Patient Portal and Premium Payments Portal: Request Data Fields

Field	GET	POST	SSO Assertion Attributes	SSO relayState Parameters	RelayState Encryption	SSO NVP	Format	Required?	Min	Max	Comments	Usage
id	✓			✓			AN	Y	1	100	InstaMed Payment ID (Alias) assigned during implementation.	ALL
accountHolderEmailAddress		✓	✓	✓	✓	✓	AN	N	1	200	Consult your Implementations Manager for specific requirements that may apply.	ALL
userID		✓	✓	✓	✓	✓	AN	Y	1	200	Consumer user ID. Unique field that identify the consumer	ALL
accountNumber		✓	✓	✓	✓	✓	AN	N	1	100	The account number (with dashes “–’’) for the account from which a check is drawn.	ALL
routingNumber		✓	✓	✓	✓	✓	AN	N	9	9	The routing number for the bank from which a check is drawn.	ALL
checkNumber		✓	✓	✓	✓	✓	AN	N	1	50	The number of the check.	ALL
checkState		✓	✓	✓	✓	✓	AN	N	2	2	Account holder's address state.	ALL
accountType		✓	✓	✓	✓	✓	AN	N	1	8	The type of account from which a check is drawn. "Checking," "Savings."	ALL
additionalInfo2		✓	✓	✓	✓	✓	AN	N	1	100	User-defined fields to be captured with the payment transaction.	ALL
additionalInfo3		✓	✓	✓	✓	✓	AN	N	1	100	See AdditionalInfo2 comments.	ALL
additionalInfo4		✓	✓	✓	✓	✓	AN	N	1	100	See AdditionalInfo2 comments.	ALL
additionalInfo5		✓	✓	✓	✓	✓	AN	N	1	100	See AdditionalInfo2 comments.	ALL
additionalInfo6		✓	✓	✓	✓	✓	AN	N	1	100	See AdditionalInfo2 comments.	ALL
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.	ALL
billingAddress1		✓	✓	✓	✓	✓	AN	N	1	55	The primary street address associated with the accountholder or guarantor.	ALL
billingAddress2		✓	✓	✓	✓	✓	AN	N	1	55	The street address second line associated with the accountholder or guarantor.	ALL
billingCity		✓	✓	✓	✓	✓	AN	N	1	30	The city associated with the accountholder or guarantor.	ALL
billingState		✓	✓	✓	✓	✓	AN	N	1	2	The state associated with the accountholder or guarantor.	ALL
billingZip		✓	✓	✓	✓	✓	AN	N	5	7	The postal code associated with the accountholder or guarantor.	ALL
billingCountry		✓	✓	✓	✓	✓	AN	N	1	50	See Country Codes.	ALL
billingAreaCode		✓	✓	✓	✓	✓	AN	N	1	3	Area code for the account holder (i.e., billing) phone number.	ALL
billingPhoneNumber		✓	✓	✓	✓	✓	AN	N	1	8	Account holder (i.e., billing) phone number.	ALL
cardNumber		✓	✓	✓	✓	✓	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.	ALL
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.	ALL
cardHolderName		✓	✓	✓	✓	✓	AN	N	1	121	Conditionally applicable based on outlet configuration. Consult your Implementations Manager for whether these fields are supported for your implementation.	ALL
cardType		✓	✓	✓	✓	✓	AN	N	1	10	Supported values: "VISA,” "MASTERCARD," "AMEX,” "DISCOVER."	ALL
checkHolderFirstName		✓	✓	✓	✓	✓	AN	N	1	50	Conditionally applicable based on outlet configuration. Consult your Implementations Manager for whether these fields are supported for your implementation.	ALL
checkHolderLastName		✓	✓	✓	✓	✓	AN	N	1	50	Conditionally applicable based on outlet configuration. Consult your Implementations Manager for whether these fields are supported for your implementation.	ALL
invoiceNumber		✓	✓	✓	✓	✓	AN	N	1	50	User-defined field to be captured with the payment transaction. Also referred to as AdditionalInfo1.	ALL
patientAddress1		✓	✓	✓	✓	✓	AN	N	1	55	Street address line 1 for the patient, which may be different than the guarantor address.	ALL
(consumerAddress1)
patientAddress2		✓	✓	✓	✓	✓	AN	N	1	55	Street address line 2 for the patient, which may be different than the guarantor address.	ALL
(consumerAddress2)
patientCity		✓	✓	✓	✓	✓	AN	N	1	30	City for the patient, which may be different than the guarantor address.	ALL
(consumerCity)
PatientState		✓	✓	✓	✓	✓	AN	N	2	2	State for the patient, which may be different than the guarantor address.	ALL
(consumerState)
patientZip1		✓	✓	✓	✓	✓	AN	N	5	5	Postal code for the patient, which may be different than the guarantor address.	ALL
(consumerZip)
patientCountry		✓	✓	✓	✓	✓	AN	N	1	50	See Country Codes.	ALL
(consumerCountry)
patientEmailAddress		✓	✓	✓	✓	✓	AN	N	1	200		ALL
(consumerEmailAddress)
patientFirstName		✓	✓	✓	✓	✓	AN	N	1	25		ALL
(consumerFirstName)
patientBirthDate		✓	✓	✓	✓	✓	DT	N	8	8		ALL
(consumerDOB)
patientID		✓	✓	✓	✓	✓	AN	N	1	50	A unique identifier for the patient, which is typically sourced from the Patient Accounting System.	ALL
(consumerID)
patientLastName		✓	✓	✓	✓	✓	AN	N	1	35		ALL
(consumerLastName)
patientMedicalRecordNumber		✓	✓	✓	✓	✓	AN	N	1	100		ALL
(consumerMedicalRecordNumber)
patientMiddleName		✓	✓	✓	✓	✓	AN	N	1	25		ALL
(consumerMiddleName)
patientAreaCode		✓	✓	✓	✓	✓	AN	N	1	3		ALL
patientPhoneNumber		✓	✓	✓	✓	✓	AN	N	1	8		ALL
patientServiceBeginDate		✓	✓	✓	✓	✓	DT	N	10	10		ALL
(consumerServiceBeginDate)
patientServiceEndDate		✓	✓	✓	✓	✓	DT	N	10	10		ALL
(consumerServiceEndDate)
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.	ALL
consumerChargeLimit		✓	✓	✓		✓	DEC	N	1	10	This is the default value for charge limit, consumer will be able to change it in UI.	ALL

consumerEnrollinAutomaticPayment		✓	✓	✓		✓	B	N	2	2	Indicate to check the Enroll in Automatic payment	ALL

saveCardOnFile		✓	✓	✓		✓	B	N	2	2	Indicate to check save payment method on file	ALL

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