Product Description Code (PID-04) is present, then Agency Qualifier Code (PID-03) is required
At least one of Product Description Code (PID-04) or Description (PID-05) is required
PID-01
349
Item Description Type
Required
Identifier (ID)
Min 1Max 1
—
PID-03
559
Agency Qualifier Code
Optional
Identifier (ID)
Min 2Max 2
—
PID-04
751
Product Description Code
Optional
String (AN)
Min 1Max 12
—
PID-05
352
Description
Optional
String (AN)
Min 1Max 80
—
MEA
415
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > SLN Loop > MEA

Measurements

OptionalMax use 20
—
Example
MEA-02
738
Measurement Qualifier
Optional
Identifier (ID)
Min 1Max 3
—
MEA-03
739
Measurement Value
Optional
Decimal number (R)
Min 1Max 15
—
DTM
480
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > SLN Loop > DTM

Date/Time Reference

OptionalMax use 10
—
Example
DTM-01
374
Date/Time Qualifier
Required
Identifier (ID)
Min 3Max 3
—
DTM-02
373
Date
Optional
Date (DT)
CCYYMMDD format
—
AMT
490
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > SLN Loop > AMT

Monetary Amount

OptionalMax use 15
—
Example
AMT-01
522
Amount Qualifier Code
Required
Identifier (ID)
Min 1Max 3
—
AMT-02
782
Monetary Amount
Required
Decimal number (R)
Min 1Max 15
—
MSG
500
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > SLN Loop > MSG

Message Text

OptionalMax use >1
—
Example
MSG-01
933
Free-Form Message Text
Required
String (AN)
Min 1Max 264
—
QTY Loop
OptionalMax >1
QTY
510
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > SLN Loop > QTY Loop > QTY

Quantity

RequiredMax use 1
—
Example
QTY-01
673
Quantity Qualifier
Required
Identifier (ID)
Min 2Max 2
—
QTY-02
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
QTY-03
C001
Composite Unit of Measure
OptionalMax 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 2Max 2
—
QTY Loop end
SLN Loop end
HL Loop
OptionalMax >1
HL
010
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > HL Loop > HL

Hierarchical Level

RequiredMax use 1
—
Example
HL-01
628
Hierarchical ID Number
Required
String (AN)
Min 1Max 12
—
HL-02
734
Hierarchical Parent ID Number
Required
String (AN)
Min 1Max 12
—
HL-03
735
Hierarchical Level Code
Required
Identifier (ID)
—
9
Line Detail
HL-04
736
Hierarchical Child Code
Optional
Identifier (ID)
—
0
No Subordinate HL Segment in This Hierarchical Structure.
IT1 Loop
OptionalMax >1
IT1
210
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > HL Loop > IT1 Loop > IT1

Baseline Item Data (Invoice)

RequiredMax use 1
—
Example
If either Quantity Invoiced (IT1-02), Unit or Basis for Measurement Code (IT1-03) or Unit Price (IT1-04) are present, then the others are required
If either Product/Service ID Qualifier (IT1-06) or Product/Service ID (IT1-07) is present, then the other is required
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
—
IT1-02
358
Quantity Invoiced
Optional
Decimal number (R)
Min 1Max 10
—
IT1-03
355
Unit or Basis for Measurement Code
Optional
Identifier (ID)
Min 2Max 2
—
IT1-04
212
Unit Price
Optional
Decimal number (R)
Min 1Max 15
—
IT1-06
235
Product/Service ID Qualifier
Optional
Identifier (ID)
Min 2Max 2
—
IT1-07
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
IT1-08
235
Product/Service ID Qualifier
Optional
Identifier (ID)
Min 2Max 2
—
IT1-09
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
PID
230
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > HL Loop > IT1 Loop > PID

Product/Item Description

OptionalMax use 200
—
Example
If Product Description Code (PID-04) is present, then Agency Qualifier Code (PID-03) is required
At least one of Product Description Code (PID-04) or Description (PID-05) is required
PID-01
349
Item Description Type
Required
Identifier (ID)
Min 1Max 1
—
PID-03
559
Agency Qualifier Code
Optional
Identifier (ID)
Min 2Max 2
—
PID-04
751
Product Description Code
Optional
String (AN)
Min 1Max 12
—
PID-05
352
Description
Optional
String (AN)
Min 1Max 80
—
QTY Loop
OptionalMax >1
QTY
290
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > HL Loop > IT1 Loop > QTY Loop > QTY

Quantity

RequiredMax use 1
—
Example
QTY-01
673
Quantity Qualifier
Required
Identifier (ID)
Min 2Max 2
—
QTY-02
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
—
QTY-03
C001
Composite Unit of Measure
OptionalMax 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 2Max 2
—
QTY Loop end
IT1 Loop end
TCD Loop
OptionalMax >1
TCD
590
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > HL Loop > TCD Loop > TCD

