X12 849 Response to Product Transfer Account Adjustment
This Draft Standard for Trial Use contains the format and establishes the data contents of the Response to Product Transfer Account Adjustment Transaction Set (849) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set can be used to transmit a detailed or summary response to a party requesting an accounting adjustment relating to a pre-authorized product transfer.
- ~ Segment
- | Element
- > Component
Interchange Control Header
To start and identify an interchange of zero or more functional groups and interchange-related control segments
Code to identify the type of information in the Authorization Information
- 00
- No Authorization Information Present (No Meaningful Information in I02)
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)
Code to identify the type of information in the Security Information
- 00
- No Security Information Present (No Meaningful Information in I04)
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)
Qualifier to designate the system/method of code structure used to designate the sender or receiver ID element being qualified
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
Qualifier to designate the system/method of code structure used to designate the sender or receiver ID element being qualified
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
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
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
A control number assigned by the interchange sender
Code sent by the sender to request an interchange acknowledgment (TA1)
- 0
- No Acknowledgment Requested
- 1
- Interchange Acknowledgment Requested
Code to indicate whether data enclosed by this interchange envelope is test, production or information
- I
- Information
- P
- Production Data
- T
- Test Data
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
To indicate the beginning of a functional group and to provide control information
Code identifying a group of application related transaction sets
- CF
- Corporate Financial Adjustment Information (844 and 849)
Code identifying party sending transmission; codes agreed to by trading partners
Code identifying party receiving transmission. Codes agreed to by trading partners
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)
Assigned number originated and maintained by the sender
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
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
Transaction Set Header
To indicate the start of a transaction set and to assign a control number
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).
- 849
- Response to Product Transfer Account Adjustment
Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set
Beginning Segment for Response to Product Transfer Account Adjustment
To identify the beginning of a Response to Product Transfer Account Adjustment Transaction Set
Code identifying purpose of transaction set
- 00
- Original
- 15
- Re-Submission
Date expressed as CCYYMMDD
- BRC02 is the date of the response to product transfer account adjustment.
Processing Date
Code qualifying the Reference Identification
- CM
- Buyer's Credit Memo
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Vendors Credit Memo Number. This is the number that we send the check.
Reference Identification
To specify identifying information
This REF segment at the Header Level is required from the manufacturer to provide the adjustment memo (chargeback) number from an original chargeback or the resubmit number from a chargeback resubmission. REF01 and REF02 must be present.
Code qualifying the Reference Identification
- AM
- Adjustment Memo (Charge Back)
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
The ABC Chargeback Debit Memo Number should appear in the REF02 with REF01 has a value of 'AM'. This is sent in the BAA Segment, Element 05 when the chargeback is sent in version 4010
Reference Identification
To specify identifying information
ABC prefers to receive this REF segment. It will contain the number of items sent on the original chargeback
Code qualifying the Reference Identification
- ZZ
- Mutually Defined
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
The number of line items ABC sent on the chargeback should appear in the REF02 when the REF01 has a value of 'ZZ'. This is sent in the CTT Segment, Element 01 when the chargeback is sent in version 4010.
This N1 at the Header Level is required to identify the wholesaler involved in a chargeback reconciliation. N101, N103, and N104 must be present
Code identifying an organizational entity, a physical location, property or an individual
- DB
- Distributor Branch
- DS
- Distributor
Code designating the system/method of code structure used for Identification Code (67)
- 11
- Drug Enforcement Administration (DEA)
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.
The Division DEA Number should appear in the N1 Segment, Element 04 when the N101 has a value of 'DB' or 'DS'. This is sent in the Chargeback in the N1 Segment, Element 04 when the chargeback in sent in version 4010.
This N1 at the Header Level is required to identify the vendor/manufacturer involved in a chargeback reconciliation. N101, N102, N103, and N104 must be present
Code identifying an organizational entity, a physical location, property or an individual
- MF
- Manufacturer of Goods
- SU
- Supplier/Manufacturer
Code designating the system/method of code structure used for Identification Code (67)
- 1
- D-U-N-S Number, Dun & Bradstreet
- 11
- Drug Enforcement Administration (DEA)
- 21
- Health Industry Number (HIN)
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.
DEA or HIN Number.
Detail
Contract Number Detail
To specify contract or reference number and status
If either the contract or member number changes then both the CON and N1 (ST) segments are mandatory.
