X12 811 Consolidated Service Invoice/Statement

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)

• CI: Consolidated Service Invoice/Statement (811)

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)

• 811: Consolidated Service Invoice/Statement

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

020 Heading > BIG

BIG Beginning Segment for Invoice

Required · Max use 1

BIG-01 · 373 · Date · Required · Date (DT) · CCYYMMDD format

BIG-02 · 76 · Invoice Number · Required · String (AN) · Min 1 Max 22

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

• DI: Debit Invoice

030 Heading > NTE

NTE Note/Special Instruction

Required · Max use 100

NTE-02 · 352 · Description · Required · String (AN) · Min 1 Max 80

050 Heading > REF

REF Reference Identification Accounts Receivable

Required · Max use >1

Variants (all may be used)

REFReference Identification Billing Account

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

• AP: Accounts Receivable Number

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

050 Heading > REF

REF Reference Identification Billing Account

Required · Max use >1

Variants (all may be used)

REFReference Identification Accounts Receivable

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

• 12: Billing Account

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

070 Heading > ITD

ITD Terms of Sale/Deferred Terms of Sale

Required · Max use 5

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

• 18: Fixed Date, Late Payment Penalty Applies

ITD-02 · 333 · Terms Basis Date Code · Required · Identifier (ID)

• 3: Invoice Date

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

080 Heading > DTM

DTM Date/Time Reference Invoice End

Required · Max use 10

Variants (all may be used)

DTMDate/Time Reference Invoice Start

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

• 187: Invoice Period End

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

080 Heading > DTM

DTM Date/Time Reference Invoice Start

Required · Max use 10

Variants (all may be used)

DTMDate/Time Reference Invoice End

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

• 186: Invoice Period Start

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

N1 Loop Payee Required Max >1

Variants (all may be used)

N1 Loop Payer

100 Heading > N1 Loop Payee > N1

N1 Name

Required · Max use 1

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

• PE: Payee

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

N1-03 · 66 · Identification Code Qualifier · Required · Identifier (ID) · Min 1 Max 2

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

120 Heading > N1 Loop Payee > N3

N3 Address Information

Required · Max use 2

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

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

130 Heading > N1 Loop Payee > N4

N4 Geographic Location

Required · Max use 1

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

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

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

N4-04 · 26 · Country Code · Optional · Identifier (ID) · Min 2 Max 3

140 Heading > N1 Loop Payee > REF

REF Reference Identification

Required · Max use 12

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

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

N1 Loop Payer Required Max >1

Variants (all may be used)

N1 Loop Payee

100 Heading > N1 Loop Payer > N1

N1 Name

Required · Max use 1

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

• PR: Payer

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

N1-03 · 66 · Identification Code Qualifier · Required · Identifier (ID) · Min 1 Max 2

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

120 Heading > N1 Loop Payer > N3

N3 Address Information

Required · Max use 2

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

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

130 Heading > N1 Loop Payer > N4

N4 Geographic Location

Required · Max use 1

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

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

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

N4-04 · 26 · Country Code · Optional · Identifier (ID) · Min 2 Max 3

Detail

HL Loop Service Provider Required Max >1

010 Detail > HL Loop Service Provider > HL

HL Hierarchical Level

Required · Max use 1

HL-01 · 628 · Hierarchical ID Number · Required · String (AN) · Min 1 Max 12

HL-03 · 735 · Hierarchical Level Code · Required · Identifier (ID)

• 1: Service/Billing Provider

HL-04 · 736 · Hierarchical Child Code · Optional · Identifier (ID)

• 1: Additional Subordinate HL Data Segment in This Hierarchical Structure.

LX Loop Required Max >1

020 Detail > HL Loop Service Provider > LX Loop > LX

LX Assigned Number

Required · Max use 1

LX-01 · 554 · Assigned Number · Required · Numeric (N0) · Min 1 Max 6

030 Detail > HL Loop Service Provider > LX Loop > SI

SI Service Characteristic Identification

Required · Max use 8

SI-01 · 559 · Agency Qualifier Code · Required · Identifier (ID)

• TI: Telecommunications Industry

SI-02 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

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

060 Detail > HL Loop Service Provider > LX Loop > AMT

AMT Monetary Amount

Required · Max use 5

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

• SC: Total Service Charge

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

NM1 Loop Required Max >1

110 Detail > HL Loop Service Provider > NM1 Loop > NM1

NM1 Individual or Organizational Name

Required · Max use 1

NM1-01 · 98 · Entity Identifier Code · Required · Identifier (ID)

• SJ: Service Provider

NM1-02 · 1065 · Entity Type Qualifier · Required · Identifier (ID)

• 2: Non-Person Entity

NM1-03 · 1035 · Name Last or Organization Name · Required · String (AN) · Min 1 Max 35

