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Invoice
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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
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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
    N1 Loop
    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

    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
    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

    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
    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
    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
    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
    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
    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
    YYMMDD format

    Date of the interchange

    ISA-10
    I09
    Interchange Time
    Required
    HHMM format

    Time of the interchange

    ISA-11
    I10
    Interchange Control Standards Identifier
    Required

    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

    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
    Min 9Max 9

    A control number assigned by the interchange sender

    ISA-14
    I13
    Acknowledgment Requested
    Required
    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
    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
    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

    Code identifying a group of application related transaction sets

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

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

    GS-03
    124
    Application Receiver's Code
    Required
    Min 2Max 15

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

    GS-04
    373
    Date
    Required
    CCYYMMDD format

    Date expressed as CCYYMMDD

    GS-05
    337
    Time
    Required
    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
    Min 1Max 9

    Assigned number originated and maintained by the sender

    GS-07
    455
    Responsible Agency Code
    Required
    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

    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

    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

    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
    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

    Beginning Segment for Invoice

    RequiredMax use 1

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

    Example
    BIG-01
    373
    Date
    Required
    CCYYMMDD format

    Date expressed as CCYYMMDD

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

    Identifying number assigned by issuer

    BIG-03
    373
    Date
    Optional
    CCYYMMDD format

    Date expressed as CCYYMMDD

    • BIG03 is the date assigned by the purchaser to purchase order.
    BIG-04
    324
    Purchase Order Number
    Required
    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

    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 Loop
    RequiredMax 200
    Variants (all may be used)
    N1N1 LoopN1N1 Loop
    N1
    070

    Name

    RequiredMax use 1

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

    Example
    N1-01
    98
    Entity Identifier Code
    Required

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

    BT
    Bill-to-Party
    N1-03
    66
    Identification Code Qualifier
    Required

    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
    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 Loop
    RequiredMax 200
    Variants (all may be used)
    N1N1 LoopN1N1 Loop
    N1
    070

    Name

    RequiredMax use 1

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

    Example
    N1-01
    98
    Entity Identifier Code
    Required

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

    RE
    Party to receive commercial invoice remittance
    SU
    Supplier/Manufacturer
    N1-02
    93
    Name
    Required
    Min 1Max 60

    Free-form name

    N1-03
    66
    Identification Code Qualifier
    Required

    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
    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
    RequiredMax 200
    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)
    N1N1 LoopN1N1 Loop
    N1
    070

    Name

    RequiredMax use 1

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

    Example
    N1-01
    98
    Entity Identifier Code
    Required

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

    ST
    Ship To
    N1-02
    93
    Name
    Required
    Min 1Max 60

    Free-form name

    N1-03
    66
    Identification Code Qualifier
    Required

    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
    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

    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
    Min 1Max 55

    Address information

    N3-02
    166
    Address Information
    Optional
    Min 1Max 55

    Address information

    N4
    100

    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
    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
    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
    Min 3Max 15

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

    ITD
    130

    Terms of Sale/Deferred Terms of Sale

    RequiredMax use >1

    To specify terms of sale

    Example
    ITD-01
    336
    Terms Type Code
    Required

    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

    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
    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
    CCYYMMDD format

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

    ITD-05
    351
    Terms Discount Days Due
    Required
    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
    CCYYMMDD format

    Date when total invoice amount becomes due expressed in format CCYYMMDD

    ITD-07
    386
    Terms Net Days
    Required
    Min 1Max 3

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

    ITD-08
    362
    Terms Discount Amount
    Required
    Min 1Max 10

    Total amount of terms discount

    Detail

    IT1 Loop
    RequiredMax 200000
    IT1
    010

    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
    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
    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

    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
    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

    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
    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

    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
    Min 1Max 48

    Identifying number for a product or service

    PID Loop
    OptionalMax 1000
    PID
    060

    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

    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
    Min 1Max 80

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

    SAC Loop
    OptionalMax 25
    SAC
    180

    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

    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

    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
    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.

    Summary

    TDS
    010

    Total Monetary Value Summary

    RequiredMax use 1

    To specify the total invoice discounts and amounts

    Example
    TDS-01
    610
    Amount
    Required
    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

    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

    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

    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
    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.
    CTT
    070

    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
    Min 1Max 6

    Total number of line items in the transaction set

    Usage notes

    This is the total number of IT1 segments.

    SE
    080

    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
    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
    Min 4Max 9

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

    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
    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
    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
    Min 1Max 5

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

    IEA-02
    I12
    Interchange Control Number
    Required
    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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