Code qualifying the Reference Identification
- VC
- Vendor Contract Number
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Contract Number that was submitted by the wholesaler to the manufacturer in the chargeback transmission. This is sent in the CON Segment, Element 02 when the chargeback is sent in version 4010.
Code designating the current status of the contract
- VA
- Valid Open Contract
The contract referenced may not literally be valid. The reject reason code that appears in the AAA segment in the PAD Loop identifies the contract-related reason for rejecting the chargeback. In order to use this mandatory data element, all contracts are considered valid - by using the VA code for the valid open contract.
Reference Identification
To specify identifying information
This REF segment at the Detail Level in the CON loop is used by the manufacturer to CORRECT the contract number referenced in the chargeback submitted by the wholesaler. REF01 and REF02 must be present.
Code qualifying the Reference Identification
- C8
- Corrected Contract Number
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Verified or Corrected Contract Number
Name
To identify a party by type of organization, name, and code
Example: N1|ST|SAMPLE CUSTOMER|11|AA1235852~
Example: N1|ST|UNAVAILABLE~
If either the contractor member number changes then both the CON and N1 (ST) segments are mandatory.
This N1 loop at the Detail Level in the CON loop is required to identify the customers or ship to locations associated with the chargeback claim. N101, N103, and N104 must be present.
Code identifying an organizational entity, a physical location, property or an individual
- ST
- Ship To
Free-form name
If you can not send the correct name back to us because it was not sent in the original chargeback this must be filled with 'UNAVAILABLE' to pass
compliance.
Code designating the system/method of code structure used for Identification Code (67)
- 11
- Drug Enforcement Administration (DEA)
- 21
- Health Industry Number (HIN)
- PI
- Payor Identification
- UL
- UCC/EAN Location Code
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.
This is sent in the N1Segment, Element 04 when the N101 has an 'ST' code and when the chargeback is sent in version 4010.
Product Adjustment Detail
To specify the product transfer type, and/or line item number
If this PAD segment is used, then a LIN segment must follow.
Alphanumeric characters assigned for differentiation within a transaction set
- PAD01 is the line item identification.
This is a sequential number starting with 1 which starts over with each CON loop.
Alphanumeric characters assigned for differentiation within a transaction set
- LIN01 is the line item identification
Code identifying the type/source of the descriptive number used in Product/Service ID (234)
- LIN02 through LIN31 provide for fifteen different product/service IDs for each item. For example: Case, Color, Drawing No., U.P.C. No., ISBN No., Model No., or SKU.
- N4
- National Drug Code in 5-4-2 Format
- ND
- National Drug Code (NDC)
- NH
- National Health Related Item Code
- UI
- U.P.C. Consumer Package Code (1-5-5)
Identifying number for a product or service
This is the NDC Number sent in the SII Segment, Element 02 when the chargeback is sent in version 4010.
Request Validation
To specify the validity of the request and indicate follow-up action authorized
Code indicating a Yes or No condition or response
- AAA01 designates whether the request is valid or invalid. Code "Y" indicates that the code is valid; code "N" indicates that the code is invalid.
- N
- No
Code identifying the agency assigning the code values
- If AAA02 is used, AAA03 contains a code from an industry code list.
- DR
- National Wholesale Druggists Association
Code assigned by issuer to identify reason for rejection
- A1
- Insufficient Wholesaler Inventory
Product quantity in chargeback claim exceeds known quantity in wholesaler's inventory. (Invalid claim - do not resubmit)
- A2
- Line Item Too Old
Requested claim on this item is past the allowable chargeback submission period. (Invalid claim - do not resubmit)
- A3
- Quantity Invalid - Free Goods
Chargeback was requested on free goods items. (Corrected by the manufacturer - do not resubmit)
- A4
- Rebill Without Offsetting Credit
Chargeback is for re-billed goods for which no
offsetting credit has been received from the wholesaler. (Correct and resubmit) - A5
- Minimum Order Quantity Not Met
- AA
- Contract Number Missing
The contract number is not supplied.
- BB
- Contract Number Incorrect
Contract number supplied does not match any valid number in manufacturer file.
- CC
- Contract Expired
Invoice date after contract expiration date.
- DD
- Reject Due to Doors
For Reconciliation Purposes, this code means 'Contract Not Yet In Force'
- EE
- Invoice Date Missing or Invalid
Invoice date for chargeback claims not supplied or invalid.
