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Response to Product Transfer Account Adjustment
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X12 849 Response to Product Transfer Account Adjustment

X12 Release 4010

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.

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
    BRC
    020
    Beginning Segment for Response to Product Transfer Account Adjustment
    Max use 1
    Required
    REF
    050
    Reference Identification
    Max use 1
    Required
    REF
    050
    Reference Identification
    Max use 12
    Optional
    N1 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

    CF
    Corporate Financial Adjustment Information (844 and 849)
    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).
    849
    Response to Product Transfer Account Adjustment
    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

    BRC
    020

    Beginning Segment for Response to Product Transfer Account Adjustment

    RequiredMax use 1

    To identify the beginning of a Response to Product Transfer Account Adjustment Transaction Set

    Example
    BRC-01
    353
    Transaction Set Purpose Code
    Required

    Code identifying purpose of transaction set

    00
    Original
    15
    Re-Submission
    BRC-02
    373
    Date
    Required
    CCYYMMDD format

    Date expressed as CCYYMMDD

    • BRC02 is the date of the response to product transfer account adjustment.
    Usage notes

    Processing Date

    BRC-03
    128
    Reference Identification Qualifier
    Required

    Code qualifying the Reference Identification

    CM
    Buyer's Credit Memo
    BRC-04
    127
    Reference Identification
    Required
    Min 1Max 30

    Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

    Usage notes

    Vendors Credit Memo Number. This is the number that we send the check.

    REF
    050

    Reference Identification

    RequiredMax use 1

    To specify identifying information

    Usage notes

    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.

    Example
    Variants (all may be used)
    REFReference Identification
    REF-01
    128
    Reference Identification Qualifier
    Required

    Code qualifying the Reference Identification

    AM
    Adjustment Memo (Charge Back)
    REF-02
    127
    Reference Identification
    Required
    Min 1Max 30

    Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

    Usage notes

    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

    REF
    050

    Reference Identification

    OptionalMax use 12

    To specify identifying information

    Usage notes

    ABC prefers to receive this REF segment. It will contain the number of items sent on the original chargeback

    Example
    Variants (all may be used)
    REFReference Identification
    REF-01
    128
    Reference Identification Qualifier
    Required

    Code qualifying the Reference Identification

    ZZ
    Mutually Defined
    REF-02
    127
    Reference Identification
    Required
    Min 1Max 30

    Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

    Usage notes

    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.

    N1 Loop
    RequiredMax 1
    Usage notes

    This N1 at the Header Level is required to identify the wholesaler involved in a chargeback reconciliation. N101, N103, and N104 must be present

    Variants (all may be used)
    N1N1 Loop
    N1
    080

    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

    DB
    Distributor Branch
    DS
    Distributor
    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 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 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.

    N1 Loop
    RequiredMax 1
    Usage notes

    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

    Variants (all may be used)
    N1N1 Loop
    N1
    080

    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

    MF
    Manufacturer of Goods
    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
    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

    DEA or HIN Number.

    Detail

    CON Loop
    RequiredMax 10000
    CON
    010

    Contract Number Detail

    RequiredMax use 1

    To specify contract or reference number and status

    Usage notes

    If either the contract or member number changes then both the CON and N1 (ST) segments are mandatory.

    Example
    CON-01
    128
    Reference Identification Qualifier
    Required

    Code qualifying the Reference Identification

    VC
    Vendor Contract Number
    CON-02
    127
    Reference Identification
    Required
    Min 1Max 30

    Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

    Usage notes

    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.

    CON-03
    846
    Contract Status Code
    Required

    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.

    REF
    030

    Reference Identification

    OptionalMax use 12

    To specify identifying information

    Usage notes

    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.

    Example
    REF-01
    128
    Reference Identification Qualifier
    Required

    Code qualifying the Reference Identification

    C8
    Corrected Contract Number
    REF-02
    127
    Reference Identification
    Required
    Min 1Max 30

    Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

    Usage notes

    Verified or Corrected Contract Number

    N1 Loop
    RequiredMax 50
    N1
    060

    Name

    RequiredMax use 1

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

    Usage notes
    ## If you have the information to send:
    Example: N1|ST|SAMPLE CUSTOMER|11|AA1235852~
    ## If you do not have the information to send:
    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.

    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

    Usage notes

    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.

    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)
    PI
    Payor Identification
    UL
    UCC/EAN Location Code
    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

    This is sent in the N1Segment, Element 04 when the N101 has an 'ST' code and when the chargeback is sent in version 4010.

    PAD Loop
    RequiredMax 1000
    PAD
    120

    Product Adjustment Detail

    RequiredMax use 1

    To specify the product transfer type, and/or line item number

    Usage notes

    If this PAD segment is used, then a LIN segment must follow.

    Example
    PAD-01
    350
    Assigned Identification
    Required
    Min 1Max 20

    Alphanumeric characters assigned for differentiation within a transaction set

    • PAD01 is the line item identification.
    Usage notes

    This is a sequential number starting with 1 which starts over with each CON loop.

