Segment Modifiers:
X - Distinguishing Identifier Suffix
nn - Segment Iteration (only after first iterartion)
nn - Element Repeat Iteration (only after first iterartion)

GSHDR - GROUP HEADER

GSHDR	GS	Functional Group Header
02		GSHDR_GS02_APP_SNDR_CD	String	Application Senders Code
03		GSHDR_GS03_APP_RCV_CD	String	Application Receivers Code
04		GSHDR_GS04_D8	Date/Time	Date
05		GSHDR_GS05_TM	Time	Time
06		GSHDR_GS06_GCN	Integer	Group Control Number

STHDR - TRANSACTION SET HEADER

STHDR	ST	820 Header
02		STHDR_ST02_TCN	String	Transaction Set Control Number
03		STHDR_ST03_IMP_CONV_REF	String	Implementation Convention Reference

STHDR	BPR	Financial Information
01		STHDR_BPR01_TRANS_HANDL_CD	String	Transaction Handling Code
02		STHDR_BPR02_TOT_PRM_PMT_AMT	Decimal	Total Premium Payment Amount
04		STHDR_BPR04_PMT_METHD_CD	String	Payment Method Code
05		STHDR_BPR05_PMT_FMT_CD	String	Payment Format Code
06		STHDR_BPR06_DFI_NR	String	Depository Financial Institution (DFI) network. If not required by this implementation guide do not
07		STHDR_BPR07_ORIG_DFI	String	Originating Depository Financial Institution (DFI)
09		STHDR_BPR09_ALC	String	Agency Location Code (ALC)
09		STHDR_BPR09_DEMND_DEPST	String	Demand Deposit
10		STHDR_BPR10_PYR_ID	String	Payer Identifier
11		STHDR_BPR11_ORG_CO_SUPP_CD	String	Originating Company Supplemental Code
12		STHDR_BPR12_DFI_NR	String	Depository Financial Institution (DFI) not required by this implementation guide, do not send.
13		STHDR_BPR13_RCV_DFI	String	Receiving Depository Financial Institution (DFI)
15		STHDR_BPR15_DEMND_DEPST	String	Demand Deposit
15		STHDR_BPR15_SAVNGS	String	Savings
16		STHDR_BPR16_CHK_EFT_EFDT_D8	Date/Time	Check Issue or EFT Effective Date

STHDR	TRN	Reassociation Trace Number
01		STHDR_TRN01_TRAC_TYP_CD	String	Trace Type Code
02		STHDR_TRN02_CHK_EFT_TRC_NR	String	Check or EFT Trace Number
03		STHDR_TRN03_ORG_CO_ID	String	Originating Company Identifier
04		STHDR_TRN04_ORG_CO_SUPP_CD	String	Originating Company Supplemental Code

STHDR	CUR	Foreign Currency Information
01		STHDR_CUR01_ENTY_ID_CD	String	Entity Identifier Code
02		STHDR_CUR02_CURRNCY_CD	String	Currency Code

STHDR	REF	Premium Receivers Identification Key	Iterated: [01-99]
02		STHDR_nnREF_MSTR_ACCT_NR	String	Master Account Number
02		STHDR_nnREF_CLT_RPT_CAT	String	Client Reporting Category
02		STHDR_nnREF_PLAN_NR	String	Plan Number
02		STHDR_nnREF_INVC_NR	String	Consolidated Invoice Number
02		STHDR_nnREF_MSTR_PLCY_NR	String	Master Policy Number
02		STHDR_nnREF_SCH_REF_NR	String	Schedule Reference Number
02		STHDR_nnREF_LCKBX	String	Lockbox

STHDR	DTM	Process Date
02		STHDR_DTM02_PRCS_D8	Date Timestamp	Process

STHDR	DTM	Delivery Date
02		STHDR_DTM02_DELVD_D8	Date Timestamp	Delivered

STHDR	DTM	Coverage Period
02		STHDR_DTM02_REPT_PERD_D8	Date Timestamp	Report Period

STHDR	DTM	Creation Date
02		STHDR_DTM02_TS_CREATN_D8	Date Timestamp	Transaction Creation

