EDI 142 Product Service Claim

EDI 142 Format



ISA*01*0000000000*01*0000000000*ZZ*ABCDEFGHIJKLMNO*ZZ*123456789012345*101127*1719*U*00400*000003438*0*P*>

GS*WA*1234567890 *999999999 *20120126*1211*1*T*004010

ST*142*0001

BGN*00*Reference Identification*20120227*1251*01*Reference Identification*01*1*00

N9*01*Reference Identification*Free-form Description*20120227*1251*01*01Reference Identification1Reference Identification1Reference Identification

N1*01*Name*1*Identification Code*01*01

N2*Name*Name

N3*Address Information*Address Information

N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier

REF*01*Reference Identification*Description*01Reference Identification1Reference Identification1Reference Identification

PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe

LX*27

N9*01*Reference Identification*Free-form Description*20120227*125111*01*01Reference Identification1Reference Identification1Reference Identification

MSG*Free-Form Message Text*AA*2

LIN*Assigned Identificat*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID

PID*F*01*10*Product Desc*Description*1S*Source Subquali*N*LAN

LOC*01*Reference Identification*Description*Reference Identification*Catego*01*Reference Identification*Description*Reference Identification*1835216312231861206*011133514194673011262208711139221075230123155047126564315686284971878621289195991964812823925483258661*3989143*01418020489859945619117332292230813003931636724111104354312518221104203072831291*3*0180422409615523761191506739354144259125674510711292660373311544253215832073061*128193037529189226*012265516722321130971416041281129739188123659631812939124907272844*8540320215199*01490855153760222117837888321559580724714220511406329172252131800723711262271813189652*87551*01226901891079629319954107532516167112350127652791842212483129380870858318552967517543025353*01*Reference Identification*Description

QTY*01*179038665*011288412981183884112392212125481117592963531342445

DTM*001*20120227*12511100*01*CC*Date Time Period

REF*01*Reference Identification*Description*01Reference Identification1Reference Identification1Reference Identification

PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe

PSC*AC*AF*AF*Reference Identification*01*Contract Number*0119301324901713669188313527416389110515409111759949412112141430632*5*001*20120227*20120227*01128452555371413991852856524441112225117222761112411198136491110872*2387272727521172*111*6954129601857794612*1*239*10*Source Subquali*01*AC*Description*1646291*N*E

SSS*A*10*AC*Service Marks and Numbers*713229905*5942237*Description*26*Source Subquali

LM*10*Source Subquali

LQ*0*Industry Code

N1*01*Name*1*Identification Code*01*01

N2*Name*Name

N3*Address Information*Address Information

N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier

N9*01*Reference Identification*Free-form Description*20120227*12511100*01*01Reference Identification1Reference Identification1Reference Identification

PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe

PRR*Assigned Identificat*10*Source Subquali*BRK*Description*10*Source Subquali*A*10*Source Subquali*1

LIN*Assigned Identificat*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID

LOC*01*Reference Identification*Description*Reference Identification*Catego*01*Reference Identification*Description*Reference Identification*192662773610362237*014680108891400219618260512511146399841203343082489307511291399659611479303606*41778137276851797011*0117926644224301311530603266311024323291774819740104162186103868117926*421913348326552804*011581073493128096185263096726531402415187182178314912844111000171943719404112140281551852174011*25203121*01314396274131302343132381162411541421943281246531172752401171072222*1*0116690139325451082265812761621295638654282711942418912415719117691472356115317*1247219396228768465*0110228883258114313035616625743417357202151955413091166071913130611760930805171416546472*01*Reference Identification*Description

QTY*01*13312645516*01434331241212175956811631154110812088120198412628225763193

DTM*001*20120227*125111*01*CC*Date Time Period

MSG*Free-Form Message Text*AA*222

RC*A1*Product/Service ID*Name*10*Source Subquali*Cas*Description*Free-Form Message Text*N

PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe

PSC*AC*AF*AF*Reference Identification*01*Contract Number*0114761264182675312509124119636985222160412282925444111135771*64*001*20120227*20120227*012297891051286332191138762707112345534248222361541425218188*153551*163411021696248965*15*1*32128234*10*Source Subquali*01*AC*Description*1313428453*N*E

SSS*A*10*AC*Service Marks and Numbers*46786794258777*3221*Description*91792339722067*Source Subquali

CID*1*01*10*Product Desc*Description*Source Subquali*N

TMD*01*10*Product Desc*01*01*Description*20120227*Reference Identification*Source Subquali

MEA*9L*1*2601139731*013084223744187522107457112473111893074221541111153900191121833299282728451279113*5738321*25152859*01**1S*BM

DTM*001*20120227*12511100*01*CC*Date Time Period

LIN*Assigned Identificat*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID

REP*Assigned Identificat*A1*Product/Service ID*A1*Product/Service ID*10*Source Subquali*AL*Description*10*Source Subquali*DAP*A1*Product/Service ID*AL*Description*10*Source Subquali*Reference Identification*Auth

REF*01*Reference Identification*Description*01Reference Identification1Reference Identification1Reference Identification

N1*01*Name*1*Identification Code*01*01

PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe

RC*A1*Product/Service ID*Name*10*Source Subquali*Cas*Description*Free-Form Message Text*N

DTM*001*20120227*1251110*01*CC*Date Time Period

LIN*Assigned Identificat*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID

ITA*A*10*AC*01*Allowance or Cha*189*843328*1*1*14050337031368*01*22451*Description*002*Source Subquali*A*01

MSG*Free-Form Message Text*AA*212023699

PRT*EXC*10*Source Subquali*N

LM*10*Source Subquali

LQ*0*Industry Code

MEA*9L*1*17560174*01239922802235412185801213193128148704631186722197172178328852*24*26456*01**1S*BM

DTM*001*20120227*125112*01*CC*Date Time Period

LIN*Assigned Identificat*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID

IT1*Assigned Identificat*17*01*15330229*AA*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID

LIN*Assigned Identificat*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID

N1*01*Name*1*Identification Code*01*01

N9*01*Reference Identification*Free-form Description*20120227*1251*01*01Reference Identification1Reference Identification1Reference Identification

PRT*EXC*10*Source Subquali*N

DTM*001*20120227*12511200*01*CC*Date Time Period

ITA*A*10*AC*01*Allowance or Cha*177793*159294425*1*35*306842*01*2056626*Description*002*Source Subquali*A*01

CUR*01*CUR*295729412*01*CUR*IMF*001*20120227*1251120*001*20120227*125112*001*20120227*12511200*001*20120227*12511200*001*20120227*125112

AMT*1*2539*C

TXI*AA*3223*3133314*CD*Tax Jurisd*0*A*370719*Tax Identification N*Assigned Identificat

CUR*01*CUR*15605*01*CUR*IMF*001*20120227*1251120*001*20120227*1251120*001*20120227*125112*001*20120227*1251120*001*20120227*12511200

TDS*103*1050562*430652*2012678

TXI*AA*5766104*1015*CD*Tax Jurisd*0*A*108*Tax Identification N*Assigned Identificat

CUR*01*CUR*2794*01*CUR*IMF*001*20120227*1251*001*20120227*125112*001*20120227*1251*001*20120227*1251*001*20120227*1251

SE*74*0001

GE*1*1

IEA*1*000000475

EDI 142 Specification

This X12 Transaction Set contains the format and establishes the data contents of the Product Service Claim Transaction Set (142) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set can be used to transmit the servicing organization, claimant, manufacturer, seller, and purchaser of the product. It can specify the product's current usage, date the product was sold, delivered, and placed in service as well as identify product model and serial numbers and serial numbers of any subassemblies. It can specify a malfunction or recall condition, service performed, labor, parts, and any other associated costs. It can show the costs of the repair and the date service was requested and when it was available to be placed back in service.

Sources

Accredited Standards Committee X12. ASC X12 Standard [Table Data]. Data Interchange Standards Association, Inc., Falls Church, VA. http://www.x12.org

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