Itemized Call Detail

RequiredMax use 1
—
Example
If either Location Qualifier (TCD-04) or Location Identifier (TCD-05) is present, then the other is required
TCD-01
350
Assigned Identification
Optional
String (AN)
Min 1Max 20
—
TCD-02
373
Date
Optional
Date (DT)
CCYYMMDD format
—
TCD-03
337
Time
Optional
Time (TM)
HHMM, HHMMSS, HHMMSSD, or HHMMSSDD format
—
TCD-04
309
Location Qualifier
Optional
Identifier (ID)
Min 1Max 2
—
TCD-05
310
Location Identifier
Optional
String (AN)
Min 1Max 30
—
TCD-10
739
Measurement Value
Optional
Decimal number (R)
Min 1Max 15
—
TCD-11
739
Measurement Value
Optional
Decimal number (R)
Min 1Max 15
—
TCD-12
782
Monetary Amount
Optional
Decimal number (R)
Min 1Max 15
—
TCD-13
782
Monetary Amount
Optional
Decimal number (R)
Min 1Max 15
—
TCD-14
782
Monetary Amount
Optional
Decimal number (R)
Min 1Max 15
—
TCD-15
782
Monetary Amount
Optional
Decimal number (R)
Min 1Max 15
—
TCD-16
662
Relationship Code
Optional
Identifier (ID)
Min 1Max 1
—
SI
600
Detail > HL Loop > HL Loop > HL Loop Sub Billing Arrangement > HL Loop > HL Loop > HL Loop > TCD Loop > SI

Service Characteristic Identification

OptionalMax use 2
—
Example
If either Service Characteristics Qualifier (SI-04) or Product/Service ID (SI-05) is present, then the other is required
If either Service Characteristics Qualifier (SI-06) or Product/Service ID (SI-07) is present, then the other is required
If either Service Characteristics Qualifier (SI-08) or Product/Service ID (SI-09) is present, then the other is required
If either Service Characteristics Qualifier (SI-10) or Product/Service ID (SI-11) is present, then the other is required
SI-01
559
Agency Qualifier Code
Required
Identifier (ID)
Min 2Max 2
—
SI-02
1000
Service Characteristics Qualifier
Required
String (AN)
Min 2Max 2
—
SI-03
234
Product/Service ID
Required
String (AN)
Min 1Max 48
—
SI-04
1000
Service Characteristics Qualifier
Optional
String (AN)
Min 2Max 2
—
SI-05
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
SI-06
1000
Service Characteristics Qualifier
Optional
String (AN)
Min 2Max 2
—
SI-07
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
SI-08
1000
Service Characteristics Qualifier
Optional
String (AN)
Min 2Max 2
—
SI-09
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
SI-10
1000
Service Characteristics Qualifier
Optional
String (AN)
Min 2Max 2
—
SI-11
234
Product/Service ID
Optional
String (AN)
Min 1Max 48
—
TCD Loop end
HL Loop end
HL Loop end
HL Loop end
HL Loop Sub Billing Arrangement end
HL Loop end
HL Loop end
Detail end

Summary

TDS
010
Summary > TDS

Total Monetary Value Summary

RequiredMax use 1
—
Example
TDS-01
610
Amount
Required
Numeric (N2)
Min 1Max 15
—
BAL Loop
OptionalMax >1
BAL
040
Summary > BAL Loop > BAL

Balance Detail

RequiredMax use 1
—
Example
BAL-01
951
Balance Type Code
Required
Identifier (ID)
Min 1Max 2
—
BAL-02
522
Amount Qualifier Code
Required
Identifier (ID)
Min 1Max 3
—
BAL-03
782
Monetary Amount
Required
Decimal number (R)
Min 1Max 15
—
BAL Loop end
CTT
115
Summary > CTT

Transaction Totals

OptionalMax use 1
—
Example
CTT-01
354
Number of Line Items
Required
Numeric (N0)
Min 1Max 6
—
SE
120
Summary > SE

Transaction Set Trailer

RequiredMax use 1
—
Example
SE-01
96
Number of Included Segments
Required
Numeric (N0)
Min 1Max 10
—
SE-02
329
Transaction Set Control Number
Required
Numeric (N)
Min 4Max 9
—
Summary end
GE

Functional Group Trailer

RequiredMax use 1
—
Example
GE-01
97
Number of Transaction Sets Included
Required
Numeric (N0)
Min 1Max 6
—
GE-02
28
Group Control Number
Required
Numeric (N0)
Min 1Max 9
—
IEA

Interchange Control Trailer

RequiredMax use 1
—
Example
IEA-01
I16
Number of Included Functional Groups
Required
Numeric (N0)
Min 1Max 5
—
IEA-02
I12
Interchange Control Number
Required
Numeric (N0)
Min 9Max 9
—

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