- FF
- Customer Not Covered
The manufacturer has no record of a contract with this customer.
- GG
- Customer Expired
Customer dropped from the contract before invoice date.
- HH
- Reject Due to Hand Hold, Ladder, Step, Running Boards, Platforms, etc.
We use this as Customer Not Yet Eligible
Invoice date precedes inclusion of customer on contract - II
- Industrial Interchange
DEA number, customer referenced ID or name/address required to identify customer is missing
- JJ
- Customer DEA Number, Referenced ID, or Address Invalid
Unable to identify the customer. DEA number customer referenced ID, or name/address invalid.
- KK
- Drug Not Covered
Drug for this chargeback not covered by this contract.
- LL
- Drug Expired
Drug dropped from the contract before invoice date.
- MM
- Drug Not Eligible
Invoice date precedes the date of inclusion of a drug on this contract.
- NN
- Drug Number Missing or Invalid
Drug number not submitted or unable to identify.
- OO
- Wholesaler Not Covered
The manufacturer has no record of inclusion of this wholesaler on this contract.
- PP
- Wholesaler Expired
Wholesaler dropped from this contract.
- Wholesaler Not Yet Eligible
Invoice date precedes the date of inclusion of this wholesaler on this contract.
- RI
- Invalid Resubmit Number
Resubmit number does not match any resubmit number assigned or does not match most recent resubmit number assigned.
- RR
- Quantity Invalid or Not Supplied
Quantity on invoice invalid or not supplied as required.
- SS
- Contract Price Missing or Incorrect
Contract price not supplied or incorrect.
- TT
- Contract Price Inserted or Corrected
The contract price was missing or incorrect but was adjusted to be correct
- UU
- Unit Cost Missing or Incorrect
Unit contract cost missing or incorrect.
- VV
- Unit Cost Inserted or Corrected
The unit contract price was missing or incorrect but was adjusted to be correct
- WW
- Extended Amount Incorrect
Extended chargeback amount incorrect.
- XX
- Extended Amount Corrected
Extended chargeback amount was incorrect, but was adjusted to be correct.
This code should never be used alone, there is always a reason - YY
- Duplicate Chargeback Request
The manufacturer has a record of the previous claim on this invoice.
Unit Detail
To specify item unit data
ABC requires the 'UIT' segment with a UIT03 value of 'CT'.
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
- EA
- Each
- PK
- Package
- UN
- Unit
Price per unit of product, service, commodity, etc.
The Unit Price is in 'Eaches' for ABC.
This is the most recent contract price the Manufacturer has in their system for AmerisourceBergen.
Code identifying the type of unit price for an item
- CT
- Contract
Unit Detail
To specify item unit data
ABC requires the UIT segment with a UIT03 value of 'SC'.
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
- EA
- Each
- PK
- Package
- UN
- Unit
Price per unit of product, service, commodity, etc.
The Unit Price is in 'eaches' for AmerisourceBergen.
This is sent in the SII Segment, Element 06 when the chargeback is sent in version 4010.
Code identifying the type of unit price for an item
- SC
- Submitted Contract
Unit Detail
To specify item unit data
AmerisourceBergen requires the UIT segment with a UIT03 value of 'SW'.
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
- EA
- Each
- PK
- Package
- UN
- Unit
Price per unit of product, service, commodity, etc.
The Unit Price is in 'eaches' for AmerisourceBergen.
This is sent in the SII Segment, Element 05 when the chargeback is sent in version 4010.
Code identifying the type of unit price for an item
- SW
- Submitted Wholesale
Unit Detail
To specify item unit data
AmerisourceBergen requires the UIT segment with a UIT03 value of 'WH'.
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
- EA
- Each
- PK
- Package
- UN
- Unit
Price per unit of product, service, commodity, etc.
The Unit Price is in 'eaches' for ABC.
This is the amount the Manufacturer invoiced ABC.
Code identifying the type of unit price for an item
- WH
- Wholesale
Quantity
To specify quantity information
AmerisourceBergen requires two 'QTY' segments.
Rebate returns are indicated by negative values in the QTY and AMT segments.
Numeric value of quantity
This is the quantity the vendor has in their system.
Quantity
To specify quantity information
AmerisourceBergen requires two 'QTY' segments.
