X12 844 Product Transfer Account Adjustment

X12 Release 4010

This Draft Standard for Trial Use contains the format and establishes the data contents of the Product Transfer Account Adjustment Transaction Set (844) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set can be used to transmit specific data in the form of a debit, credit, or request for credit relating to pre-authorized product transfer actions.

Delimiters

• ~ Segment
• | Element
• > Component

ISA

Interchange Control Header

RequiredMax use 1

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

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 10 Max 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 10 Max 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 2 Max 2 · Qualifier to designate the system/method of code structure used to designate the sender or receiver ID element being qualified · 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 Min 15 Max 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 2 Max 2 · Qualifier to designate the system/method of code structure used to designate the sender or receiver ID element being qualified · 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 Min 15 Max 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 9 Max 9 · A control number assigned by the interchange sender

ISA-14 · I13 · Acknowledgment Requested · Required Min 1 Max 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 1 Max 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 1 Max 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

GS

Functional Group Header

RequiredMax use 1

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

GS-01 · 479 · Functional Identifier Code · Required · Code identifying a group of application related transaction sets · CF Corporate Financial Adjustment Information (844 and 849)

GS-02 · 142 · Application Sender's Code · Required Min 2 Max 15 · Code identifying party sending transmission; codes agreed to by trading partners

GS-03 · 124 · Application Receiver's Code · Required Min 2 Max 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 1 Max 9 · Assigned number originated and maintained by the sender

GS-07 · 455 · Responsible Agency Code · Required Min 1 Max 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

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). · 844 Product Transfer Account Adjustment

ST-02 · 329 · Transaction Set Control Number · Required Min 4 Max 9 · Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set

BAA

020

Beginning Segment for Product Transfer Account Adjustment

RequiredMax use 1

To identify the beginning of a Product Transfer Account Adjustment Transaction Set and further define the type of product account adjustment transaction set and its reference number and date

Example

If either Reference Identification Qualifier (BAA-04) or Reference Identification (BAA-05) is present, then the other is required

BAA-01 · 353 · Transaction Set Purpose Code · Required · Code identifying purpose of transaction set · 00 Original

BAA-02 · 640 · Transaction Type Code · Required · Code specifying the type of transaction · RA Request for Credit

BAA-03 · 373 · Date · Required CCYYMMDD format · Date expressed as CCYYMMDD BAA03 is the account adjustment date. · Usage notes This is the date the chargeback was generated by the computer.

BAA-04 · 128 · Reference Identification Qualifier · Optional · Code qualifying the Reference Identification · AM Adjustment Memo (Charge Back)

BAA-05 · 127 · Reference Identification · Optional Min 1 Max 30 · Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier · Usage notes ABC Debit Memo Numbers are 11 Digits. The leading two digits are the Company Code (61 for Mainland, and 33 for Puerto Rico), followed by a 2 digit fiscal year (2011 = 11) then the seven digit document number. Example Mainland: 61 + 11 + 1234567 Example Puerto Rico: 33 + 11 + 1234567

N1 Loop

OptionalMax 50

Variants (all may be used)

N1N1 Loop

N1

070

Name

RequiredMax use 1

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

Example

At least one of Name (N1-02) or Identification Code Qualifier (N1-03) is required

N1-01 · 98 · Entity Identifier Code · Required · Code identifying an organizational entity, a physical location, property or an individual · DB Distributor Branch

N1-02 · 93 · Name · Optional Min 1 Max 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)

N1-04 · 67 · Identification Code · Required Min 2 Max 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.

N1 Loop

OptionalMax 50

Variants (all may be used)

N1N1 Loop

N1

070

Name

RequiredMax use 1

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

N1-01 · 98 · Entity Identifier Code · Required · Code identifying an organizational entity, a physical location, property or an individual · SU Supplier/Manufacturer

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)

N1-04 · 67 · Identification Code · Required Min 2 Max 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.

Detail

CON Loop

RequiredMax 10000

CON

010

Contract Number Detail

RequiredMax use 1

To specify contract or reference number and status

CON-01 · 128 · Reference Identification Qualifier · Required · Code qualifying the Reference Identification · VC Vendor Contract Number

CON-02 · 127 · Reference Identification · Required Min 1 Max 30 · Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

CON-03 · 846 · Contract Status Code · Required · Code designating the current status of the contract · VA Valid Open Contract

N1 Loop

OptionalMax 50

N1

050

Name

RequiredMax use 1

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

Example

At least one of Name (N1-02) or Identification Code Qualifier (N1-03) is required

If either Identification Code Qualifier (N1-03) or Identification Code (N1-04) is present, then the other is required

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 · Optional Min 1 Max 60 · Free-form name

N1-03 · 66 · Identification Code Qualifier · Optional · Code designating the system/method of code structure used for Identification Code (67) · 11 Drug Enforcement Administration (DEA) UL UCC/EAN Location Code GLN (Global Location Number)

N1-04 · 67 · Identification Code · Optional Min 2 Max 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 DEA or GLN Number.

N3

070

Address Information

OptionalMax use 2

To specify the location of the named party

N3-01 · 166 · Address Information · Required Min 1 Max 55 · Address information

N4

080

Geographic Location

OptionalMax use 1

To specify the geographic place of the named party

N4-01 · 19 · City Name · Optional Min 2 Max 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 · Optional Min 2 Max 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 · Optional Min 3 Max 15 · Code defining international postal zone code excluding punctuation and blanks (zip code for United States)

REF

090

Reference Identification

OptionalMax use 12

To specify identifying information

Example

Variants (all may be used)

REFReference Identification

REF-01 · 128 · Reference Identification Qualifier · Required · Code qualifying the Reference Identification · 2U Payer Identification Number

REF-02 · 127 · Reference Identification · Required Min 1 Max 30 · Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

REF

090

Reference Identification

OptionalMax use 1

To specify identifying information

Example

Variants (all may be used)

REFReference Identification

REF-01 · 128 · Reference Identification Qualifier · Required · Code qualifying the Reference Identification · HI Health Industry Number (HIN)

REF-02 · 127 · Reference Identification · Required Min 1 Max 30 · Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

SII Loop

OptionalMax >1

SII

105

Sales Item Information

RequiredMax use 1

To specify line item information related to a sale of an item

SII-01 · 235 · Product/Service ID Qualifier · Required · Code identifying the type/source of the descriptive number used in Product/Service ID (234) · ND National Drug Code (NDC) NH National Health Related Item Code UP U.P.C. Consumer Package Code (1-5-5-1)

SII-02 · 234 · Product/Service ID · Required Min 1 Max 48 · Identifying number for a product or service · Usage notes NDC or UPC Number or the National Health Related Item Code

SII-03 · 380 · Quantity · Required Min 1 Max 15 · Numeric value of quantity SII03 is the amount of the product identified in SII01 and SII02. · Usage notes A positive value represents the quantity sold. In previous versions, quantity sold was indicated by a code 32 in the QTY01. A negative value represents returns. In previous versions, returns were indicated by a code 76 in the QTY01.

SII-04 · C001 · Composite Unit of Measure

C001-01 · 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 · EA Each

SII-05 · 212 · Unit Price · Required Min 1 Max 15 · Price per unit of product, service, commodity, etc. SII05 is the wholesale acquisition price.

SII-06 · 212 · Unit Price · Required Min 1 Max 15 · Price per unit of product, service, commodity, etc. SII06 is the contract price.

