Payment Transaction Import Data Fields

Field #Field NameFormatRequiredMinMaxComment
1Record ID"IMPTI10"Y77
2Merchant IDANY150The unique ID associated with your merchant processing account, which will be given by your Implementation Manager.
3Store IDANY150Default value is 1.
4Terminal IDANY150May differ by location ( at no extra cost to the provider ) to enhance security and reporting.
5Payment Transaction TypeANY135Supported values are: "CreditCard,” "eCheck" and "Cash".
6Payment Transaction ActionANY135Supported values are: "AuthCapt" and "Credit".
7Transaction DateDTY1414Date/time in CCYYMMDDHHMMSS format.
8AmountDECYAlways positive decimal value. Payment Transaction action = "Credit" should cause this field to be interpreted as a refund.
9Card TypeANO125This field is returned when the transaction type is CreditCard. Values include: "VISA,” "MC,” "AMEX,” "DISCOVER" and "OTHER".
10Check AccountTypeANO150Checking, Saving and Business.
11Card/Check NumberANY150Truncated CardNumber or check number.
12Card Expiration Date ANSApplicable for credit card only. Expiration date in the MMCCYY format.
13Check Routing NumberANS1010When Payment Transaction action is eCheck, this field is required.
14Authorization NumberANO150
15Is SwipedANO11Supported values are: "Y" or "N" indicating whether the card/check was swiped or not.
16Account/Card Holder NameANO1150
19Account/Card Holder Address 1ANO1150
20Account/Card Holder Address 2ANO1150
21Account/Card Holder CityANO150
22Account/Card Holder StateANO22
23Account/Card Holder ZipCodeANO515
24Account/Card Holder CountryANO150
25Account/Card Holder Phone #ANO113Field in xxx-xxx-xxxx format.
26Account/Card Holder Email AddressANO150
27Patient LastNameANO150
28Patient FirstNameANO150
29Patient MiddleNameANO150
30Patient Account NumberANO150
31Patient Address 1ANO1150
32Patient Address 2ANO1150
33Patient CityANO150
34Patient StateANO130
35Patient ZipCodeANO115
36Patient CountryANO150
37Patient Phone #ANO113Field in xxx-xxx-xxxx format.
40Patient Medical Record #ANO150
41Patient DOBDTO1414In CCYYMMDD format.
42StatusANO2020Defaulted to approved. Possible statuses: settled, denied, voided or approved.
43AdditionalInfo1ANO1100User-defined fields to be captured with the payment transaction.
44AdditionalInfo2ANO1100See AdditionalInfo1 comments.
45AdditionalInfo3ANO1100See AdditionalInfo1 comments.
46AdditionalInfo4ANO1100See AdditionalInfo1 comments.
47AdditionalInfo5ANO1100See AdditionalInfo1 comments.
48AdditionalInfo6ANO1100See AdditionalInfo1 comments.
49UserANO1100If not included, user will be set to PTI.