Rebate returns are indicated by negative values in the QTY and AMT segments.
Code specifying the type of quantity
- 83
- Submitted Quantity Sold
- 84
- Submitted Quantity Returned
Numeric value of quantity
This is sent in the SII Segment, Element 03 when the chargeback is sent in version 4010.
Monetary Amount
To indicate the total monetary amount
- The AMT segment is to be used only in cases where the amount cannot be computed from other detail.
An AMT segment for the Adjusted Chargeback Claim Amount is required.
Rebate returns are indicated by negative values in the QTY and AMT segments.
Monetary Amount
To indicate the total monetary amount
- The AMT segment is to be used only in cases where the amount cannot be computed from other detail.
An AMT segment for the Submitted Chargeback Claim Amount is required.
Rebate returns are indicated by negative values in the QTY and AMT segments
Reference Identification
To specify identifying information
The REF segment at the Detail Level of the CON/PAD loop is required to provide the wholesaler invoice number and the resubmit number at the item level in the case of a chargeback resubmission. REF01 and REF2 must be present.
Code qualifying the Reference Identification
- DI
- Distributor Invoice Number
This is sent in the N9 Segment, Element 02 when the chargeback is sent in version 4010.
- L1
- Letters or Notes
This code would qualify any optional notes and comments pertaining to anoriginal or resubmitted chargeback line and should be placed in REF03.
- RX
- Resubmit number
The number assigned by the manufacturer to identify a previously submitted chargeback that was rejected due to error. The wholesaler provides this number when the chargeback is corrected and resubmitted. Not all manufacturers assign resubmit numbers.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
This is the AmerisourceBergen invoice number. Or Resubmit Number Or Comments.
Date/Time Reference
To specify pertinent dates and times
The DTM segment at the Detail Level in the CON/PAD loop is required to provide the wholesaler invoice date. DTM01 and DTM02 must be present.
Summary
Transaction Totals
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 the quantities (QTY02) for each QTY segment.
Total number of line items in the transaction set
A total number of 'PAD' segments in the transaction set. This is the number of rejected lines
Monetary Amount
To indicate the total monetary amount
- The AMT segment is to be used only in cases where the amount cannot be computed from other detail.
This AMT segment at the Summary Level is required to provide the TOTAL AMOUNT of the chargeback reconciliation credit memo. AMT01 and AMT02 must be present.
Monetary amount
This is the amount the vendor is willing to pay AmerisourceBergen. It will be the difference between the submitted chargeback claim amount and the net adjustment amount
Monetary Amount
To indicate the total monetary amount
- The AMT segment is to be used only in cases where the amount cannot be computed from other detail.
This AMT segment at the Summary Level is required to provide the TOTAL AMOUNT of the chargeback reconciliation credit memo. AMT01 and AMT02 must be present.
Monetary Amount
To indicate the total monetary amount
- The AMT segment is to be used only in cases where the amount cannot be computed from other detail.
This AMT segment at the Summary Level is required to provide the TOTAL AMOUNT of the chargeback reconciliation credit memo. AMT01 and AMT02 must be present.
Transaction Set Trailer
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)
Total number of segments included in a transaction set including ST and SE segments
Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set
Functional Group Trailer
To indicate the end of a functional group and to provide control information
Total number of transaction sets included in the functional group or interchange (transmission) group terminated by the trailer containing this data element
Assigned number originated and maintained by the sender
Interchange Control Trailer
To define the end of an interchange of zero or more functional groups and interchange-related control segments
Sample from AmerisourceBergen
BRC|00|20110415|CM|98765432~
REF|AM|61111234567~
REF|ZZ|25~
N1|DB||11|RA0210409~
N1|SU|VENDOR NAME|11|BB1234567~
CON|VC|ABCD1|VA~
N1|ST|SAMPLE CUSTOMER|11|AA1235852~
PAD|1~
LIN||ND|00551970803~
AAA|N|DR|YY~
UIT|UN|2606|CT~
UIT|UN|2553.88|SC~
UIT|UN|2606|SW~
UIT|UN|2606|WH~
QTY|83|11~
QTY|32|11~
AMT|S|573.32~
AMT|A|0~
REF|DI|046123456~
REF|RX|602888S18~
DTM|003|20110401~
CTT|1~
AMT|S|73965.54~
AMT|NA|573.32~
AMT|A|73392.22~
SE|27|2006
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