SII-07 · 782 · Monetary Amount · Required Min 1 Max 15 · Monetary amount SII07 is the extended rebate amount. · Usage notes Extended Chargeback (SII05 - SII06) x SII03 = SII07

N9

107

Reference Identification

OptionalMax use 1

To transmit identifying information as specified by the Reference Identification Qualifier

N9-01 · 128 · Reference Identification Qualifier · Required · Code qualifying the Reference Identification · DI Distributor Invoice Number

N9-02 · 127 · Reference Identification · Optional Min 1 Max 30 · Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

N9-04 · 373 · Date · Optional CCYYMMDD format · Date expressed as CCYYMMDD

N9-06 · 623 · Time Code · Optional · Code identifying the time. In accordance with International Standards Organization standard 8601, time can be specified by a + or - and an indication in hours in relation to Universal Time Coordinate (UTC) time; since + is a restricted character, + and - are substituted by P and M in the codes that follow N906 reflects the time zone which the time reflects. · L1 Unique Line Item Identifier

N9-07 · C040 · Reference Identifier

C040-01 · 128 · Reference Identification Qualifier · Required Min 2 Max 3 · Code qualifying the Reference Identification

C040-02 · 127 · Reference Identification · Required Min 1 Max 30 · Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

C040-03 · 128 · Reference Identification Qualifier · Optional · Code qualifying the Reference Identification · 8X Transaction Category or Type

C040-04 · 127 · Reference Identification · Optional · Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier · 00 for original 18 for credit/rebill with original 41 for credit/rebill with no original

Summary

CTT

010

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 CON segments.
  If used, hash total (CTT02) is the sum of adjustment quantities (QTY02) for each QTY segment.

CTT-01 · 354 · Number of Line Items · Required Min 1 Max 6 · Total number of line items in the transaction set · Usage notes Total number of CON segments

AMT

020

Monetary Amount

OptionalMax use 5

To indicate the total monetary amount

AMT-01 · 522 · Amount Qualifier Code · Required Min 1 Max 3 · Code to qualify amount

AMT-02 · 782 · Monetary Amount · Required Min 1 Max 15 · Monetary amount · Usage notes Total Chargeback Amount Sum of SII07

SE

030

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)

SE-01 · 96 · Number of Included Segments · Required Min 1 Max 10 · Total number of segments included in a transaction set including ST and SE segments

SE-02 · 329 · Transaction Set Control Number · Required Min 4 Max 9 · Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set

GE

Functional Group Trailer

RequiredMax use 1

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

GE-01 · 97 · Number of Transaction Sets Included · Required Min 1 Max 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 1 Max 9 · Assigned number originated and maintained by the sender

IEA

Interchange Control Trailer

RequiredMax use 1

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

IEA-01 · I16 · Number of Included Functional Groups · Required Min 1 Max 5 · A count of the number of functional groups included in an interchange

IEA-02 · I12 · Interchange Control Number · Required Min 9 Max 9 · A control number assigned by the interchange sender

EDI Samples

Sample from AmerisourceBergen

ST|844|100001757~
BAA|00|RA|20210220|AM|6192955447~
N1|DB|ABC DC SACRAMENTO|11|RA0310603~
N1|SU||11|043569607~
CON|VC|V797D70168|VA~
N1|ST|CSDC TRAVIS-TRAVIS AFB CA ROOM 136|11|RC0351849~
N3|106 BODIN CIRCLE, BUILDING 791~
N4|TRAVIS AFB|CA|94535~
SII|ND|54738054803|1|EA|6.53|5.94|.59~
N9|DI|0987543262||20210216|||L1>4187818169000020~
CON|VC|V797D70168|VA~
N1|ST|MISAWA AB MARK FOR MEDICAL MATERIEL|11|PM0059661~
N3|UNIT 5024, BLDG. 99~
N4|APO|AP|96319~
SII|ND|54738054803|11|EA|6.53|5.94|6.49~
N9|DI|0987637270||20210217|||L1>4188602230000160~
CON|VC|V797D70168|VA~
N1|ST|US NAVAL HOSP OKINAWA - HT0720 ATTN SUPPLY OFFICER N68470|11|PM0059661~
N3|PSC 482 BLDG 966 TARAWA RD CAMP FOS~
N4|FPO|AP|96362~
SII|ND|54738054803|4|EA|6.53|5.94|2.36~
N9|DI|0987637769||20210217|||L1>4188603101000380~
CTT|3~
AMT|CC|9.44~
SE|25|100001757~