accountHolderEmailAddress | | | ✓ | | | ✓ | AN | N | 1 | 200 | Consult your Implementations Manager for specific requirements that may apply. |
accountNumber | | | ✓ | | | ✓ | AN | N | 1 | 100 | The account number ( with dashes “–’’ ) for the account from which a check is drawn. |
routingNumber | | | ✓ | | | ✓ | AN | N | 9 | 9 | The routing number for the bank from which a check is drawn. |
checkNumber | | | ✓ | | | ✓ | AN | N | 1 | 50 | The number of the check. |
checkState | | | ✓ | | | ✓ | AN | N | 2 | 2 | Account holder's address state. |
accountType | | | ✓ | | | ✓ | AN | N | 1 | 8 | The type of account from which a check is drawn. "Checking," "Savings." |
additionalInfo2 | | | ✓ | | | ✓ | AN | N | 1 | 100 | User-defined fields to be captured with the payment transaction. |
additionalInfo3 | | | ✓ | | | ✓ | AN | N | 1 | 100 | See AdditionalInfo2 comments. |
additionalInfo4 | | | ✓ | | | ✓ | AN | N | 1 | 100 | See AdditionalInfo2 comments. |
additionalInfo5 | | | ✓ | | | ✓ | AN | N | 1 | 100 | See AdditionalInfo2 comments. |
additionalInfo6 | | | ✓ | | | ✓ | AN | N | 1 | 100 | See AdditionalInfo2 comments. |
amount | | | ✓ | | | ✓ | DEC | N | 1 | 10 | The amount of money being authorized or charged to a credit or debit card, or the amount for which a check is written. Must be greater than 0. |
billingAddress1 | | | ✓ | | | ✓ | AN | N | 1 | 55 | The primary street address associated with the accountholder or guarantor. |
billingAddress2 | | | ✓ | | | ✓ | AN | N | 1 | 55 | The street address second line associated with the accountholder or guarantor. |
billingCity | | | ✓ | | | ✓ | AN | N | 1 | 30 | The city associated with the accountholder or guarantor. |
billingState | | | ✓ | | | ✓ | AN | N | 1 | 2 | The state associated with the accountholder or guarantor. |
billingZip | | | ✓ | | | ✓ | AN | N | 5 | 7 | The postal code associated with the accountholder or guarantor. |
billingCountry | | | ✓ | | | ✓ | AN | N | 1 | 50 | See Table 89 in the Appendix to reference a standard table of country codes. |
billingAreaCode | | | ✓ | | | ✓ | AN | N | 1 | 3 | Area code for the account holder ( i.e., billing ) phone number. |
billingPhoneNumber | | | ✓ | | | ✓ | AN | N | 1 | 8 | Account holder ( i.e., billing ) phone number. |
card Number | | | ✓ | | | ✓ | AN | N | 1 | 16 | Credit card number with no spaces or hyphens. Users may also key or swipe this information on the Patient Payments or Payment Plans page. |
cardExpDate | | | ✓ | | | ✓ | DT | N | 4 | 4 | This is the credit card’s expiration date, and it must be a valid date. Should be one of the following: MM-YY or MM/YY. |
cardHolderName | | | ✓ | | | ✓ | AN | N | 1 | 121 | Conditionally applicable based on outlet configuration. Consult your Implementations Manager for whether these fields are supported for your implementation. |
cardType | | | ✓ | | | ✓ | AN | N | 1 | 10 | Supported values: "VISA,” "MASTERCARD," "AMEX,” "DISCOVER." |
checkHolderFirstName | | | ✓ | | | ✓ | AN | N | 1 | 50 | Conditionally applicable based on outlet configuration. Consult your Implementations Manager for whether these fields are supported for your implementation. |
