1 | Record ID | "IMPPN10" | Y | 7 | 7 | |
2 | Payment Plan ID | AN | Y | 32 | 32 | Unique ID for Save on File transaction. |
3 | Merchant ID | AN | Y | 1 | 50 | The unique ID associated with your merchant processing account, which will be given by your Implementations Manager. |
4 | Store ID | AN | Y | 1 | 50 | See MerchantID comments. |
5 | Terminal ID | AN | Y | 1 | 50 | See MerchantID comments. |
6 | Transaction Date | DT | Y | 8 | 8 | Payment Plan creation date. |
7 | Total Charge | DEC | O | | | |
8 | Card Type | AN | O | 1 | 25 | This field is returned when the transaction type is Card. Values include: "VISA,” "MC,” "AMEX,” "DISCOVER,” "OTHER." |
9 | Patient LastName | AN | O | 1 | 50 | |
10 | Patient FirstName | AN | O | 1 | 50 | |
11 | Patient MiddleName | AN | O | 1 | 50 | |
12 | Patient DOB | DT | O | 8 | 8 | |
13 | Patient Account Number | AN | O | 1 | 50 | |
14 | Patient Medical Record Number | AN | O | 1 | 50 | |
15 | Patient Address 1 | AN | O | 1 | 150 | |
16 | Patient Address 2 | AN | O | 1 | 150 | |
17 | Patient City | AN | O | 1 | 50 | |
18 | Patient State | AN | O | 1 | 30 | |
19 | Patient ZipCode | AN | O | 1 | 15 | |
20 | Service Begin Date | DT | O | 8 | 8 | |
21 | Service End Date | DT | O | 8 | 8 | |
22 | AdditionalInfo1 | AN | O | 1 | 100 | User-defined fields to be captured with the payment transaction. |
23 | AdditionalInfo2 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
24 | AdditionalInfo3 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
25 | AdditionalInfo4 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
26 | AdditionalInfo5 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
27 | AdditionalInfo6 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |