Product transfer account adjustment response (X12)

Required. Interchange sender partner ID qualifier.

Required. Interchange receiver partner ID qualifier.

Required. This value is dependent on X12 version.

• Version 4012 and earlier, this is the interchange control standards identifier. Valid value is U

• Version 4020 and later, this is the repetition separator, a delimiter that separates repeated occurrences of a data element or composite data structure, which must be different than the data element separator, component separator, and segment terminator."

Required. Interchange level acknowledgment requested.

Valid values:

• 0 - No acknowledgment requested

• 1 - Interchange level acknowledgment requested

Required. Indicates whether the interchange is for production, test, or information purposes.

Valid values:

• I - Information

• P - Production data

• T - Test data

Required. GS group function code.

Valid value is CF - Product Transfer Account Response X12 849

Required. Responsible Agency Code.

Valid values:

• T - Transportation Data Coordinating Committee (TDCC)

• X - Accredited Standards Committee X12

Required. Transaction set purpose code.

Valid values:

• 00 - Original

• 02 - Create (Add)

• 03 - Delete

• 15 - Resend, Manufacturer response to chargeback resubmission

• 8 - Reissue, Manufacturer response to a credit and rebill of original chargeback request

• 41 - Correct and verified, Manufacturer response to a chargeback request where original sale was at wholesaler cost/no original chargeback

• 45 - Followup, Look for line level details for transaction type identification

Required. Reference identification qualifier for contract number.

Valid values:

• CM - Credit memo

• TN- Transaction reference

Required. Reference identification qualifier for the contract class.

Valid values:

• RX - Number assigned by the manufacturer to identify a previously submitted chargeback

• ZZ - Mutually defined

• 2U - Payer Identification Number for 340B Programs

• DH - Drug Enforcement Administration Number

• HI - Health Industry Number (HIN)

• L1- Letters or notes

• LU - GS1-US Global Location Number (GLN)

• P7 - Chargeback detail line number

• C8 - Corrected contract number

• 8X - Processing function type or transaction category code

• DI - Distributor invoice number

Required. Entity identifier code for an organization, physical location, property or individual for use of the currency.

Valid values:

• SE - Selling party currency

• BY - Buying party currency

Required. Yes or no condition response code.

Valid values:

• Y - Request is accepted

• N - Rejected

• U - Unknown

• W - Not applicable

Rejection reason code identifier.

Valid values as per HDA guideline and other healthcare partners:

• 01 - Price Authorization Invalid

• 04 - Authorized Quantity Exceeded

• BB - Contract Number Incorrect, Contract number supplied does not match any valid contract number in Manufacturer database

• EE - Invoice date for chargeback claim is missing or invalid

• FF - Manufacturer does not find contract submitted for this customer.

• KK - Drug not covered, Drug for this chargeback not ever covered on this contract

• MM - Drug not yet eligible, Invoice date precedes date of inclusion of drug on this contract

• OO - Wholesaler not covered/ID not recognized, Manufacturer has no record of inclusion of this distributor on this contract or cannot identify them

• RR- Quantity invalid or not supplied, Quantity on invoice invalid or not supplied as required

• SS - Contract price not supplied or incorrect - Corrected in this 849 response transaction

Action code identifies consequent action has to be taken by receiver of this message.

Valid values: as per HDA guidelines

• C - Please Correct and Resubmit

• N - Resubmission Not Allowed

• P - Please Resubmit Original Transaction

• R - Resubmission Allowed

• S - Do Not Resubmit; Inquiry Initiated to a Third Party

• W - Please Wait 30 Days and Resubmit

• X - Please Wait 10 Days and Resubmit

• Y - Do Not Resubmit; We will Hold Your Request and Respond Again Shortly

• D - Resubmit Entire Claim, The entire claim has to be resubmitted

Required. Entity qualifier for the party identifier and address information.

Valid values:

• BY - Customer party

• SU - Supplier party

• ST - Ship to party

• DS - Distributor party

• MF - manufacturer party

• DB - Distributor branch

Required. Identifier code qualifier.

Valid values:

• 1 - DUNS

• 2 - SCAC

• 9 - DUNS+4

• 11 - Drug Enforcement Agency registration number

• 21 - Health Industry Number

• 91 - Company identifier

• 92 - Company location identifier

• UL - Global Location Number

• PI - US_340B_ID

• PP - Pharmacy_Processor_Number

Required. Party identifier as qualified by N103 mapping to companyIdentifierValue.

If N103 is present, N104 is required.

Communication Number Qualifier identifying the contact person's telephone number or email address.

Valid values:

• TE - Telephone number

• EM - email address

Communication Number Qualifier identifying the contact person's telephone number or email address.

Valid values:

• TE - Telephone number

• EM - email address

Required. Reference identification qualifier.

Transaction reference type for X12 segments REF and N9 and EDIFACT RFF for general reference data that is not a transaction document identifier. HDA mapping. Valid value is VC - Vendor/Supplier contract number

Required. Reference identification id, Reference information as defined for a particular transaction set or as specified by the Reference Identification Qualifier

vendor or supplier contract id

Required. Yes or not condition response code.

Valid values:

• Y - Request is accepted

• N - Rejected

• U - Unknown

• W - Not applicable

Code identifying the agency assigning the code values.

Valid value is DR - National Wholesale Druggists Association

Rejection reason code identifier.

Valid values list include: as per HDA guideline and other healthcare partners.

• 01 - Price Authorization Invalid

• 04 - Authorized Quantity Exceeded

• BB - Contract Number Incorrect, Contract number supplied does not match any valid contract number in Manufacturer database

• EE - Invoice date for chargeback claim is missing or invalid

• FF - Manufacturer does not find contract submitted for this customer

• KK - Drug not covered, Drug for this chargeback not ever covered on this contract

• MM- Drug not yet eligible, Invoice date precedes date of inclusion of drug on this contract

• OO - Wholesaler not covered/ID not recognized, Manufacturer has no record of inclusion of this distributor on this contract or cannot identify them

• RR - Quantity invalid or not supplied, Quantity on invoice invalid or not supplied as required

• SS - Contract price not supplied or incorrect - Corrected in this 849 response transaction

Action code identifies consequent action has to be taken by receiver of this message.

Valid values: as per HDA guidelines

• C - Please Correct and Resubmit

• N - Resubmission Not Allowed

• P - Please Resubmit Original Transaction

• R - Resubmission Allowed

• S - Do Not Resubmit; Inquiry Initiated to a Third Party

• W - Please Wait 30 Days and Resubmit

• X - Please Wait 10 Days and Resubmit

• Y - Do Not Resubmit; We will Hold Your Request and Respond Again Shortly

• D - Resubmit Entire Claim, The entire claim has to be resubmitted

Required. Reference identification qualifier for the previous contract number.

Valid values is C8 - Corrected Contract Number

Required. Reference identifier value: check number.

If REF01 present, REF02 is required

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

HDA: Identifier or description defined by qualifier code in transactionReferenceIdentifier (REF02).

CON level N1 name segment loop for the party information extended with dates and reference identifiers.

HDA usage note: This N1 loop at the Detail Level in the CON loop is required to identify customers belonging to the buying group or individual parties involved in chargeback contract

Required. Identifier code qualifier.

Valid values:

• 1 - DUNS

• 2 - SCAC

• 9 - DUNS+4

• 11 - Drug Enforcement Agency registration number

• 21 - Health Industry Number

• 91 - Company identifier

• 92 - Company location identifier

• UL - Global Location Number

• PI - US_340B_ID

• PP - Pharmacy_Processor_Number

Required. Party identifier as qualified by N103 mapping to companyIdentifierValue.

If N103 is present, N104 is required

REF reference segment for mapping for referenc identifiers.

HDA Description: This REF segment at the Detail Level in the CON/N1 loop is used in response to chargeback request to provide other information regarding the customers involved in reconsilation process including: Payer identification number (340 programs), DEA, Health industry number, GLN and Produc line numbers. REF01 and REF02 must be present and in some instances, REF03 may be appropriate for description clarification.

Required. Reference information for identifiers that are not related to transaction documents. This group would map to X12 segments REF and N9 and EDIFACT RFF for information other than transaction documents.

HDA mapping. Valid values

• RX - Number assigned by the manufacturer to identify a previously submitted chargeback

• ZZ - Mutually defined

• 2U - Payer Identification Number for 340B Programs

• DH - Drug Enforcement Administration Number

• HI - Health Industry Number (HIN)

• L1- Letters or notes

• LU - GS1-US Global Location Number (GLN)

• P7 - Chargeback detail line number

• C8 - Corrected contract number

• 8X - Processing function type or transaction category code

• DI - Distributor invoice number

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

HDA: Identifier or description defined by qualifier code in transactionReferenceIdentifier (REF02).

Product adjustment detailed group. Adjustments with reason codes but without reference to an invoice.

If PAD present, any of PAD01, PAD02 required.

Required. Yes or no condition response code.

Valid values:

• Y - Request is accepted

• N - Rejected

• U - Unknown

• W - Not applicable

Code identifying the agency assigning the code values.

Valid value is DR - National Wholesale Druggists Association

Rejection reason code identifier.

Valid values list include: as per HDA guideline and other healthcare partners.

• 01 - Price Authorization Invalid

• 04 - Authorized Quantity Exceeded

• BB - Contract Number Incorrect, Contract number supplied does not match any valid contract number in Manufacturer database

• EE - Invoice date for chargeback claim is missing or invalid

• FF - Manufacturer does not find contract submitted for this customer

• KK - Drug not covered, Drug for this chargeback not ever covered on this contract

• MM- Drug not yet eligible, Invoice date precedes date of inclusion of drug on this contract

• OO - Wholesaler not covered/ID not recognized, Manufacturer has no record of inclusion of this distributor on this contract or cannot identify them

• RR - Quantity invalid or not supplied, Quantity on invoice invalid or not supplied as required

• SS - Contract price not supplied or incorrect - Corrected in this 849 response transaction

Action code identifies consequent action has to be taken by receiver of this message.

Valid values: as per HDA guidelines

• C - Please Correct and Resubmit

• N - Resubmission Not Allowed

• P - Please Resubmit Original Transaction

• R - Resubmission Allowed

• S - Do Not Resubmit; Inquiry Initiated to a Third Party

• W - Please Wait 30 Days and Resubmit

• X - Please Wait 10 Days and Resubmit

• Y - Do Not Resubmit; We will Hold Your Request and Respond Again Shortly

• D - Resubmit Entire Claim, The entire claim has to be resubmitted

Specifies item unit details of a contract that is being requested/corrected in response. HDA usage note:. CON-PAD-UIT

Four occurrences of this segment at the detail level in the productAdjustmentDetails loop are required to add an item in a response to chargeback request: to specify the contract price, submitted contract price, whole sale price and submittted wholesale price.

Required. Unit of measure for recorded product in adjustment.

Valid values:

• CA – Case
• CP – Crate
• CT – Carton
• DS – Display
• DZ – Dozen
• EA – Each
• PR – Pair
• PC – Piece
• PF – Pallet
• PK – Package
• PT – Pint
• QT – Quart
• RL – Roll
• SC – Square Centimeter
• SF – Square Foot
• SH – Sheet
• SI – Square Inch
• SM – Square Meter
• ST – Set
• SY – Square Yard
• T3 – Thousand Pieces
• TH – Thousand
• TY – Tray
• UN – Unit

Item unit price.

if UIT03 present, UIT02 is required.

Code identifying the type of unit price.

Valid values:

• CT - CONTRACT

• WH - WHOLESALE

• SC - SUBMITTEDCONTRACT

• SW - SUBMITTEDWHOLESALE

Quantity of item in response to chargeback claim.

Notes: Rebate returns are indicated by negative values in the QTY and AMT segments.

Required. Quantity type for return.

Valid values:

• 32 - Sold

• 76 - Returned

• 83 - Submitted sold

• 84 - Submitted returned

Unit of measure used for pricing.

Valid values

• 02 – Statute Mile
• 4G – Microliter
• AM – Ampoule
• AV – Capsule
• BD – Bundle
• BG – Bag
• BO – Bottle
• BX – Box
• C3 – Centiliter
• CA – Case
• CC – Cubic Centimeter
• CF – Cubic Feet
• CG – Card Blister
• CH – Container
• CI – Cubic Inches
• CL – Cylinder
• CM – Centimeter
• CN – Can
• CP – Crate
• CQ – Cartridge
• CR – Cubic Meters
• CT – Carton
• DA – Day
• DI – Dispenser
• DK – Kilometers
• DL – Deciliter
• DM – Decimeter
• DQ – Cubic decimeters
• DR – Drum
• DS – Display
• DZ – Dozen
• EA – Each
• FO – US Fluid Ounce
• FT – Foot
• GA – US Gallon
• GL – Gram/Liter
• GR – Gram
• GS – Gross
• H4 – Hectoliter
• HF – Hundred Feet
• HR – Hours
• IN – Inch
• K6 – Kiloliters
• KG – Kilogram
• KT – Kit
• LB – US Pound
• LF – Linear Foot
• LO – Lot (unit of procurement)
• LT – Liter
• LY – Linear Yard
• MC – Microgram
• ME – Milligram
• ML – Milliliter
• MM – Millimeter
• MO – Months
• 01 – Cubic millimeter
• MR – Meter
• OZ – Ounce
• P1 – Percent
• PC – Piece
• PF – Pallet
• PH – Pack
• PK – Package
• PR – Pair
• PT – Pint
• QT – Quart
• RL – Roll
• SC – Square Centimeter
• SF – Square Foot
• SH – Sheet
• SI – Square Inch
• SM – Square Meter
• SP – Self Package
• ST – Set
• SY – Square Yard
• SZ – Syringe
• T3 – Thousand Pieces
• TB – Tube
• TH – Thousands
• TN – Tonne
• TS – Thousands
• TY – Tray
• U2 – Tablet
• UM – Million
• UN – Unit
• US – Dosage Form
• V2 – Pouch
• VI – Vial
• WK – Week
• YD – Yard
• YR – Years

Monetary amount.

HDA Notes: The AMT segment is to be used only in cases where the amount cannot be computed from other detail.

Submitted chargeback claim amount is equal to the value of the chargeback claim amount at the summary level in the canonical productTransferAccountRequest — which was submitted by the distributor to the manufacturer.

Adjusted chargeback claim amount is equal to the value of the credit memo issued by the manufacturer.

Required. Qualifier code defining amount for.

Valid values:

• A - Adjusted chargeback amount

• S - Submitted chargeback amount

Credit or debit flag code indicating whether the amount is a credit or a debit.

Valid values:

• C - Credit

• D - Debit

DTM date segment in CON-PAD loop group 120.

HDA usage description: This date segment at the detail level in the canonical productAdjustmentDetails array (X12CON/PAD loop) is only used to provide the item Invoiced and PO Received date.

Required. Date type qualifier for contract dates in CON-PAD-DTM loop.

Valid values:

• 003 - Invoice

• 008 - PO Received date

REF reference segment for mapping for reference identifiers.

HDA Description: This REF segment at the Detail Level in the CON/N1 loop is used in response to chargeback request to provide other information regarding the customers involved in reconsilation process including: Payer identification number (340 programs), DEA, Health industry number, GLN and Product line numbers. REF01 and REF02 must be present and in some instances, REF03 may be appropriate for description clarification.

Notes:

if REF01 = 8X then transaction type REF02 will have priority then BRC01

REF02 = 00 - Original

• 15- for resubmission

• 18 - credit / rebill with original

• 41 - credit / rebill with out original

Required. Reference information for identifiers that are not related to transaction documents. This group would map to X12 segments REF and N9 and EDIFACT RFF for information other than transaction documents.

HDA mapping. Valid values

• RX - Number assigned by the manufacturer to identify a previously submitted chargeback

• ZZ - Mutually defined

• 2U - Payer Identification Number for 340B Programs

• DH - Drug Enforcement Administration Number

• HI - Health Industry Number (HIN)

• L1- Letters or notes

• LU - GS1-US Global Location Number (GLN)

• P7 - Chargeback detail line number

• C8 - Corrected contract number

• 8X - Processing function type or transaction category code

• DI - Distributor invoice number

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

HDA: Identifier or description defined by qualifier code in transactionReferenceIdentifier (REF02).

Monetary amount. summary level.

HDA Notes: The AMT segment is to be used only in cases where the amount cannot be computed from other detail.\n\nSubmitted chargeback claim amount is equal to the value of the chargeback claim amount at the summary level in the canonical productTransferAccountRequest — which was submitted by the distributor to the manufacturer. \n\nAdjusted chargeback claim amount is equal to the value of the credit memo issued by the manufacturer.

Required. Qualifier code defining amount for.

Valid values:

• A - Adjusted chargeback amount

• S - Submitted chargeback amount

• N - Net adjustment amount

Credit or debit flag code indicating whether the amount is a credit or a debit.

Valid values:

• C - Credit

• D - Debit