File Name: PS_<ClientID>_<YYYYMMDD>_<UniqueID>SourceInterchangeID-SourceInterchangeQualifier-GroupID-<GUID>
Frequency: Processed as received.
Format: Pipe delimited with no header record.
| Field # | Field Name | Format | Min | Max | Req'd | Comment |
|---|---|---|---|---|---|---|
| 1 | RecordID | AN | 7 | 7 | Y | IMPSCIF |
| 2 | Patient ID | AN | 2 | 80 | Y | |
| 3 | Patient First | AN | 1 | 25 | O | |
| 4 | Patient Middle | AN | 1 | 25 | O | |
| 5 | Patient Last | AN | 1 | 80 | O | If name cannot be parsed, include full name in this field |
| 6 | Patient DOB | DT | 1 | 35 | O | |
| 7 | Patient Phone Number | AN | 10 | 10 | O | |
| 8 | Invoice Number | AN | 2 | 80 | O | |
| 9 | Amount Due | DEC | 1 | 25 | Y | |
| 10 | Invoice Date | DT | 1 | 35 | Y | |
| 11 | Client ID | AN | 1 | 80 | Y | Assigned by InstaMed |
| 12 | Provider ID | AN | 2 | 80 | O | |
| 13 | Provider Name | AN | 2 | 80 | O | |
| 14 | Provider Street1 Address | AN | 1 | 200 | O | |
| 15 | Provider Street2 Address | AN | 1 | 200 | O | |
| 16 | Provider City | AN | 1 | 100 | O | |
| 17 | Provider State | AN | 2 | 2 | O | |
| 18 | Provider Zip | AN | 5 | 5 | O | |
| 19 | Dynamic Field 1 | AN | 1 | -1 | O | |
| 20 | Dynamic Field 2 | AN | 1 | -1 | O | |
| 21 | Dynamic Field 3 | AN | 1 | -1 | O | |
| 22 | Dynamic Field 4 | AN | 1 | -1 | O | |
| 23 | Status | AN | 1 | 1 | Y | S (summary only – no PDF provided) |
| 24 | Status Description | AN | 1 | 30 | O | (summary only – no PDF provided) |
| 25 | PDF Start Page | NUM | 1 | 30 | O | Not used |
| 26 | PDF End Page | NUM | 1 | 30 | O | Not used |
| 27 | PDF File Name | AN | 1 | -1 | O | Not used |
| 28 | Patient Email Address | AN | 1 | 100 | N | |
| 29 | Recipient First Name | AN | 1 | 25 | O | |
| 30 | Recipient Middle Name | AN | 1 | 25 | O | |
| 31 | Recipient Last Name | AN | 1 | 80 | O | |
| 32 | Recipient Street 1 | AN | 1 | -1 | O | |
| 33 | Recipient Street 2 | AN | 1 | -1 | O | |
| 34 | Recipient City | AN | 1 | -1 | O | |
| 35 | Recipient State | AN | 2 | 2 | O | |
| 36 | Recipient Zip 1 | AN | 5 | 5 | O | |
| 37 | Recipient Zip 2 | AN | 4 | 4 | O | |
| 38 | Guarantor ID | AN | 1 | 80 | O | |
| 39 | Guarantor First Name | AN | 1 | 25 | O | |
| 40 | Guarantor Last Name | AN | 1 | 80 | O | |
| 41 | Master Patient Account ID | AN | 1 | 80 | O | |
| 42 | Total Charge | DEC | 1 | 25 | O | |
| 43 | Discount | DEC | 1 | 25 | O | |
| 44 | Payer Paid | DEC | 1 | 25 | O | |
| 45 | Payer Adjustment | DEC | 1 | 25 | O | |
| 46 | Patient Paid | DEC | 1 | 25 | O | |
| 47 | Previous Balance | DEC | 1 | 25 | O | |
| 48 | Statement Reference Number | AN | 36 | 36 | O |