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Novant Health EDI Implementation Guide for (810) InvoicesINVOICE SPECS810FUNCTIONAL GROUP – INThis transaction set is used by Novant Health to establish billing for goods andservices provided by our vendors to us.ANSI X12Version 004010Note: The “Requirement Designator (Req. Des.)” is based on NovantHealth’s requirements.Table 1 – ansaction Set HeaderBeginning Segment for oopRepeatTable 2 – DetailPositionNumberSegmentIdentifier010IT1LOOP ID – IT1Baseline Item Data (Invoice)LoopRepeat200000Table 3 – 0SAC080SEANSI X12 Version 004010Page 1 of 10Req.Des.MOMaxUse110LOOP ID – SACService, Promotion, Allowance, or Charge InfoO1Transaction Set TrailerM1NameTotal Monetary Value SummaryTax InformationLoopRepeat25Implementation Guide2/6/2009
Novant Health EDI Implementation Guide for (810) InvoicesSegmentSTPosition 0Transaction Set HeaderTo indicate the start of a transaction set and to assign a control engthST01143Transaction Set Identifier CodeMIDTo indicate the start of a transaction set and to assign a control numberValue ‘810’ST02329Transaction Set Control NumberMAN4/9Control Number assigned by customer. The value must match the value specified inelement SE02.EXAMPLEANSI X12 Version 004010Page 2 of 103/3ST*810*000000001!Implementation Guide2/6/2009
Novant Health EDI Implementation Guide for (810) InvoicesSegmentBIGPosition 0Beginning Segment for InvoiceTo indicate the beginning of an invoice transaction set and transmit identifyingnumbers and engthDT8/8BIG01373Invoice DateMThe date that was assigned to the invoice by the vendor. (Who wepurchased the product from)BIG0276Invoice NumberMANThe invoice number assigned by the vendor. (Who we purchased the productfrom).BIG03BIG04BIG05BIG06BIG07373Purchase Order DateNot Used324Purchase Order NumberMAN1/22The purchase order number that was originally sent by Novant Health which this invoicerefers328Release NumberNot Used327Change Order Sequence Number640Transaction Type CodeType of invoice sentNot UsedOIDValueDICRUsageDebit InvoiceCredit MemoBIG08353Transaction Set Purpose CodeNot UsedBIG09306Action CodeNot UsedBIG1076Invoice NumberNot UsedEXAMPLEANSI X12 Version 004010Page 3 of !Implementation Guide2/6/2009
Novant Health EDI Implementation Guide for (810) InvoicesSegmentIT1Position 0Baseline Item Data (Invoice)To specify the basic and most frequently used line item data for the invoice andrelated ntTypeLengthIT101350Assigned IdentificationMAN1/20PO (purchase order) line number should be returned on the invoice so there is a perfectmatch.IT102358Quantity InvoicedQuantity Amount InvoicedIT103IT104IT105IT106355 Unit or Basis for Measure Code212Unit PriceUnit Price for item639R1/10MID2/2MR1/17 Basis of Unit Price Code235Product/Service ID QualifierCode specifying type of Product number being sentValueVCMNot UsedMID2/2UsageVendor Catalog NumberIT107234Product/Service IDVendor’s Item NumberMAN1/48IT108235Product/Service ID QualifierCode specifying type of Product number being sentMID2/2MAN1/48ValueINIT109UsageBuyer’s Item Number (Novant Health’sitem number)234Product/Service IDNovant’s Item NumberIT110235Product/Service ID QualifierNot UsedIT111234Product/Service IDNot UsedIT112235Product/Service ID QualifierNot UsedIT113234Product/Service IDNot UsedANSI X12 Version 004010Page 4 of 10Implementation Guide2/6/2009
Novant Health EDI Implementation Guide for (810) InvoicesIT114235Product/Service ID QualifierNot UsedIT115234Product/Service IDNot UsedIT116235Product/Service ID QualifierNot UsedIT117234Product/Service IDNot UsedIT118235Product/Service ID QualifierNot UsedIT119234Product/Service IDNot UsedIT120235Product/Service ID QualifierNot UsedIT121234Product/Service IDNot UsedIT122235Product/Service ID QualifierNot UsedIT123234Product/Service IDNot UsedIT124235Product/Service ID QualifierNot UsedIT125234Product/Service IDNot UsedEXAMPLEANSI X12 Version 004010Page 5 of tation Guide2/6/2009