L1000A - PREMIUM RECEIVERS NAME

L1000A	N1	Premium Receiver?s Name
02		L1000A_N102_PREM_RCV_LNM	String	Premium Receiver?s Last or Organization Name
04		L1000A_N104_DUNS_NR	String	D-U-N-S Number, Dun and Bradstreet
04		L1000A_N104_DUNS4_NR	String	D-U-N-S+4, D-U-N-S Number with Four Character Suffix
04		L1000A_N104_INS_ASGND_ID	String	Insurance Company Assigned Identification Number
04		L1000A_N104_TAX_ID	String	Federal Taxpayer?s Identification Number
04		L1000A_N104_CMS_PLANID	String	Centers for Medicare and Medicaid Services PlanID

L1000A	N2	Premium Receiver Additional Name
01		L1000A_N201_PRM_RCV_ADDL_NM	String	Premium Receiver?s Additional Name

L1000A	N3	Premium Receiver?s Address
01		L1000A_N301_PREM_RCV_ADDR	String	Premium Receiver?s Address Line
02		L1000A_N302_PREM_RCV_ADDR	String	Premium Receiver?s Address Line

L1000A	N4	Premium Receiver?s City, State, and ZIP Code
01		L1000A_N401_PREM_RCV_CITY_NM	String	Premium Receiver?s City Name
02		L1000A_N402_PRM_RCV_STAT	String	Premium Receiver?s State Code
03		L1000A_N403_PRM_RCV_ZIP	String	Premium Receiver?s Postal Zone or Zip Code
04		L1000A_N404_CNTRY_CD	String	Country Code
07		L1000A_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L1000A	RDM	Premium Receiver?s Remittance Delivery Method
01		L1000A_RDM01_REMIT_DEL_MTH_CD	String	Remittance Delivery Method Code
02		L1000A_RDM02_PREM_RCV_LNM	String	Premium Receiver?s Last or Organization Name
03		L1000A_RDM03_PREM_RCV_COMM_NR	String	Premium Receiver?s Communication Number

L1000B - PREMIUM PAYERS NAME

L1000B	N1	Premium Payer?s Name
02		L1000B_N102_PREM_PYR_NM	String	Premium Payer Name
04		L1000B_N104_DUNS_NR	String	D-U-N-S Number, Dun and Bradstreet
04		L1000B_N104_DUNS4_NR	String	D-U-N-S+4, D-U-N-S Number with Four Character Suffix
04		L1000B_N104_EMP_ID_NR	String	Employer?s Identification Number
04		L1000B_N104_STAT_ASGND_NR	String	State or Province Assigned Number
04		L1000B_N104_INS_ASGND_ID	String	Insurance Company Assigned Identification Number
04		L1000B_N104_TAX_ID	String	Federal Taxpayer?s Identification Number
04		L1000B_N104_PAYR_ID	String	Payor Identification

L1000B	N2	Premium Payer Additional Name
01		L1000B_N201_PREM_PYR_ADDL_NM	String	Premium Payer Additional Name

L1000B	N3	Premium Payer?s Address
01		L1000B_N301_PREM_PYR_ADDR	String	Premium Payer Address Line
02		L1000B_N302_PREM_PYR_ADDR	String	Premium Payer Address Line

L1000B	N4	Premium Payer?s City, State, ZIP Code
01		L1000B_N401_PREM_PYR_CITY	String	Premium Payer City Name
02		L1000B_N402_PREM_PYR_STAT	String	Premium Payer State Code
03		L1000B_N403_PREM_PYR_ZIP	String	Premium Payer Postal Zone or ZIP Code
04		L1000B_N404_CNTRY_CD	String	Country Code
07		L1000B_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L1000B	PER	Premium Payer?s Administrative Contact	Iterated: [01-99]
02		L1000B_nnPER02_PREM_PYR_CON_NM	String	Premium Payer Contact Name
04		L1000B_nnPER04_EMAIL	String	Electronic Mail
04		L1000B_nnPER04_FAX	String	Facsimile
04		L1000B_nnPER04_PHN_NR	String	Telephone
06		L1000B_nnPER06_EMAIL	String	Electronic Mail
06		L1000B_nnPER06_PHN_EXT	String	Telephone Extension
06		L1000B_nnPER06_FAX	String	Facsimile
06		L1000B_nnPER06_PHN_NR	String	Telephone
08		L1000B_nnPER08_EMAIL	String	Electronic Mail
08		L1000B_nnPER08_PHN_EXT	String	Telephone Extension
08		L1000B_nnPER08_FAX	String	Facsimile
08		L1000B_nnPER08_PHN_NR	String	Telephone

L1000C - INTERMEDIARY BANK INFORMATION (Value Qualified)

Mapping Prefix: L1000C_04 - Asset Account Holder

Mapping Prefix: L1000C_0B - Interim Funding Organization

Mapping Prefix: L1000C_8W - Payment Address

Mapping Prefix: L1000C_AK - Party to Whom Acknowledgment Should Be Sent

Mapping Prefix: L1000C_BE - Beneficiary

Mapping Prefix: L1000C_BK - Bank

Mapping Prefix: L1000C_C1 - In Care Of Party no. 1

Mapping Prefix: L1000C_C2 - In Care Of Party no. 2

Mapping Prefix: L1000C_IAT - Party Executing and Verifying

Mapping Prefix: L1000C_MJ - Financial Institution

Mapping Prefix: L1000C_RB - Receiving Bank

Mapping Prefix: L1000C_Z6 - Transferring Party

Mapping Prefix: L1000C_ZB - Party to Receive Credit

Mapping Prefix: L1000C_ZL - Federal Medicare or Medicaid Payment Mandate - Category 2

L1000C	N1	Intermediary Bank Information
02		L1000C_yy_N102_INTER_BANK_NM	String	Intermediary Bank Name
04		L1000C_yy_N104_BANK_ID_CD	String	Bank Identification Code
04		L1000C_yy_N104_DEPT	String	Department
04		L1000C_yy_N104_ORG_CD_DEST_TS	String	Code assigned by the organization that is the ultimate destination of the transaction set
04		L1000C_yy_N104_ASGD_3RD_PTY	String	Assigned by Third Party
04		L1000C_yy_N104_ASGD_CLGHS	String	Assigned by Clearinghouse
04		L1000C_yy_N104_FINS	String	Financial Identification Numbering System (FINS)
04		L1000C_yy_N104_CAN_INST_RT_NR	String	Canadian Financial Institution Routing Number
04		L1000C_yy_N104_PAYEE_ID_NR	String	Payee Identification Number
04		L1000C_yy_N104_2ND_AGNT_ID	String	Secondary Agent Identification

L1000C	N2	Intermediary Bank Additional Name
01		L1000C_yy_N201_INTR_BNK_ADL_NM	String	Intermediary Bank Additional Name

L1000C	N3	Intermediary Bank?s Address
01		L1000C_yy_N301_INTER_BNK_ADDR	String	Intermediary Bank Address Line
02		L1000C_yy_N302_INTER_BNK_ADDR	String	Intermediary Bank Address Line

L1000C	N4	Intermediary Bank?s City, State, ZIP Code
01		L1000C_yy_N401_INTER_BANK_CITY	String	Intermediary Bank City Name
02		L1000C_yy_N402_INTER_BANK_STAT	String	Intermediary Bank State Code
03		L1000C_yy_N403_INTER_BANK_ZIP	String	Intermediary Bank Postal Zone or ZIP Code
04		L1000C_yy_N404_CNTRY_CD	String	Country Code
07		L1000C_yy_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L1000C	PER	Intermediary Bank?s Administrative Contact	Iterated: [01-99]
02		L1000C_yy_nnPER02_INTR_BNK_CON	String	Intermediary Bank Contact Name
04		L1000C_yy_nnPER04_EMAIL	String	Electronic Mail
04		L1000C_yy_nnPER04_FAX	String	Facsimile
04		L1000C_yy_nnPER04_PHN_NR	String	Telephone
06		L1000C_yy_nnPER06_EMAIL	String	Electronic Mail
06		L1000C_yy_nnPER06_PHN_EXT	String	Telephone Extension
06		L1000C_yy_nnPER06_FAX	String	Facsimile
06		L1000C_yy_nnPER06_PHN_NR	String	Telephone
08		L1000C_yy_nnPER08_EMAIL	String	Electronic Mail
08		L1000C_yy_nnPER08_PHN_EXT	String	Telephone Extension
08		L1000C_yy_nnPER08_FAX	String	Facsimile
08		L1000C_yy_nnPER08_PHN_NR	String	Telephone

L2000A - ORGANIZATION SUMMARY REMITTANCE (Value Qualified)

Mapping Prefix: L2000A_2L - Corporation

Mapping Prefix: L2000A_AG - Agent/Agency

Mapping Prefix: L2000A_NH - Association

Mapping Prefix: L2000A_RGA - Responsible Government Agency

Mapping Prefix: L2000A_UN - Union

L2000A	ENT	Organization Summary Remittance
01		L2000A_yy_ENT01_ASSGD_NR	Integer	Assigned Number
04		L2000A_yy_ENT04_DUNS_NR	String	D-U-N-S Number, Dun and Bradstreet
04		L2000A_yy_ENT04_DUNS4_NR	String	D-U-N-S+4, D-U-N-S Number with Four Character
04		L2000A_yy_ENT04_EMP_ID_NR	String	Employer?s Identification Number
04		L2000A_yy_ENT04_TAX_ID	String	Federal Taxpayer?s Identification Number

L2200A - ORGANIZATION SUMMARY REMITTANCE LEVEL ADJUSTMENT FOR PREVIOUS PAYMENT

L2200A	ADX	Organization Summary Remittance Level Adjustment for Previous Payment
01		L2200A_ADX01_PREM_PMT_ADJ_AMT	Decimal	Premium Payment Adjustment Amount
02		L2200A_ADX02_PREM_PMT_ADJ_RSN	String	Premium Payment Adjustment Reason

L2300A - ORGANIZATION SUMMARY REMITTANCE DETAIL

L2300A	RMR	Organization Summary Remittance Detail
02		L2300A_RMR02_ACCT_NR	String	Account Number
02		L2300A_RMR02_GRP_POLCY_NR	String	Group or Policy Number
02		L2300A_RMR02_CNTRCT_NR	String	Contract Number
02		L2300A_RMR02_INVC_NR	String	Invoice Number
03		L2300A_RMR03	String	Payment Action Code
04		L2300A_RMR04_DTL_PRM_PMT_AMT	Decimal	Detail Premium Payment Amount
05		L2300A_RMR05_BILL_PREM_AMT	Decimal	Billed Premium Amount

L2300A	REF	Reference Information	Iterated: [01-99]
02		L2300A_nnREF_MSTR_ACCT_NR	String	Master Account Number
02		L2300A_nnREF_CLT_RPT_CAT	String	Client Reporting Category
02		L2300A_nnREF_PLAN_NR	String	Plan Number
02		L2300A_nnREF_INVC_NR	String	Consolidated Invoice Number
02		L2300A_nnREF_MSTR_PLCY_NR	String	Master Policy Number
02		L2300A_nnREF_ATTCH_CD	String	Attachment Code
02		L2300A_nnREF_LCKBX	String	Lockbox
02		L2300A_nnREF_LOC_NR	String	Location Number
02		L2300A_nnREF_MUTLY_DEF	String	Mutually Defined

L2300A	DTM	Organizational Coverage Period
02		L2300A_DTM02_REPT_PERD_D8	Date Timestamp	Report Period
02		L2300A_DTM02_D8	Date Timestamp	Due Date

L2310A - SUMMARY LINE ITEM

L2310A	IT1	Summary Line Item
01		L2310A_IT101_LIN_ITM_CTL_NR	String	Line Item Control Number

L2312A - SERVICE, PROMOTION, ALLOWANCE, OR CHARGE INFORMATION (Single Iteration)

L2312A	SAC	Service, Promotion, Allowance, or Charge Information
02		L2312A_xx_SAC02_SVC_PRM_CHG_CD	String	Service, Promotion, Allowance, or Charge Code
05		L2312A_xx_SAC05_AMT	String	Amount

L2315A - MEMBER COUNT (Single Iteration)

L2315A	SLN	Member Count
01		L2315A_xx_SLN01_LIN_ITM_CTL_NR	String	Line Item Control Number
04		L2315A_xx_SLN04_HEAD_CT	Decimal	Head Count
05	01	L2315A_xx_SLN0501_UNIT_MSMT_CD	String	Unit or Basis for Measurement Code

L2320A - ORGANIZATION SUMMARY REMITTANCE LEVEL ADJUSTMENT FOR CURRENT PAYMENT

L2320A	ADX	Organization Summary Remittance Level Adjustment for Current Payment
01		L2320A_ADX01_ADJ_AMT	Decimal	Adjustment Amount
02		L2320A_ADX02_ADJ_RSN_CD	String	Adjustment Reason Code

L2000B - INDIVIDUAL REMITTANCE

L2000B	ENT	Individual Remittance
01		L2000B_ENT01_ASSGD_NR	Integer	Assigned Number
04		L2000B_ENT04_SSN	String	Social Security Number
04		L2000B_ENT04_EMP_ID	String	Employee Identification Number
04		L2000B_ENT04_UNQ_IND_ID	String	Standard Unique Health Identifier for each Individual in the United States

L2100BX - INDIVIDUAL NAME

L2100BX	NM1	Individual Name
03		L2100BX_NM103_IND_LNM	String	Individual Last Name
04		L2100BX_NM104_IND_FNM	String	Individual First Name
05		L2100BX_NM105_IND_MNM	String	Individual Middle Name
06		L2100BX_NM106_IND_PFX	String	Individual Name Prefix
07		L2100BX_NM107_IND_SFX	String	Individual Name Suffix
09		L2100BX_NM109_SSN	String	Social Security Number
09		L2100BX_NM109_EMPLY_ID_NR	String	Employee Identification Number
09		L2100BX_NM109_INSRD_UNQ_ID	String	Insured?s Unique Identification Number

L2200BX - INDIVIDUAL PREMIUM ADJUSTMENT FOR PREVIOUS PAYMENT

L2200BX	ADX	Individual Premium Adjustment for Previous Payment
01		L2200BX_ADX01_PREM_PMT_ADJ_AMT	Decimal	Premium Payment Adjustment Amount
02		L2200BX_ADX02_PREM_PMT_ADJ_RSN	String	Premium Payment Adjustment Reason

L2300B - INDIVIDUAL PREMIUM REMITTANCE DETAIL

L2300B	RMR	Individual Premium Remittance Detail
02		L2300B_RMR02_ACCT_NR	String	Account Number
02		L2300B_RMR02_PENSN_CNTCT	String	Pension Contract
02		L2300B_RMR02_HLTH_INS_PLCY	String	Health Insurance Policy Number
02		L2300B_RMR02_LIF_INS_PLCY	String	Life Insurance Policy Number
02		L2300B_RMR02_CNTRCT_NR	String	Contract Number
02		L2300B_RMR02_INS_CERT_NR	String	Insurance Certificate Number
02		L2300B_RMR02_INS_PLCY_NR	String	Insurance Policy Number
02		L2300B_RMR02_INVC_NR	String	Invoice Number
02		L2300B_RMR02_CERTFCTN	String	Certification
04		L2300B_RMR04_DTL_PRM_PMT_AMT	Decimal	Detail Premium Payment Amount
05		L2300B_RMR05_BILL_PREM_AMT	Decimal	Billed Premium Amount

L2300B	REF	Reference Information	Iterated: [01-99]
02		L2300B_nnREF_MSTR_ACCT_NR	String	Master Account Number
02		L2300B_nnREF_PLAN_NR	String	Plan Number
02		L2300B_nnREF_INVC_NR	String	Consolidated Invoice Number
02		L2300B_nnREF_MSTR_PLCY_NR	String	Master Policy Number
02		L2300B_nnREF_ATTCH_CD	String	Attachment Code
02		L2300B_nnREF_LOC_NR	String	Location Number
02		L2300B_nnREF_MUTLY_DEF	String	Mutually Defined

L2300B	DTM	Individual Coverage Period
02		L2300B_DTM02_REPT_PERD_D8	Date Timestamp	Report Period
02		L2300B_DTM02_D8	Date Timestamp	Due Date

L2320B - INDIVIDUAL PREMIUM ADJUSTMENT FOR CURRENT PAYMENT

L2320B	ADX	Individual Premium Adjustment for Current Payment
01		L2320B_ADX01_ADJ_AMT	Decimal	Adjustment Amount
02		L2320B_ADX02_ADJ_RSN_CD	String	Adjustment Reason Code

STHDR	SE	Transaction Set Trailer
01		STHDR_SE01_TS_SEG_CT	Integer	Transaction Segment Count
02		STHDR_SE02_TCN	String	Transaction Set Control Number

GSHDR	GE	Functional Group Trailer
01		GSHDR_GE01_NR_TS_INCLUDED	Integer	Number of Transaction Sets Included
02		GSHDR_GE02_GCN	Integer	Group Control Number