NM1-08 · 66 · Identification Code Qualifier · Required · Identifier (ID)

• 41: Telecommunications Carrier Identification Code

NM1-09 · 67 · Identification Code · Required · String (AN) · Min 2 Max 80

160 Detail > HL Loop Service Provider > NM1 Loop > PER

PER Administrative Communications Contact

Required · Max use >1

PER-01 · 366 · Contact Function Code · Required · Identifier (ID)

• BI: Bill Inquiry Contact
• MA: Maintenance Contact
• OC: Order Contact

PER-03 · 365 · Communication Number Qualifier · Required · Identifier (ID)

• TE: Telephone

PER-04 · 364 · Communication Number · Required · String (AN) · Min 1 Max 80

170 Detail > HL Loop Service Provider > NM1 Loop > TXI

TXI Tax Information

Optional · Max use >1

TXI-01 · 963 · Tax Type Code · Required · Identifier (ID)

• FD: Federal Tax
• SP: State/Provincial Tax

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

TXI-03 · 954 · Percent · Optional · Decimal number (R) · Min 1 Max 10

TXI-04 · 955 · Tax Jurisdiction Code Qualifier · Required · Identifier (ID)

• VD: Vendor defined

TXI-05 · 956 · Tax Jurisdiction Code · Required · String (AN) · Min 1 Max 10

TXI-06 · 441 · Tax Exempt Code · Required · Identifier (ID)

• 2: No (Not Tax Exempt)

TXI-07 · 662 · Relationship Code · Required · Identifier (ID)

• A: Add

TXI-10 · 350 · Assigned Identification · Optional · String (AN) · Min 1 Max 20

ITA Loop Optional Max >1

180 Detail > HL Loop Service Provider > ITA Loop > ITA

ITA Allowance, Charge or Service

Required · Max use 1

ITA-01 · 248 · Allowance or Charge Indicator · Required · Identifier (ID)

• C: Charge

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

• TI: Telecommunications Industry

ITA-04 · 331 · Allowance or Charge Method of Handling Code · Required · Identifier (ID)

• 04: Credit Customer Account
• 06: Charge to be Paid by Customer

ITA-05 · 341 · Allowance or Charge Number · Optional · String (AN) · Min 1 Max 16

ITA-07 · 360 · Allowance or Charge Total Amount · Required · Numeric (N2) · Min 1 Max 15

ITA-09 · 332 · Percent · Optional · Decimal number (R) · Min 1 Max 6

ITA-13 · 352 · Description · Required · String (AN) · Min 1 Max 80

ITA-14 · 150 · Special Charge or Allowance Code · Required · Identifier (ID)

• SUR: Surcharge

ITA-16 · 662 · Relationship Code · Required · Identifier (ID)

• A: Add

HL Loop Group Required Max >1

010 Detail > HL Loop Service Provider > HL Loop Group > HL

HL Hierarchical Level

Required · Max use 1

HL-01 · 628 · Hierarchical ID Number · Required · String (AN) · Min 1 Max 12

HL-02 · 734 · Hierarchical Parent ID Number · Required · String (AN) · Min 1 Max 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 Required Max >1

210 Detail > HL Loop Service Provider > HL Loop Group > IT1 Loop > IT1

IT1 Baseline Item Data (Invoice)

Required · Max use 1

IT1-02 · 358 · Quantity Invoiced · Required · Decimal number (R) · Min 1 Max 10

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

• M4: Monetary Value

IT1-04 · 212 · Unit Price · Required · Decimal number (R) · Min 1 Max 15

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

• SV: Service Rendered

IT1-07 · 234 · Product/Service ID · Required · String (AN) · Min 1 Max 48

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

• ZZ: Mutually Defined

IT1-09 · 234 · Product/Service ID · Required · String (AN) · Min 1 Max 48

220 Detail > HL Loop Service Provider > HL Loop Group > IT1 Loop > SI

SI Service Characteristic Identification

Required · Max use 2

SI-01 · 559 · Agency Qualifier Code · Required · Identifier (ID)

• TI: Telecommunications Industry

SI-02 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

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

230 Detail > HL Loop Service Provider > HL Loop Group > IT1 Loop > PID

PID Product/Item Description

Optional · Max use 200

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

• F: Free-form

PID-05 · 352 · Description · Required · String (AN) · Min 1 Max 80

270 Detail > HL Loop Service Provider > HL Loop Group > IT1 Loop > DTM

DTM Date/Time Reference

Optional · Max use 10

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

• 150: Service Period Start

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

HL Loop Charge Detail Optional Max >1

Variants (all may be used)

HL Loop Line Detail

010 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Charge Detail > HL

HL Hierarchical Level

Required · Max use 1

HL-01 · 628 · Hierarchical ID Number · Required · String (AN) · Min 1 Max 12

HL-02 · 734 · Hierarchical Parent ID Number · Required · String (AN) · Min 1 Max 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 Required Max >1

390 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Charge Detail > SLN Loop > SLN

SLN Subline Item Detail

Required · Max use 1

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 1 Max 20

SLN-03 · 662 · Relationship Code · Required · Identifier (ID)

• I: Included

SLN-04 · 380 · Quantity · Required · Decimal number (R) · Min 1 Max 15

SLN-05 · 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)

• M4: Monetary Value

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

SLN-08 · 662 · Relationship Code · Required · Identifier (ID)

• I: Included
• O: Information Only

SLN-09 · 235 · Product/Service ID Qualifier · Optional · Identifier (ID) · Min 2 Max 2

SLN-10 · 234 · Product/Service ID · Optional · String (AN) · Min 1 Max 48

400 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Charge Detail > SLN Loop > SI

SI Service Characteristic Identification

Required · Max use 2

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

SI-01 · 559 · Agency Qualifier Code · Required · Identifier (ID)

• IA: International Agency for Research on Cancer (IARC)
• TI: Telecommunications Industry

SI-02 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

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

SI-04 · 1000 · Service Characteristics Qualifier · Optional · String (AN) · Min 2 Max 2

SI-05 · 234 · Product/Service ID · Optional · String (AN) · Min 1 Max 48

SI-06 · 1000 · Service Characteristics Qualifier · Optional · String (AN) · Min 2 Max 2

SI-07 · 234 · Product/Service ID · Optional · String (AN) · Min 1 Max 48

410 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Charge Detail > SLN Loop > PID

PID Product/Item Description

Required · Max use 200

At least one of Product Description Code (PID-04) or Description (PID-05) is required

If Product Description Code (PID-04) is present, then Agency Qualifier Code (PID-03) is required

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

• F: Free-form

PID-03 · 559 · Agency Qualifier Code · Optional · Identifier (ID) · Min 2 Max 2

PID-04 · 751 · Product Description Code · Optional · String (AN) · Min 1 Max 12

PID-05 · 352 · Description · Optional · String (AN) · Min 1 Max 80

480 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Charge Detail > SLN Loop > DTM

DTM Date/Time Reference

Optional · Max use 10

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

• 150: Service Period Start
• 151: Service Period End

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

490 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Charge Detail > SLN Loop > AMT

AMT Monetary Amount

Optional · Max use 15

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

• AP: Amount Prior to Fractionalization
• AX: Previous Price

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

HL Loop Line Detail Optional Max >1

010 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Charge Detail > HL Loop Line Detail > HL

HL Hierarchical Level

Required · Max use 1

HL-01 · 628 · Hierarchical ID Number · Required · String (AN) · Min 1 Max 12

HL-02 · 734 · Hierarchical Parent ID Number · Required · String (AN) · Min 1 Max 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.

USD Loop Required Max >1

620 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Charge Detail > HL Loop Line Detail > USD Loop > USD

USD Usage-Sensitive Detail

Required · Max use 1

USD-01 · 662 · Relationship Code · Required · Identifier (ID)

• O: Information Only

USD-08 · 782 · Monetary Amount · Required · Decimal number (R) · Min 1 Max 15

USD-09 · 610 · Amount · Required · Numeric (N2) · Min 1 Max 15

USD-10 · 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)

• M4: Monetary Value

USD-11 · 740 · Range Minimum · Required · Decimal number (R) · Min 1 Max 15

USD-12 · 741 · Range Maximum · Required · Decimal number (R) · Min 1 Max 15

625 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Charge Detail > HL Loop Line Detail > USD Loop > SI

SI Service Characteristic Identification

Required · Max use 2

SI-01 · 559 · Agency Qualifier Code · Required · Identifier (ID)

• TI: Telecommunications Industry

SI-02 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

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

SI-04 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

SI-05 · 234 · Product/Service ID · Required · String (AN) · Min 1 Max 48

HL Loop Line Detail Optional Max >1

Variants (all may be used)

HL Loop Charge Detail

010 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Line Detail > HL

HL Hierarchical Level

Required · Max use 1

HL-01 · 628 · Hierarchical ID Number · Required · String (AN) · Min 1 Max 12

HL-02 · 734 · Hierarchical Parent ID Number · Required · String (AN) · Min 1 Max 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.

LX Loop Required Max >1

020 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Line Detail > LX Loop > LX

LX Assigned Number

Required · Max use 1

LX-01 · 554 · Assigned Number · Required · Numeric (N0) · Min 1 Max 6

030 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Line Detail > LX Loop > SI

SI Service Characteristic Identification

Required · Max use 8

SI-01 · 559 · Agency Qualifier Code · Required · Identifier (ID)

• TI: Telecommunications Industry

SI-02 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

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

060 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Line Detail > LX Loop > AMT

AMT Monetary Amount

Required · Max use 5

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

• SC: Total Service Charge

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

NM1 Loop Optional Max >1

110 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Line Detail > NM1 Loop > NM1

NM1 Individual or Organizational Name

Required · Max use 1

NM1-01 · 98 · Entity Identifier Code · Required · Identifier (ID)

• SJ: Service Provider

NM1-02 · 1065 · Entity Type Qualifier · Required · Identifier (ID)

• 2: Non-Person Entity

NM1-03 · 1035 · Name Last or Organization Name · Required · String (AN) · Min 1 Max 35

NM1-08 · 66 · Identification Code Qualifier · Required · Identifier (ID)

• 41: Telecommunications Carrier Identification Code
• 42: Telecommunications Pseudo Carrier Identification Code

NM1-09 · 67 · Identification Code · Required · String (AN) · Min 2 Max 80

TCD Loop Optional Max >1

590 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Line Detail > TCD Loop > TCD

TCD Itemized Call Detail

Required · Max use 1

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

TCD-03 · 337 · Time · Required · Time (TM) · HHMM, HHMMSS, HHMMSSD, or HHMMSSDD format

TCD-04 · 309 · Location Qualifier · Required · Identifier (ID)

• CI: City

TCD-05 · 310 · Location Identifier · Required · String (AN) · Min 1 Max 30

TCD-06 · 156 · State or Province Code · Required · Identifier (ID) · Min 2 Max 2

TCD-07 · 309 · Location Qualifier · Required · Identifier (ID)

• CI: City

TCD-08 · 310 · Location Identifier · Required · String (AN) · Min 1 Max 30

TCD-09 · 156 · State or Province Code · Required · Identifier (ID) · Min 2 Max 2

TCD-11 · 739 · Measurement Value · Required · Decimal number (R) · Min 1 Max 15

TCD-13 · 782 · Monetary Amount · Required · Decimal number (R) · Min 1 Max 15

TCD-16 · 662 · Relationship Code · Required · Identifier (ID)

• I: Included

600 Detail > HL Loop Service Provider > HL Loop Group > HL Loop Line Detail > TCD Loop > SI

SI Service Characteristic Identification

Required · Max use 2

SI-01 · 559 · Agency Qualifier Code · Required · Identifier (ID)

• TI: Telecommunications Industry

SI-02 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

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

SI-04 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

SI-05 · 234 · Product/Service ID · Required · String (AN) · Min 1 Max 48

SI-06 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

SI-07 · 234 · Product/Service ID · Required · String (AN) · Min 1 Max 48

SI-08 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

SI-09 · 234 · Product/Service ID · Required · String (AN) · Min 1 Max 48

SI-14 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

SI-15 · 234 · Product/Service ID · Required · String (AN) · Min 1 Max 48

SI-16 · 1000 · Service Characteristics Qualifier · Required · String (AN) · Min 2 Max 2

SI-17 · 234 · Product/Service ID · Required · String (AN) · Min 1 Max 48

Summary

010 Summary > TDS

TDS Total Monetary Value Summary

Optional · Max use 1

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

ITA Loop Optional Max >1

020 Summary > ITA Loop > ITA

ITA Allowance, Charge or Service

Required · Max use 1

ITA-01 · 248 · Allowance or Charge Indicator · Required · Identifier (ID)

• C: Charge

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

• TI: Telecommunications Industry

ITA-04 · 331 · Allowance or Charge Method of Handling Code · Required · Identifier (ID)

• 06: Charge to be Paid by Customer

ITA-07 · 360 · Allowance or Charge Total Amount · Required · Numeric (N2) · Min 1 Max 15

ITA-14 · 150 · Special Charge or Allowance Code · Required · Identifier (ID)

• LPC: Late payment charge

ITA-16 · 662 · Relationship Code · Required · Identifier (ID)

• A: Add

BAL Loop Required Max >1

040 Summary > BAL Loop > BAL

BAL Balance Detail

Required · Max use 1

BAL-01 · 951 · Balance Type Code · Required · Identifier (ID)

• A: Adjustment
• M: Current Month
• N: Month
• P: Previous Month

BAL-02 · 522 · Amount Qualifier Code · Required · Identifier (ID)

• NA: Net Adjustment
• PB: Billed Amount
• TP: Total payment amount
• TT: Total Transaction Amount

BAL-03 · 782 · Monetary Amount · Required · Decimal number (R) · Min 1 Max 15

115 Summary > CTT

CTT Transaction Totals

Required · Max use 1

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

120 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