Record ID: IMDPA10
File Format: Piped Delimited
| Field # | Field Name | Format | Required? | Min | Max | Comment |
|---|---|---|---|---|---|---|
| 1 | Record ID | "IMDPA10" | Y | 7 | 7 | |
| 2 | Merchant ID | AN | Y | 1 | 50 | The unique ID associated with your merchant processing account, which will be provided by your Implementations Manager. |
| 3 | Store ID | AN | Y | 1 | 50 | Default value is 1. |
| 4 | Terminal ID | AN | Y | 1 | 50 | May differ by location (at no extra cost to the provider) to enhance security and reporting. |
| 5 | Payment Transaction Type | AN | Y | 1 | 35 | Supported values are: "CreditCard," "eCheck," "DebitCard" and "Cash." |
| 6 | Payment Transaction Action | AN | Y | 1 | 35 | Supported Values are: "AuthCapt" and "Credit." |
| 7 | Amount | DEC | O | Always positive decimal value. Payment Transaction action = "Credit" should cause this field to be interpreted as a refund. | ||
| 8 | Card Type | AN | O | 1 | 25 | This field is returned when the transaction type is CreditCard. Values include: "VISA," "MC," "AMEX," "DISCOVER" and "OTHER." |
| 9 | Transaction ID | AN | Y | 1 | 50 | This is a unique ID assigned by InstaMed. E.g., "3c4fabfad61e47e4aa10b52529476529." |
| 10 | Authorization Number | AN | S | 1 | 50 | |
| 11 | Transaction Date | DT | Y | 14 | 14 | Date/time in CCYYMMDDHHMMSS format. |
| 12 | Transaction Status Code | AN | Y | 1 | 10 | Supported values are: A, C, CB, D, RI, S, SE, V See Transaction Status Codes. |
| 13 | Patient LastName | AN | O | 1 | 50 | |
| 14 | Patient FirstName | AN | O | 1 | 50 | |
| 15 | Patient MiddleName | AN | O | 1 | 50 | |
| 16 | Patient Account Number | AN | O | 1 | 50 | |
| 17 | Patient Address 1 | AN | O | 1 | 150 | |
| 18 | Patient Address 2 | AN | O | 1 | 150 | |
| 19 | Patient City | AN | O | 1 | 50 | |
| 20 | Patient State | AN | O | 1 | 30 | |
| 21 | Patient ZipCode | AN | O | 1 | 15 | |
| 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. |