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

STHDR	BGN	Beginning Segment
01		STHDR_BGN01_TS_PURP_CD	String	Transaction Set Purpose Code
02		STHDR_BGN02_TS_REF_NR	String	Transaction Set Reference Number
03		STHDR_BGN03_TS_CRTN_D8	Date/Time	Transaction Set Creation Date
04		STHDR_BGN04_TS_CRTN_TM	Time	Transaction Set Creation Time
05		STHDR_BGN05_TIMZON_CD	String	Time Zone Code
06		STHDR_BGN06_ORIG_TS_REF_NR	String	Original Transaction Set Reference Number
08		STHDR_BGN08_ACTN_CD	String	Action Code

STHDR	REF	Transaction Set Policy Number
02		STHDR_REF_MSTR_PLCY_NR	String	Master Policy Number

STHDR	DTP	File Effective Date
03		STHDR_DTP_EFF_D8	Start Date	Effective (D8)
03		STHDR_DTP_RPT_STRT_D8	Start Date	Report Start (D8)
03		STHDR_DTP_RPT_END_D8	Start Date	Report End (D8)
03		STHDR_DTP_MNT_EFF_D8	Start Date	Maintenance Effective (D8)
03		STHDR_DTP_ENRLL_D8	Start Date	Enrollment (D8)
03		STHDR_DTP_PMT_CMM_D8	Start Date	Payment Commencement (D8)

STHDR	QTY	Transaction Set Control Totals
02		STHDR_QTY02_DEP_TOT	Date Timestamp	Dependent Total
02		STHDR_QTY02_EMPLYE_TOT	Date Timestamp	Employee Total
02		STHDR_QTY02_TOT	Date Timestamp	Total

L1000A - SPONSOR NAME

L1000A	N1	Sponsor Name
02		L1000A_N102_PLN_SPNSR_NM	String	Plan Sponsor Name
04		L1000A_N104_EMP_ID_NR	String	Employer?s Identification Number
04		L1000A_N104_ORG_CD_DEST_TS	String	Code assigned by the organization that is the ultimate destination of the transaction set
04		L1000A_N104_TAX_ID	String	Federal Taxpayer?s Identification Number

L1000B - PAYER

L1000B	N1	Payer
02		L1000B_N102_INSR_NM	String	Insurer Name
04		L1000B_N104_ORG_CD_DEST_TS	String	Code assigned by the organization that is the ultimate destination of the transaction set
04		L1000B_N104_TAX_ID	String	Federal Taxpayer?s Identification Number
04		L1000B_N104_CMS_PLANID	String	Centers for Medicare and Medicaid Services PlanID

L1000C - TPA/BROKER NAME (Value Qualified)

Mapping Prefix: L1000C_BO - Broker or Sales Office

Mapping Prefix: L1000C_TV - Third Party Administrator (TPA)

L1000C	N1	TPA/Broker Name
02		L1000C_yy_N102_TPA_BRKR_NM	String	TPA or Broker Name
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_TAX_ID	String	Federal Taxpayer?s Identification Number
04		L1000C_yy_N104_CMS_PLANID	String	Centers for Medicare and Medicaid Services PlanID

L1000C	ACT	TPA/Broker Account Information
01		L1000C_yy_ACT01_TPABKR_ACCT_NR	String	TPA or Broker Account Number
06		L1000C_yy_ACT06_TPABKR_ACCT_NR	String	TPA or Broker Account Number

L2000 - MEMBER LEVEL DETAIL

L2000	INS	Member Level Detail
01		L2000_INS01_MEM_IND	String	Member Indicator
02		L2000_INS02_IND_RELAT_CD	String	Individual Relationship Code
03		L2000_INS03_MAINT_TYP_CD	String	Maintenance Type Code
04		L2000_INS04_MAINT_RSN_CD	String	Maintenance Reason Code
05		L2000_INS05_BENE_STAT_CD	String	Benefit Status Code
06	01	L2000_INS0601_MDCR_PLAN_CD	String	Medicare Plan Code
06	02	L2000_INS0602_MDCR_ELIG_RSN_CD	String	Medicare Eligibility Reason Code
07		L2000_INS07_COBRA_EVNT_CD	String	Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code
08		L2000_INS08_EMPMT_STAT_CD	String	Employment Status Code
09		L2000_INS09_STUD_STAT_CD	String	Student Status Code
10		L2000_INS10_HANDCP_IND	String	Handicap Indicator
12		L2000_INS12_MBR_IND_DEATH_D8	Date/Time	Member Individual Death Date
13		L2000_INS13_CNFDTL_CD	String	Confidentiality Code
17		L2000_INS17_BRTH_SEQ_NR	String	Birth Sequence Number

L2000	REF	Subscriber Identifier
02		L2000_REF_SUB_NR	String	Subscriber Number

L2000	REF	Member Policy Number
02		L2000_REF_GRP_POLCY_NR	String	Group or Policy Number

L2000	REF	Member Supplemental Identifier
02		L2000_REF_CLT_RPT_CAT	String	Client Reporting Category
02		L2000_REF_CLNT_NR	String	Client Number
02		L2000_REF_CASE_NR	String	Case Number
02		L2000_REF_PIN	String	Personal Identification Number (PIN)
02		L2000_REF_XREF_NR	String	Cross Reference Number
02		L2000_REF_PERSL_ID_NR	String	Personal ID Number
02		L2000_REF_NABP_NR	String	National Council for Prescription Drug Programs Pharmacy Number
02		L2000_REF_DEPT_AGCY_NR	String	Department/Agency Number
02		L2000_REF_HIC_NR	String	Health Insurance Claim (HIC) Number
02		L2000_REF_POS_CD	String	Position Code
02		L2000_REF_PRIOR_ID	String	Prior Identifier Number
02		L2000_REF_UNIT_NR	String	Unit Number
02		L2000_REF_MUTLY_DEF	String	Mutually Defined

L2000	DTP	Member Level Dates
03		L2000_DTP_RCVD_D8	Start Date	Received (D8)
03		L2000_DTP_RETRMNT_D8	Start Date	Retirement (D8)
03		L2000_DTP_DIS_RET_WRK_D8	Start Date	Initial Disability Period Return To Work (D8)
03		L2000_DTP_LST_WRK_D8	Start Date	Initial Disability Period Last Day Worked (D8)
03		L2000_DTP_ENRL_SIG_D8	Start Date	Enrollment Signature Date (D8)
03		L2000_DTP_COBRA_EVNT_D8	Start Date	Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event (D8)
03		L2000_DTP_MNT_EFF_D8	Start Date	Maintenance Effective (D8)
03		L2000_DTP_EMP_BGN_D8	Start Date	Employment Begin (D8)
03		L2000_DTP_EMP_END_D8	Start Date	Employment End (D8)
03		L2000_DTP_MDCR_BGN_D8	Start Date	Medicare Begin (D8)
03		L2000_DTP_MDCR_END_D8	Start Date	Medicare End (D8)
03		L2000_DTP_COBRA_BGN_D8	Start Date	Consolidated Omnibus Budget Reconciliation Act (COBRA) Begin (D8)
03		L2000_DTP_COBRA_END_D8	Start Date	Consolidated Omnibus Budget Reconciliation Act (COBRA) End (D8)
03		L2000_DTP_EDU_BGN_D8	Start Date	Education Begin (D8)
03		L2000_DTP_EDU_END_D8	Start Date	Education End (D8)
03		L2000_DTP_ELIG_BGN_D8	Start Date	Eligibility Begin (D8)
03		L2000_DTP_ELIG_END_D8	Start Date	Eligibility End (D8)
03		L2000_DTP_ADJ_HIR_D8	Start Date	Adjusted Hire (D8)
03		L2000_DTP_CRD_SVC_BGN_D8	Start Date	Credited Service Begin (D8)
03		L2000_DTP_CRD_SVC_END_D8	Start Date	Credited Service End (D8)
03		L2000_DTP_PLN_SUSP_D8	Start Date	Plan Participation Suspension (D8)
03		L2000_DTP_REHR_D8	Start Date	Rehire (D8)
03		L2000_DTP_MDCD_BGN_D8	Start Date	Medicaid Begin (D8)
03		L2000_DTP_MDCD_END_D8	Start Date	Medicaid End (D8)

L2100A - MEMBER NAME (Value Qualified)

Mapping Prefix: L2100A_74 - Corrected Insured

Mapping Prefix: L2100A_IL - Insured or Subscriber

L2100A	NM1	Member Name
03		L2100A_yy_NM103_MBR_LNM	String	Member Last Name
04		L2100A_yy_NM104_MBR_FNM	String	Member First Name
05		L2100A_yy_NM105_MBR_MNM	String	Member Middle Name
06		L2100A_yy_NM106_MBR_PFX	String	Member Name Prefix
07		L2100A_yy_NM107_MBR_SFX	String	Member Name Suffix
09		L2100A_yy_NM109_SSN	String	Social Security Number
09		L2100A_yy_NM109_MUTLY_DEFND	String	Mutually Defined

L2100A	PER	Member Communications Numbers
04		L2100A_yy_PER04_ALTRN_PHN_NR	String	Alternate Telephone
04		L2100A_yy_PER04_BPR_NR	String	Beeper Number
04		L2100A_yy_PER04_CELL_PHN	String	Cellular Phone
04		L2100A_yy_PER04_EMAIL	String	Electronic Mail
04		L2100A_yy_PER04_PHN_EXT	String	Telephone Extension
04		L2100A_yy_PER04_FAX	String	Facsimile
04		L2100A_yy_PER04_HM_PHN_NR	String	Home Phone Number
04		L2100A_yy_PER04_PHN_NR	String	Telephone
04		L2100A_yy_PER04_WRK_PHN_NR	String	Work Phone Number
06		L2100A_yy_PER06_ALTRN_PHN_NR	String	Alternate Telephone
06		L2100A_yy_PER06_BPR_NR	String	Beeper Number
06		L2100A_yy_PER06_CELL_PHN	String	Cellular Phone
06		L2100A_yy_PER06_EMAIL	String	Electronic Mail
06		L2100A_yy_PER06_PHN_EXT	String	Telephone Extension
06		L2100A_yy_PER06_FAX	String	Facsimile
06		L2100A_yy_PER06_HM_PHN_NR	String	Home Phone Number
06		L2100A_yy_PER06_PHN_NR	String	Telephone
06		L2100A_yy_PER06_WRK_PHN_NR	String	Work Phone Number
08		L2100A_yy_PER08_ALTRN_PHN_NR	String	Alternate Telephone
08		L2100A_yy_PER08_BPR_NR	String	Beeper Number
08		L2100A_yy_PER08_CELL_PHN	String	Cellular Phone
08		L2100A_yy_PER08_EMAIL	String	Electronic Mail
08		L2100A_yy_PER08_PHN_EXT	String	Telephone Extension
08		L2100A_yy_PER08_FAX	String	Facsimile
08		L2100A_yy_PER08_HM_PHN_NR	String	Home Phone Number
08		L2100A_yy_PER08_PHN_NR	String	Telephone
08		L2100A_yy_PER08_WRK_PHN_NR	String	Work Phone Number

L2100A	N3	Member Residence Street Address
01		L2100A_yy_N301_MBR_ADDR	String	Member Address Line
02		L2100A_yy_N302_MBR_ADDR	String	Member Address Line

L2100A	N4	Member City, State, ZIP Code
01		L2100A_yy_N401_MBR_CITY	String	Member City Name
02		L2100A_yy_N402_MBR_STAT	String	Member State Code
03		L2100A_yy_N403_MBR_ZIP	String	Member Postal Zone or Zip Code
04		L2100A_yy_N404_CNTRY_CD	String	Country Code
06		L2100A_yy_N406_AREA	String	Area
06		L2100A_yy_N406_COUNTY	String	County/Parish
07		L2100A_yy_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2100A	DMG	Member Demographics
02		L2100A_yy_DMG02_MBR_DOB_D8	Date/Time	Member Birth Date
03		L2100A_yy_DMG03_GENDR_CD	String	Gender Code
04		L2100A_yy_DMG04_MARTL_STAT	String	Marital Status Code
05	01	L2100A_yy_DMG0501_Enn_RAC_ETH_CD	String	Race or Ethnicity Code
05	03	L2100A_yy_DMG0503_Enn_CS_RC_ETH	String	Classification of Race or Ethnicity
06		L2100A_yy_DMG06_CTZN_STATS_CD	String	Citizenship Status Code
11		L2100A_yy_DMG11_RACETH_COLL_CD	String	Race or Ethnicity Collection Code

L2100A	EC	Employment Class	Iterated: [01-99]
01		L2100A_yy_nnEC01_EMPMT_CLSS_CD	String	Employment Class Code
02		L2100A_yy_nnEC02_EMPMT_CLSS_CD	String	Employment Class Code
03		L2100A_yy_nnEC03_EMPMT_CLSS_CD	String	Employment Class Code

