36W79719R0001-003.doc

ASC X12

Electronic Data Interchange

Draft Specifications for Prime Vendor Interface with vista February 2011 Department of Veteran Affairs

CIOFO

Birmingham, Alabama

Table of Contents

ASC X12, Electronic Data Interchange

Prime Vendor Interface Specifications

1. Purpose

This document specifies an interface to VISTA based on the ASC X12 Protocol for Electronic Data Interchange (EDI). It is the intent that this interface form the basis for creating export files compatible with the Prime Vendor Interface. Outlined are the segments and data elements which will be used by all prime vendors to export Invoice data to such an interface.

The segments and data elements which are used from the 810 transaction set will still be in strict accordance with the ASC X12 Standard.

2. Overview

2.1 Statement of Intent

The vendor will continue to provide the normal paper invoices and related documents as agreed upon. The file format will adhere to the

ASC X12 Standard. This form of EDI is prevalent within the health care industry.

2.2 Scope and Audience

This document describes the file format for electronic invoicing data as exported by prime vendors. It is intended for use by vendors offering proposals concerning prime vendor contracts and provides guidelines on the specific data and data format required for a successful interface with VISTA.

3. General Specifications

3.1 Segment Requirement Designators

M = Required by the ASC X12 Standard or as a part of the Prime Vendor Interface specifications.

R = Required by VISTA O = Optional

3.2 Data Element

A. Data Element Types

AN = String containing letters, digits, spaces, and/or special characters

DT = Date

ID = Identifier

N = Numeric

R = Decimal

TM = Time F= Free Text B. Data Element Length

The Data Element length is the range, minimum to maximum, of the number of character positions available to represent the data element.

3.3 Data Element Descriptions

Table 1: Interchange Control Header

Sample: ISA^00^ ^00^

^ZZ^ 999999

^ZZ^588

^950214^1005^U^00200^900456789^0^P^>~ Name and Description Requirement

This qualifier identifies the type of information in the

Authorization information.

Present

This information is used for additional identification or authorization of the sender or the data in the interchange.

This qualifier is used for identifying the type of information in the security information

This is used for identifying the security information about the sender of the data in the interchange.

This qualifier indicates the system (or method) of code structure used to designate the sender or receiver ID element that is being qualified.

This is the identification code of the sender.

vendor telephone number

This qualifier indicates the system (or method) of code structure used to designate the sender or receiver ID element that is being qualified.

This is the identification code of the receiver of the data.

This is the date in YYMMDD format

Table 1: Interchange Control Header - Continued

Reference Data Element

Designator No. Name and Description Requirement

Time is expressed in 24-hour clock time (HHMMSS). The time range is 000000 through 235959.

This code identifies the agency responsible for the control standard used by the message.

X12, TDCC, & UCS

This is the version number of the interchange control segments.

X12.5 - 1987

This number uniquely identifies the interchange data to the sender. Note: This is the same number as in the IEA02 data element.

This is sent by the sender to request an interchange acknowledgment.

This indicates whether data enclosed by this interchange envelope is test or production.

Reserved for future expansion in separating data element subgroups. It must be different from the data element separator.

Table 2: Functional Group Header

Sample: GS^IN^999999^588^950214^1005^012345678^X^003020~

Description Requirement

This code identifies a group of application related transaction sets.

This code identifies the party sending the transmission. The codes are agreed to by the trading partners.

vendor telephone number

This code identifies the party receiving the transmission.

The codes are agreed to by the trading partners.

The date is in YYMMDD format.

Time is expressed in 24-hour clock time ( HHMMSS). The time range is 000000 through 235959.

This is an assigned number that is initiated and maintained by the sender. . Note: This is the same Group Control

Number as in the GE102 data element.

This is used with data element GS08 to identify the issuer of the standard.

Committee X12

This indicates the version, release, subrelease, and industry identifier (including GS and GE segments) of the EDI standard being used.

Approved by ASC X12 though

June 1991.

Table 3: Transaction Set Header (ST)

Sample: ST^810^000000022~

Reference Data Element

This code is a unique identification of a transaction set.

The control number is assigned by the originator for the transaction set. The entry a four-digit number with leading zeros beginning with 0001 at the start of a new entry. It increments by one (+1) for every transaction set exported on that business day. Note: This is the same control number as in the SE02 data element

Type Length

Table 4: Beginning Segment for Invoice (BIG)

Sample: BIG^950214^201^950214^P2O01~

Reference Data Element

This is the invoice issue date.

The number is the identifying number assigned by issuer.

This date is assigned by the Department of Veterans Affairs.

This is the identifying purchase order number as assigned by the Department of Veterans Affairs .

BIG05 thru

BIG07

not used

Table 5: Reference Numbers (REF)

Sample: REF^CR^23201~

REF^TJ^102030~

Reference Data Element

The code qualifies the reference number.

Number

TJ - Federal Taxpayer’s

Identification Number

If the Reference Number Qualifier REF01 is CR, enter the customer account number. If the Reference Number

Qualifier is TJ, enter the federal taxpayer’s identification number.

REF03

not used

Table 6: Name (N1)

Sample: N1^BY^VA MEDICIAL CENTER^21^RA1000C00~

N1^DS^DRUGS DISTRIBUTOR INC.^21^KA1000R00~

N1^ST^VA MEDICAL CENTER^21^JR1000P00~

Reference Data Element

This identifies an organizational entity or a physical location.

DS - Distributor

ST - Ship To

This is a free-form name.

This designates the system/method of code structure used for Identification Code (67).

Number

This code identifies the party (as indicated in data element

N103)

the Buying Party (BY), Distributor

(DS), and Ship To (ST)

Table 7: Additional Name Information (N2) -- This segment is optional if N3 contains data.

Sample: N2^DEPARTMENT OF VETERANS AFFAIRS~

N2^DEPARTMENT OF VETERANS AFFAIRS^~

This is a continuation of the free-form name in N201.

This is a continuation of the free-form name in N201.

Table 8: Address Information (N3) -- This segment is optional if N2 contains data.

Sample: N3^123 VETERANS BLVD.~

N3^456 DRUG LANE~

N3^123 VETERANS BLVD.^RECEIVING DEPT.~

Reference Data Element

Table 9: Geographic Location (N4)

Sample: N4^LOUISVILLE^KY^40202~

N4^LEXINGTON^KY^40601~

N4^LOUISVILLE^KY^40202~

Reference Data Element

This is free-form text for the city name.

This is the standard U.S. two letter state abbreviation.

This code defines international postal.

Note: The U.S. zip code is either 5 digits or 5 digits + 4 digits separated by a dash (e.g., 231434595)

N404-N406 not used

Table 10: Terms of Sale/Deferred Terms of Sale (ITD) -- Optional segment.

Sample: ITD^14^^^950301^15^950302^16^34.67~

Reference Data Element

This identifies the type of payment terms.

ITD02

not used

This is the terms of the discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date.

This is the date payment is due if the discount is to be earned. The date is in YYMMDD format.

This is the number of days in the terms discount period by which payment is due if the terms discount is earned.

This is the date when the total invoice amount becomes due.

This is the number of days until the total invoice amount is due (discount is not applicable).

This is the total amount of the terms discount.

ITD09 thru

ITD15

not used

Table 11: Date/Time Reference ( DTM)

Sample: DTM^002^950210~

DTM^035^950212~

Reference Data Element

This specifies the type of date and/or time.

035 – Delivered

This is in YYMMDD format.

DTM03 &

DTM05

not used

Table 12: Baseline Item Data (Invoice) (IT1)

Sample: IT1^1^12^CC^9.32^DS^ND^00032227780^VN^46789~

Reference Data Element

The ID consists of alphanumeric characters assigned for differentiation within a transaction set. Note: This data element contains the line item number in order of appearance on the invoice. The format is positive numbers with no decimal places.

The quantity is the number of units involved.

This code identifies the basic unit of measure as follows:

AM

Ampoule

JR

Jar

BG

Bag

KG

Kilogram

BI

Bar

LB

Pound

BO

Bottle

ME

Milligram

BX

Box

ML

Milliliter

CC

Cubic Centimeter

OZ

Ounce

KA

Cake

PK

Package

CN

Can

PH

Pack (PAK)

CH

Container

PT

Pint

CA

Case

QT

Quart

CT

Carton

RA

Rack

DI

Dispenser

RL

Roll

DR

Drum

ST

Set

EA

Each

TY

Tray

GA

Gallon

TB

Tube

GR Gram

VI

Vial

description.

This is the price per unit of product.

Table 12: Baseline Item Data (Invoice) (IT1) - Continued

Reference Data Element

This identifies the type of unit price for an item.

This identifies the type or source of the descriptive number used in the Product/Service ID (IT107).

This is an identifying number for a product or service as indicated by IT106. Enter the product’s national drug code.

This code identifies the type or source of the descriptive number used in the Product/Service ID (IT109).

This is an identifying number for a product or service as indicated by IT108. Enter the vendor’s item number.

This identifies the type or source of the descriptive number used in the Product/Service ID (IT111) for medical supplies.

Code

This is an identifying number for a product or service as indicated by IT110. Enter the product’s consumer package code for medical supplies.

IT112 thru

IT125

not used

Table 13: Product/Item Description (PID)

Sample: PID^F^^^^VASOPRESS MDV 20U 1ML A/R 25~

This code identifies the type or source of the descriptive number used in the Product/Service ID (PID05).

A free-text description to clarify the related data elements and their content.

Table 14: Item Physical Details (P04)

Sample: P04^^25^ZZ^^^^100^PH~

Package Size (i.e. # bottles in sell unit)

This code identifies the type or source of the descriptive number used in the Product/Service ID (P0402).

P0409

Inner Pack Unit of Measure Code (i.e. # pills in bottle)

This code identifies the type or source of the descriptive number used in the Product/Service ID (P0409).

Table 15: Transaction Totals (CTT)

Sample: CTT^2^^^^^^CLOSED~

This is the total number of IT1 line items in the transaction set.

CTT02 thru

CTT06

not used

This description is the purchase order status. If all items on the purchase order have been shipped, enter the word

Closed. If items on the purchase order are outstanding, enter the word Partial.

Partial

Table 16: Transaction Set Trailer (SE)

Sample: SE^23^000000022~

This is the total number of segments in the transaction set including ST and SE segments.

The control number is assigned by the originator for the transaction set.

Note: This is the same control number as in the ST02 data element.

Table 17: Functional Group Trailer

Sample: GE^1^012345678~

This is the total number of transaction sets included in the functional group or interchange (transmission) group terminated by the trailer containing this element. There is only one transaction set of 810.

This is the assigned number that is initiated and maintained by the sender. Note: This is the same Group Control

Number as in the GS06 data element.

Length Code Table 18: Interchange Control Trailer

Sample: IEA^1^900456789~

This is the number of functional groups included in a transmission. There is only one transaction type.

This uniquely identifies the interchange data to the sender.

Note: This is the same number as in the ISA13 data element.

3.4 Implementation and Control Structure

A. Implementation

The vendor will have the invoice file available for download from their website…..

(ya’ll decide, what goes here.)

B. Invoice file Format Invoice files are named as shown in this example:

2011B084058885$KCM2b7AV.DAT

Component Breakdown:

1.) 2011B084058885 This is a unique identifier associated with the Purchase Order Number. Generally, the unit is identified by year, month and P.O. Number. The value is determined by the vendor.

The length of this segment must be 14 characters.

2.) $KCM

Standard encryption code used by VISTA software 3.) 2b7

Security encryption code of invoice file

VITAL Part of file name:

This part is essential in the naming of the file.

To accomplish this value, the following items are required:

a. The size of the file (in bytes)

b. The square root of the size of the file, without decimal values.

c. The value of a+b

d. The value derived from step c. is then converted into a Hexidecimal value.

In this example:

Size of the file is 670 bytes.

The square root is 25.

670+25=695.

695 converted to Hex = ‘2b7’.

4.) AV

Standard encryption code used by VISTA software

5.) .DAT

File extension NOTE: This does not preclude the vendor from providing the normal paper invoices and related documents as agreed upon prior to this interface.

B. Control Structure

In the INVOICE file, the data element delimiter and segment line terminator are defined in the ISA segment. Segments do not have to be terminated by a carriage return. The transaction set should look like the sample on page 21. Segment lines cannot exceed 245 characters each. All other rules of ASC X12 apply C. Segment Layout

ISA <--------------------------------------------------------------------

GS <----------------------------------------------

ST <---------------------------

BIG

REF

N1

N2

N3 | I | G

N4 | N | R | I

ITD

| V | O | N

DTM

| O | U | T

IT1 <--

| I | P | E

| line items | C | R

IT1 <--

| E | O | C

PID

| F | H P04 | A

CTT

| N

SE <---------------------------

| G

ST <---------------------------

| I | E

BIG

| N

REF

| I | V N1 | N | O

N2 | V | I | D

N3 | O | C | A

N4 | I | E | T

ITD

| C | S | A

DTM

| E

IT1 <--

| line items

IT1 <--

PID

P04

CTT

SE <---------------------------

GE <----------------------------------------------

IEA <--------------------------------------------------------------------

3.5 Transaction Set 810 Examples

Electronic Invoice Transaction Set 810

(As Used for the Prime Vendor Interface)

The Prime Vendor sends one electronic invoice (INVOICE NUM) to a VA facility’s pharmacy. The pharmacy is using the Tax Identification Number to uniquely identify the vendor, the product's National Drug Code (NDC) to cross-reference with the vendor's product item number, and the UPC Consumer Code to uniquely identify a medical supply. Data Element values in quotes (i.e., "PO

NUM") are symbolic in nature and are not intended as the literal representation of valid data as in Example 1. Example 2 is a sample of what actual data might look like.

Example 1: Template of a Transaction Set

ISA^00^ ^00^ ^ZZ^"DUNN & BRADSTREET#"^ZZ^588 ^950214^

1005^U^00200^”INTERCHANGE CONTROL #”^0^P^>~

GS^IN^"DUNN & BRADSTREET#"^588^950214^1005^”GROUP CONTROL #”^X^003020~

ST^810^"TRANACTION SET CONTROL #"~

BIG^950214^"INVOICE#"^950214^"PURCHASE ORDER#"~

REF^CR^"CONSUMER REFERENCE #"~

REF^TJ^"VENDOR'S FEDERAL TAX ID#"~

N1^BY^"BUYING PARTY NAME"^21^"HEALTH INDUSTRY ID#"~

N2^"BUYING PARTY NAME CONT."^"BUYING PARTY NAME CONT."~

N3^"ADDRESS INFO"^"ADDRESS INFO"~

N4^"CITY NAME"^"STATE CODE"^"ZIP CODE"~

N1^DS^"DISTRIBUTOR NAME"^21^"HEALTH INDUSTRY ID#"~

N2^"DISTRIBUTOR NAME CONT."^"DISTRIBUTOR NAME CONT."~

N3^"ADDRESS INFO"^"ADDRESS INFO"~

N4^"CITY NAME"^"STATE CODE"^"ZIP CODE"~

N1^ST^"SHIP TO NAME"^21^"HEALTH INDUSTRY ID#"~

N2^"SHIP TO NAME CONT."^"SHIP TO NAME CONT."~

N3^"ADDRESS INFO"^"ADDRESS INFO"~

N4^"CITY NAME"^"STATE CODE"^"ZIP CODE"~

ITD^14^^^"PAYMENT DATE"^15^"PAYMENT DUE DATE"^16^"TOTAL AMT"~

DTM^002^"DELIVERY REQUESTED DATE"~

DTM^035^"DELIVERY DATE"~

IT1^1^12^CC^9.32^DS^ND^"NDC#"^VN^VENDOR ITEM #^UP^

"UPC CONSUMER CODE"~

IT1^2^10^CA^21.50^DS^ND^"NDC#"^VN^VENDOR ITEM #^UP^

"UPC CONSUMER CODE"~

PID^F^^^^PV-DRUG DESCRIPTION~

P04^^PACKAGE SIZE^ZZ^^^^INNER PACK^PH~

CTT^2^^^^^^CLOSED~

SE^23^"TRANSACTION SET CONTROL#"~

GE^1^"GROUP CONTROL #"~

IEA^1^"INTERCHANGE CONTROL #"~

Example 2: Mock Transaction Set

ISA^00^

^00^

^ZZ^999999

^ZZ^588

950214^1005^U^00200^900456789^0^P^>~

GS^IN^999999^588^950214^1005^012345678^X^003020~

ST^810^000000022~

BIG^950214^201^950214^P2O01~

REF^CR^23201~

REF^TJ^102030~

N1^BY^VA MEDICIAL CENTER^21^RA1000C00~

N2^DEPARTMENT OF VETERANS AFFAIRS~

N3^123 VETERANS BLVD.~

N4^LOUISVILLE^KY^40202~

N1^DS^DRUGS DISTRIBUTOR INC.^21^KA1000R00~

N3^456 DRUG LANE~

N4^LEXINGTON^KY^40601~

N1^ST^VA MEDICAL CENTER^21^JR1000P00~

N2^DEPARTMENT OF VETERANS AFFAIRS^~

N3^123 VETERANS BLVD.^RECEIVING DEPT.~

N4^LOUISVILLE^KY^40202~

ITD^14^^^950301^15^950302^16^34.67~

DTM^002^950210~

DTM^035^950212~

IT1^1^12^CC^9.32^DS^ND^00032227780^VN^46789~

IT1^2^10^CA^21.50^DS^ND^00181053725^VN^878212~

PID^F^^^^VASOPRESS MDV 20U 1ML A/R 25~

P04^^25^ZZ^^^^100^PH~

CTT^2^^^^^^CLOSED~

SE^23^000000022~

GE^1^012345678~

IEA^1^900456789~

May 1995

Draft Specifications May 1995

Draft Specifications