1 | Record ID | "IMSPR10" | Y | 7 | 7 | |
2 | Payment Plan ID | AN | O | 32 | 32 | Unique ID for Save on File transaction. |
3 | Amount | DEC | Y | | | Charge to be applied to card on file. |
4 | Process Date | DT | Y | 8 | 8 | Scheduled payment date. Must be a date occurring in the future ( i.e., not current day or past ). |
5 | MerchantID | AN | Y | 1 | 50 | If empty, payment plan value will be used instead. |
6 | StoreID | AN | Y | 1 | 50 | If empty, payment plan value will be used instead. |
7 | TerminalID | AN | Y | 1 | 50 | If empty, payment plan value will be used instead. |
8 | Transaction Type | AN | Y | 6 | 6 | "Charge" or "Refund." |
9 | Patient LastName | AN | C | 1 | 50 | |
10 | Patient FirstName | AN | C | 1 | 50 | |
11 | Patient MiddleName | AN | O | 1 | 50 | |
12 | Patient DOB | DT | C | 8 | 8 | |
13 | Patient Account Number | AN | O | 1 | 50 | If empty, payment plan value will be used instead. |
14 | Patient Medical Record Number | AN | O | 1 | 50 | |
15 | Patient Address 1 | AN | O | 1 | 150 | If empty, payment plan value will be used instead. |
16 | Patient Address 2 | AN | O | 1 | 150 | If empty, payment plan value will be used instead. |
17 | Patient City | AN | O | 1 | 50 | If empty, payment plan value will be used instead. |
18 | Patient State | AN | O | 1 | 30 | If empty, payment plan value will be used instead. |
19 | Patient ZipCode | AN | O | 1 | 15 | If empty, payment plan value will be used instead. |
20 | Service Begin Date | DT | C | 8 | 8 | If empty, payment plan value will be used instead. |
21 | Service End Date | DT | C | 8 | 8 | If empty, payment plan value will be used instead. |
22 | Total Billed Amount | DEC | O | | | |
23 | AdditionalInfo1 | AN | O | 1 | 100 | User-defined fields to be captured with the payment transaction. |
24 | AdditionalInfo2 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
25 | AdditionalInfo3 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
26 | AdditionalInfo4 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
27 | AdditionalInfo5 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
28 | AdditionalInfo6 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |