| Field # | Field Name | Format | Required? | Min | Max | Comment |
| 1 | Record ID | "IMSPE10" | 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. |
| 5 | MerchantID | AN | O | 2 | 50 | If empty, payment plan value will be used instead. |
| 6 | StoreID | AN | O | 2 | 50 | If empty, payment plan value will be used instead. |
| 7 | TerminalID | AN | O | 2 | 50 | If empty, payment plan value will be used instead. |
| 8 | Transaction Type | AN | Y | 6 | 6 | "Charge" or "Refund." |
| 9 | Patient LastName | AN | Y | 1 | 50 | |
| 10 | Patient FirstName | AN | Y | 1 | 50 | |
| 11 | Patient MiddleName | AN | O | 1 | 50 | |
| 12 | Patient DOB | DT | Y | 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 Zip Code | AN | O | 1 | 15 | If empty, payment plan value will be used instead. |
| 20 | Service Begin Date | DT | O | 8 | 8 | If empty, payment plan value will be used instead. |
| 21 | Service End Date | DT | O | 8 | 8 | If empty, payment plan value will be used instead. |
| 22 | Total Billed Amount | DEC | O | | | |
| 23 | Overcharge | Dec | O | | | Overcharge = (Scheduled Amount + Amount) – Estimated. |
| 24 | AdditionalInfo1 | AN | O | 1 | 100 | User-defined fields to be captured with the payment transaction. |
| 25 | AdditionalInfo2 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
| 26 | AdditionalInfo3 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
| 27 | AdditionalInfo4 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
| 28 | AdditionalInfo5 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
| 29 | AdditionalInfo6 | AN | O | 1 | 100 | See AdditionalInfo1 comments. |
| 30 | Error Code | AN | R | 1 | 10 | See Scheduled Payment Request Exception Error Codes below |
| 31 | Error Description | AN | O | 1 | 250 | |
Payment Plan – Scheduled Payment Request Exception Error Codes
| Error Code | Description |
| 1 | Invalid Payment Plan |
| 2 | Inactive Payment Plan |
| 3 | Validation Error |