    LIN
    130

    Item Identification

    RequiredMax use 1

    To specify basic item identification data

    Example
    LIN-01
    350
    Assigned Identification
    Optional
    Min 1Max 20

    Alphanumeric characters assigned for differentiation within a transaction set

    • LIN01 is the line item identification
    LIN-02
    235
    Product/Service ID Qualifier
    Required

    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)
    LIN-03
    234
    Product/Service ID
    Required
    Min 1Max 48

    Identifying number for a product or service

    Usage notes

    This is the NDC Number sent in the SII Segment, Element 02 when the chargeback is sent in version 4010.

    AAA
    140

    Request Validation

    OptionalMax use 10

    To specify the validity of the request and indicate follow-up action authorized

    Example
    AAA-01
    1073
    Yes/No Condition or Response Code
    Required

    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
    AAA-02
    559
    Agency Qualifier Code
    Required

    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
    AAA-03
    901
    Reject Reason Code
    Required

    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.

    QQ
    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.

    UIT
    170

    Unit Detail

    RequiredMax use 1

    To specify item unit data

    Usage notes

    ABC requires the 'UIT' segment with a UIT03 value of 'CT'.

    Example
    UIT-01
    C001
    Composite Unit of Measure
    To identify a composite unit of measure (See Figures Appendix for examples of use)
    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
    PK
    Package
    UN
    Unit
    UIT-02
    212
    Unit Price
    Required
    Min 1Max 15

    Price per unit of product, service, commodity, etc.

    Usage notes

    The Unit Price is in 'Eaches' for ABC.
    This is the most recent contract price the Manufacturer has in their system for AmerisourceBergen.

    UIT-03
    639
    Basis of Unit Price Code
    Required

    Code identifying the type of unit price for an item

    CT
    Contract
    UIT
    170

    Unit Detail

    RequiredMax use 5

    To specify item unit data

    Usage notes

    ABC requires the UIT segment with a UIT03 value of 'SC'.

    Example
    UIT-01
    C001
    Composite Unit of Measure
    To identify a composite unit of measure (See Figures Appendix for examples of use)
    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
    PK
    Package
    UN
    Unit
    UIT-02
    212
    Unit Price
    Required
    Min 1Max 15

    Price per unit of product, service, commodity, etc.

    Usage notes

    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.

    UIT-03
    639
    Basis of Unit Price Code
    Required

    Code identifying the type of unit price for an item

    SC
    Submitted Contract
    UIT
    170

    Unit Detail

    RequiredMax use 1

    To specify item unit data

    Usage notes

    AmerisourceBergen requires the UIT segment with a UIT03 value of 'SW'.

    Example
    UIT-01
    C001
    Composite Unit of Measure
    To identify a composite unit of measure (See Figures Appendix for examples of use)
    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
    PK
    Package
    UN
    Unit
    UIT-02
    212
    Unit Price
    Required
    Min 1Max 15

    Price per unit of product, service, commodity, etc.

    Usage notes

    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.

    UIT-03
    639
    Basis of Unit Price Code
    Required

    Code identifying the type of unit price for an item

    SW
    Submitted Wholesale
    UIT
    170

    Unit Detail

    RequiredMax use 1

    To specify item unit data

    Usage notes

    AmerisourceBergen requires the UIT segment with a UIT03 value of 'WH'.

    Example
    UIT-01
    C001
    Composite Unit of Measure
    To identify a composite unit of measure (See Figures Appendix for examples of use)
    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
    PK
    Package
    UN
    Unit
    UIT-02
    212
    Unit Price
    Required
    Min 1Max 15

    Price per unit of product, service, commodity, etc.

    Usage notes

    The Unit Price is in 'eaches' for ABC.
    This is the amount the Manufacturer invoiced ABC.

    UIT-03
    639
    Basis of Unit Price Code
    Required

    Code identifying the type of unit price for an item

    WH
    Wholesale
    QTY
    180

    Quantity

    RequiredMax use 1

    To specify quantity information

    Usage notes

    AmerisourceBergen requires two 'QTY' segments.
    Rebate returns are indicated by negative values in the QTY and AMT segments.

    Example
    Variants (all may be used)
    QTYQuantity
    QTY-01
    673
    Quantity Qualifier
    Required

    Code specifying the type of quantity

    32
    Quantity Sold
    76
    Returns
    QTY-02
    380
    Quantity
    Required
    Min 1Max 15

    Numeric value of quantity

    Usage notes

    This is the quantity the vendor has in their system.

    QTY-03
    C001
    Composite Unit of Measure
    To identify a composite unit of measure (See Figures Appendix for examples of use)
    C001-01
    355
    Unit or Basis for Measurement Code
    Required
    Min 2Max 2

    Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken

    QTY
    180

    Quantity

    RequiredMax use 5

    To specify quantity information

    Usage notes

    AmerisourceBergen requires two 'QTY' segments.
    Rebate returns are indicated by negative values in the QTY and AMT segments.

    Example
    Variants (all may be used)
    QTYQuantity
    QTY-01
    673
    Quantity Qualifier
    Required

    Code specifying the type of quantity

    83
    Submitted Quantity Sold
    84
    Submitted Quantity Returned
    QTY-02
    380
    Quantity
    Required
    Min 1Max 15

    Numeric value of quantity

    Usage notes

    This is sent in the SII Segment, Element 03 when the chargeback is sent in version 4010.

    QTY-03
    C001
    Composite Unit of Measure
    To identify a composite unit of measure (See Figures Appendix for examples of use)
    C001-01
    355
    Unit or Basis for Measurement Code
    Required
    Min 2Max 2

    Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken

    AMT
    190

    Monetary Amount

    RequiredMax use 1

    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.
    Usage notes

    An AMT segment for the Adjusted Chargeback Claim Amount is required.
    Rebate returns are indicated by negative values in the QTY and AMT segments.

    Example
    Variants (all may be used)
    AMTMonetary Amount
    AMT-01
    522
    Amount Qualifier Code
    Required

    Code to qualify amount

    A
    Adjusted Chargeback Claim Amount
    AMT-02
    782
    Monetary Amount
    Required
    Min 1Max 15

    Monetary amount

    Usage notes

    This is the amount the vendor has agreed to credit ABC.

    AMT
    190

    Monetary Amount

    RequiredMax use 2

    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.
    Usage notes

    An AMT segment for the Submitted Chargeback Claim Amount is required.
    Rebate returns are indicated by negative values in the QTY and AMT segments

    Example
    Variants (all may be used)
    AMTMonetary Amount
    AMT-01
    522
    Amount Qualifier Code
    Required

    Code to qualify amount

    S
    Submitted Chargeback Claim Amount
    AMT-02
    782
    Monetary Amount
    Required
    Min 1Max 15

    Monetary amount

    Usage notes

    This is sent in the SII Segment, Element 07 when the chargeback is sent in
    version 4010

    REF
    210

    Reference Identification

    RequiredMax use 12

    To specify identifying information

    Usage notes

    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.

    Example
    REF-01
    128
    Reference Identification Qualifier
    Required

    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.

    REF-02
    127
    Reference Identification
    Required
    Min 1Max 30

    Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

    Usage notes

    This is the AmerisourceBergen invoice number. Or Resubmit Number Or Comments.

    DTM
    220

    Date/Time Reference

    RequiredMax use 10

    To specify pertinent dates and times

    Usage notes

    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.

    Example
    DTM-01
    374
    Date/Time Qualifier
    Required

    Code specifying type of date or time, or both date and time

    003
    Invoice
    DTM-02
    373
    Date
    Required
    CCYYMMDD format

    Date expressed as CCYYMMDD

    Usage notes

    This is sent in the N9 Segment, Element 04 when the chargeback is sent in version 4010

    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 the quantities (QTY02) for each QTY segment.
    Example
    CTT-01
    354
    Number of Line Items
    Required
    Min 1Max 6

    Total number of line items in the transaction set

    Usage notes

    A total number of 'PAD' segments in the transaction set. This is the number of rejected lines

    AMT
    020

    Monetary Amount

    RequiredMax use 1

    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.
    Usage notes

    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.

    Example
    Variants (all may be used)
    AMTMonetary AmountAMTMonetary Amount
    AMT-01
    522
    Amount Qualifier Code
    Required

    Code to qualify amount

    A
    Adjusted Chargeback Claim Amount
    AMT-02
    782
    Monetary Amount
    Required
    Min 1Max 15

    Monetary amount

    Usage notes

    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

    AMT
    020

    Monetary Amount

    OptionalMax use 5

    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.
    Usage notes

    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.

    Example
    Variants (all may be used)
    AMTMonetary AmountAMTMonetary Amount
    AMT-01
    522
    Amount Qualifier Code
    Required

    Code to qualify amount

    NA
    Net Adjustment
    AMT-02
    782
    Monetary Amount
    Required
    Min 1Max 15

    Monetary amount

    Usage notes

    This is the amount the vendor is denying to pay ABC.

    AMT
    020

    Monetary Amount

    RequiredMax use 1

    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.
    Usage notes

    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.

    Example
    Variants (all may be used)
    AMTMonetary AmountAMTMonetary Amount
    AMT-01
    522
    Amount Qualifier Code
    Required

    Code to qualify amount

    S
    Submitted Chargeback Claim Amount
    AMT-02
    782
    Monetary Amount
    Required
    Min 1Max 15

    Monetary amount

    Usage notes

    This is sent in the AMT Segment, Element 02 when the chargeback is sent in version 4010.

    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)

    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|849|2006~
    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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