Novant Health EDI Implementation Guide for (810) InvoicesSegmentTDSPosition S01010Total Monetary Value SummaryTo specify the total invoice discounts and amountsMandatoryDataElementName610AmountTotal Amount of untNot UsedTDS03610AmountNot UsedTDS04610AmountNot UsedEXAMPLEANSI X12 Version 004010Page 6 of 10TDS*8654!Implementation Guide2/6/2009
Novant Health EDI Implementation Guide for (810) InvoicesSegmentTXIPosition 0Tax InformationTo specify tax ypeLengthTXI01963Tax Type CodeAny valid Tax Type CodeMID2/2TXI02782Monetary AmountTax Amount due on InvoiceMR1/18TXI03954PercentNot UsedTXI04955Tax Jurisdiction Code QualifierNot UsedTXI05956Tax Jurisdiction CodeNot UsedTXI06441Tax Exempt CodeNot UsedTXI07662Relationship CodeNot UsedTXI08828Dollar Basis for PercentNot UsedTXI09325Tax Identification NumberNot UsedTXI10350Assigned IdentificationNot UsedEXAMPLEANSI X12 Version 004010Page 7 of 10TXI*FT*5.66!Implementation Guide2/6/2009
Novant Health EDI Implementation Guide for (810) InvoicesSegmentSACPosition C01SAC02040Service, Promotion, Allowance, or Charge InformationTo request or identify a service, promotion, allowance or charge; to specify theamount or percentage for the service, promotion, allowance or charge.OptionalDataElementName248Allowance or Charge IndicatorAny Valid Allowance or Charge Indicator1300Service, Promotion, Allowance, orCharge CodeAny Valid gency Qualifier CodeNot UsedSAC041301Agency Service, Promotion Allowance, orCharge CodeNot UsedSAC05610AmountCharge AmountMN2SAC06378Allowance/Charge Percent QualifierNot UsedSAC07332PercentNot UsedSAC08118RateNot UsedSAC09355Unit or Basis for Measurement CodeNot UsedSAC10380QuantityNot UsedSAC11380QuantityNot UsedSAC12331Allowance or Charge Method of HandlingCodeNot UsedSAC13127Reference IdentificationNot UsedSAC14770Option NumberNot UsedSAC15SAC16EXAMPLEANSI X12 Version 004010Page 8 of 10352DescriptionDescription of Charge819Language CodeOAN1/151/80Not ion Guide2/6/2009
Novant Health EDI Implementation Guide for (810) InvoicesSegmentCTTPosition T01070Transaction TotalsTo transmit a hash total for a specific element in the transaction set.OptionalDataElementName354Number of Line ItemsThe total number of line itemsReq.Des.ElementTypeLengthMN01/6CTT02347Hash TotalNot UsedCTT0381WeightNot UsedCTT04355Unit or Basis for Measurement CodeNot UsedCTT05183VolumeNot UsedCTT06355Unit or Basis for Measurement CodeNot UsedCTT07352DescriptionNot UsedEXAMPLEANSI X12 Version 004010Page 9 of 10CTT*1!Implementation Guide2/6/2009
Novant Health EDI Implementation Guide for (810) InvoicesSegmentSEPosition 0Transaction Set TrailerTo indicate the end of the transaction set and provide the count of the transmittedsegments (including the beginning (ST) and ending (SE) ypeLengthSE0196Number of Included SegmentsMN01/10Total number of segments included in a transaction set including ST and SE segments.SE02354Transaction Set Control NumberMAN4/9Identifying control number that must be unique within the transaction set functional groupassigned by the originator for a transaction set. This value must be identical to thatspecified in the ST02 element.EXAMPLEANSI X12 Version 004010Page 10 of 10SE*11*000000001!Implementation Guide2/6/2009
Novant Health EDI Implementation Guide for (810) Invoices ANSI X12 Version 004010 Implementation Guide Page 9 of 10 2/6/2009 Segment CTT Position Number: Title: Description: Usage: 070 Transaction Totals To transmit a hash total for a specific element in the transaction set. . 855 Author: Presbyterian Hospital Created Date:
