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Please Select Field Name Group(s) Please Select Field Name Group(s) HEADER FIELDS: AccountNumber • CustomerAddressL1 • CustomerAddressL2 • CustomerName • CustomerPONumber • DueDate • EndDate • FOB • InvoiceDate • InvoiceNumber • OrderDate • OrderNumber • PaymentRecieved • PaymentTerms • PreviousBalance • SalesTax • ShippingAddressL1 • ShippingAddressL2 • ShippingMethod • StartDate • TotalAmountDue • VendorName • VendorNameL1 • VendorNameL2 • VendorNumber • VendorPhone LINE-ITEM DETAIL: Code • Description • Quantity • Units • Price Per Unit • Tax Rate Per Unit • Charge

Please Select Field Name Group Please Select Field Name Group W-2 FIELDS: a_EmployeeSSN • b_EmployerEIN • c_EmployerAddressL1 • c_EmployerAddressL2 • c_EmployerName • d_ControlNumber • e_EmployeeFirstName • e_EmployeeLastName • f_EmployeeAddressL1 • f_EmployeeAddressL2 • 1_WagesTipsOther •

Please Select Field Name Group(s) Please Select Field Name Group(s) HEADER FIELDS: EmployerName • EmployerAddressL1 • EmployerAddressL2 • EmployeeName • EmployeeAddressL1 • EmployeeAddressL2 • EmployeeSSN • PayPeriodStart • PayPeriodEnd • MaritalStatus • StateExemptions • LocalExemptions • AdditionalTax EARNINGS FIELDS: RegularRate RegularHours • RegularPayThisPeriod • RegularPayYTD • OvertimeRate • OvertimeHours • OvertimeThisPeriod • OvertimeYTD • HolidayRate • HolidayHours • HolidayPayThisPeriod • HolidayPayYTD • TuitionRate • TuitionHours • TuitionPayThisPeriod • TuitionPayYTD • GrossPayThisPeriod • GrossPayYTD • NetPayThisPeriod • NetPayYTD DEDUCTION FIELDS: DeductionDesc • DeductionAmtThisPeriod • DeductionAmtYTD

Please Select Field Name Group(s) Please Select Field Name Group(s) HEADER FIELDS: AccountNumber • Carrier • CustomerAddressL1 • CustomerAddressL2 • CustomerName • CustomerPONumber • ContactPhone • DueDate • EndDate • FOB • InvoiceDate • InvoiceNumber • OrderDate • OrderNumber • PaymentRecieved • PaymentTerms • PreviousBalance • SalesTax • ShippingAddressL1 • ShippingAddressL2 • ShippingMethod • StartDate • TotalAmountDue • TotalPackages • VendorName • VendorNameL1 • VendorNameL2 • VendorNumber • VendorPhone CURRENT CHARGE DETAILS: Desc Quantity • UOM • Currency • UnitPrice • ROE • Charge SHIPPING DETAILS: ContainerNumber • Desc • Service • PCD PACKING LIST DETAILS: Code • Desc • Quantity • UOM • NetWeight • NetWeightUOM • GrossWeight • GrossWeightUOM • Volume • UOM

Please Select Field Name Group(s) Please Select Field Name Group(s) HEADER FIELDS: VendorName • CustomerName • AccountNumber • ServiceAddress1 • ServiceAddress2 • Tariff • StatementNumber • StatementDate • CurrentCharges • TotalAmountDue • SupplierName • SupplierAccountNumber • Tariff • PreviousBalance • PaymentRecieved1 • PaymentRecieved2 • PaymentDate • StartDate • EndDate • NumberDays • DueDate • BudgetBilling • AutoPay USAGE FIELDS: MeterNumber • StartDate • EndDate • Desc • CurrentRead • CurrentReadType • PreviousRead • PreviousReadType • Difference • MeterMultiplier • Usage • UsageUnits • RateType • DemandUsage • DemandUnits • DemandReadType • Provider CHARGE FIELDS: Desc • Usage • UsageUnits • Rate Charge

Additional Options (Applies only when vendor provides data) Additional Options (Applies only when vendor provides data) Separate Supply and Delivery Charges Capture multiple meters, same commodity (up to 4) Capture additional service addresses on same bill (up to 2) Electricity Natural Gas Water Waste Sewer Rooftop Solar Community Solar EV Charging

Please Select Field Name Group(s) Please Select Field Name Group(s) HEADER FIELDS: VendorName • CustomerName • AccountNumber • ServiceAddress1 • ServiceAddress2 • Tariff • StatementNumber • StatementDate • CurrentCharges • TotalAmountDue • SupplierName • SupplierAccountNumber • Tariff • PreviousBalance • PaymentRecieved1 • PaymentRecieved2 • PaymentDate • StartDate • EndDate • NumberDays • DueDate • BudgetBilling • AutoPay USAGE FIELDS: MeterNumber • StartDate • EndDate • Desc • CurrentRead • CurrentReadType • PreviousRead • PreviousReadType • Difference • MeterMultiplier • Usage • UsageUnits • RateType • DemandAmt • DemandUnits • DemandReadType • Provider CHARGE FIELDS: Desc • Usage • UsageUnits • Rate • Charge

Additional Options (Applies only when vendor provides data) Additional Options (Applies only when vendor provides data) Separate Supply and Delivery Charges Multiple meters, same commodity (up to 4) Water Waste Sewer Steam Propane Cable Phone Internet

Do you need help with Summary Bills (10s - 1000s of bills in same pdf) Do you need help with Summary Bills (10s - 1000s of bills in same pdf) Yes

Please Select Field Name Group Please Select Field Name Group HEADER FIELDS: MemberFirstName • MemberLastName • MemberID • GroupNumber • PlanNumber • PlanID • GroupNumber • EffectiveDate • CoverageDescL1 • CoverageDescL2 • CoverageDescL3 • CoverageDescL4 • CoverageDescL5 • InsuranceProviderL1 • InsuranceProviderL2 • InsuranceProviderL3 • InsuranceProviderL4

Please Select Field Name Group Please Select Field Name Group HEADER FIELDS: AccountNumber • AccountPhoneNumber • CellsAnalyzed • CellsCounted • ClientReference • DateCollected • TimeCollected • DateRecieved • DateReported • DOB • Gender • IndicationsDesc • InterpetationDescL1 • InterpetationDescL2 • InterpetationDescL3 • LabNumber • LabName • OrderingPhysician • PatientFirstName • PatientLastName • PatientIDNumber • ReferenceInterval • SpecifimenType • SpecifmenNumber • TestName • TestDescL1 • TestDescL2 • TestDescL3 • TestResultsL1 • TestResultsL2 • TestAdditionalInfo

Please Select Field Name Group(s) Please Select Field Name Group(s) HEADER FIELDS: MemberFirstName • MemberLastName • MemberAddressL1 • MemberAddressL2 • MemberNumber • GroupNumber • PatientFirstName • PatientLastName • PatientDOB • PatientIDNumber • PatientAccountNumber • Patient • Gender • Date PRESCRIPTION FIELDS: PrescriptionsforName • PrescrptionFillDate • PharmacyRXNumber • Physician ADMISSIONS FIELDS: AdmittingPhysician • AuthorizationNumber • AdmissionDate • DaysAuthorized • LevelofCare • NextClinicalReviewDate • LevelofCare • AuthorizedFacility TEST ORDER FIELDS: OrderDate • TestDesc • PhysicansOffice • Reason • OrderingPhysician • CaseManagerName • CaseManagerPhone • CaseManagerFax I WILL NEED ADDITIONAL FIELDS

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