checkHolderLastName | | | ✓ | | | ✓ | AN | N | 1 | 50 | Conditionally applicable based on outlet configuration. Consult your Implementations Manager for whether these fields are supported for your implementation. |
invoiceNumber | | | ✓ | | | ✓ | AN | N | 1 | 50 | User-defined field to be captured with the payment transaction. Also referred to as AdditionalInfo1. |
patientAddress1 | | | ✓ | | | ✓ | AN | N | 1 | 55 | Street address line 1 for the patient, which may be different than the guarantor address. |
patientAddress2 | | | ✓ | | | ✓ | AN | N | 1 | 55 | Street address line 2 for the patient, which may be different than the guarantor address. |
patientCity | | | ✓ | | | ✓ | AN | N | 1 | 30 | City for the patient, which may be different than the guarantor address. |
patientState | | | ✓ | | | ✓ | AN | N | 2 | 2 | State for the patient, which may be different than the guarantor address. |
patientZip1 | | | ✓ | | | ✓ | AN | N | 5 | 5 | Postal code for the patient, which may be different than the guarantor address. |
patientZip2 | | | ✓ | | | ✓ | AN | N | 4 | 4 | Zip+4 for the patient, which may be different than the guarantor address. |
patientCountry | | | ✓ | | | ✓ | AN | N | 1 | 50 | See Table 89 in the Appendix to reference a standard table of country codes. |
patientEmailAddress | | | ✓ | | | ✓ | AN | N | 1 | 200 | |
patientFirstName | | | ✓ | | | ✓ | AN | N | 1 | 25 | |
patientBirthDate | | | ✓ | | | ✓ | DT | N | 8 | 8 | |
patientID | | | ✓ | | | ✓ | AN | N | 1 | 50 | A unique identifier for the patient, which is typically sourced from the Patient Accounting System. |
patientLastName | | | ✓ | | | ✓ | AN | N | 1 | 35 | |
patientMedicalRecordNumber | | | ✓ | | | ✓ | AN | N | 1 | 100 | |
patientMiddleName | | | ✓ | | | ✓ | AN | N | 1 | 25 | |
patientAreaCode | | | ✓ | | | ✓ | AN | N | 1 | 3 | |
patientPhoneNumber | | | ✓ | | | ✓ | AN | N | 1 | 8 | |
patientServiceBeginDate | | | ✓ | | | ✓ | DT | N | 10 | 10 | |
patientServiceEndDate | | | ✓ | | | ✓ | DT | N | 10 | 10 | |
transactionCode | | | ✓ | | | ✓ | AN | N | 1 | 50 | Note : Please submit the Transaction Code rather than description. Consult your Implementations Manager to configure Transaction Codes on your account. |
additionalCode1 | | | ✓ | | | ✓ | | | | | |
additionalCode2 | | | ✓ | | | ✓ | | | | | |
additionalCode3 | | | ✓ | | | ✓ | | | | | |
additionalCode4 | | | ✓ | | | ✓ | | | | | |
additionalCode5 | | | ✓ | | | ✓ | | | | | |
additionalCode6 | | | ✓ | | | ✓ | | | | | |
additionalInfo1 | | | ✓ | | | ✓ | | | | | |
authorizationNumber | | | ✓ | | | ✓ | | | | | |
cardHolderFirstName | | | ✓ | | | ✓ | | | | | |
cardHolderLastName | | | ✓ | | | ✓ | | | | | |
consumerSecondaryAccountNumber | | | ✓ | | | ✓ | | | | | |
customerDLLNumber | | | ✓ | | | ✓ | | | | | |
customerPhoneNumber | | | ✓ | | | ✓ | | | | | |
estimatedAmount | | | ✓ | | | ✓ | | | | | |
initialPaymentAmount | | | ✓ | | | ✓ | | | | | |
patientName | | | ✓ | | | ✓ | | | | | |
receiverName | | | ✓ | | | ✓ | | | | | |
userName | | | ✓ | | | ✓ | | | | | |
Guarantor ID | | | | | | | AN | O | 1 | 80 | |
Guarantor First Name | | | | | | | AN | O | 1 | 35 | |
Guarantor Last name | | | | | | | AN | O | 1 | 60 | |