L2100A	ICM	Member Income
02		L2100A_yy_ICM02_YTD	Decimal	Year-to-Date
02		L2100A_yy_ICM02_SINGL	Decimal	Single
02		L2100A_yy_ICM02_HRLY	Decimal	Hourly
02		L2100A_yy_ICM02_QUARTLY	Decimal	Quarterly
02		L2100A_yy_ICM02_SEMIANNL	Decimal	Semiannual
02		L2100A_yy_ICM02_UNKWN	Decimal	Unknown
02		L2100A_yy_ICM02_WKLY	Decimal	Weekly
02		L2100A_yy_ICM02_BIWKLY	Decimal	Biweekly
02		L2100A_yy_ICM02_SEMIMTHLY	Decimal	Semimonthly
02		L2100A_yy_ICM02_MNTHLY	Decimal	Monthly
02		L2100A_yy_ICM02_DAILY	Decimal	Daily
02		L2100A_yy_ICM02_ANNUL	Decimal	Annual
02		L2100A_yy_ICM02_2CAL_MOS	Decimal	Two Calendar Months
02		L2100A_yy_ICM02_LMPSM_SEP_ALNC	Decimal	Lump-Sum Separation Allowance
03		L2100A_yy_ICM03_WRK_HRS_CT	Decimal	Work Hours Count
04		L2100A_yy_ICM04_LOC_ID_CD	String	Location Identification Code
05		L2100A_yy_ICM05_SALARY_GRD_CD	String	Salary Grade Code

L2100A	AMT	Member Policy Amounts
02		L2100A_yy_AMT02_COINS_ACTL	Date Timestamp	Co-insurance - Actual
02		L2100A_yy_AMT02_COPAY_AMT	Date Timestamp	Co-Payment Amount
02		L2100A_yy_AMT02_DED_AMT	Date Timestamp	Deductible Amount
02		L2100A_yy_AMT02_EXP_EXP_AMT	Date Timestamp	Expected Expenditure Amount
02		L2100A_yy_AMT02_OTH_UNLS_AMT	Date Timestamp	Other Unlisted Amount
02		L2100A_yy_AMT02_PREM_AMT	Date Timestamp	Premium Amount
02		L2100A_yy_AMT02_SPENDOWN	Date Timestamp	Spend Down

L2100A	HLH	Member Health Information
01		L2100A_yy_HLH01_HLTH_REL_CD	String	Health Related Code
02		L2100A_yy_HLH02_MBR_HGT	Decimal	Member Height
03		L2100A_yy_HLH03_MBR_WGT	Decimal	Member Weight

L2100A	LUI	Member Language	Iterated: [01-99]
02		L2100A_yy_nnLUI02_ISO3953_LGCD	String	NISO Z39.53 Language Codes
02		L2100A_yy_nnLUI02_I639_LANG_CD	String	ISO 639 Language Codes
03		L2100A_yy_nnLUI03_LANG_DESC	String	Language Description
04		L2100A_yy_nnLUI04_LANG_USE_IND	String	Language Use Indicator

L2100B - INCORRECT MEMBER NAME

L2100B	NM1	Incorrect Member Name
03		L2100B_NM103_PRI_INC_MBR_LNM	String	Prior Incorrect Member Last Name
04		L2100B_NM104_PRI_INC_MBR_FNM	String	Prior Incorrect Member First Name
05		L2100B_NM105_PRI_INC_MBR_MNM	String	Prior Incorrect Member Middle Name
06		L2100B_NM106_PRI_INC_MBR_PFX	String	Prior Incorrect Member Name Prefix
07		L2100B_NM107_PRI_INC_MBR_SFX	String	Prior Incorrect Member Name Suffix
09		L2100B_NM109_SSN	String	Social Security Number
09		L2100B_NM109_MUTLY_DEF	String	Mutually Defined

L2100B	DMG	Incorrect Member Demographics
02		L2100B_DMG02_PRI_INS_DOB_D8	Date/Time	Prior Incorrect Insured Birth Date
03		L2100B_DMG03_PRI_INC_GENDR_CD	String	Prior Incorrect Insured Gender Code
04		L2100B_DMG04_MARTL_STAT	String	Marital Status Code
05	01	L2100B_DMG0501_Enn_RAC_ETH_CD	String	Race or Ethnicity Code
05	02	L2100B_DMG0502_Enn_CD_LST_QL_CD	String	Code List Qualifier Code
05	03	L2100B_DMG0503_Enn_RAC_ETH_CD	String	Race or Ethnicity Code
06		L2100B_DMG06_CTZN_STATS_CD	String	Citizenship Status Code
10		L2100B_DMG10_CD_LST_QL_CD	String	Code List Qualifier Code
11		L2100B_DMG11_RACETH_COLL_CD	String	Race or Ethnicity Collection Code

L2100C - MEMBER MAILING ADDRESS

L2100C

NM1

Member Mailing Address

L2100C	N3	Member Mail Street Address
01		L2100C_N301_MBR_ADDR	String	Member Address Line
02		L2100C_N302_MBR_ADDR	String	Member Address Line

L2100C	N4	Member Mail City, State, ZIP Code
01		L2100C_N401_MBR_MAIL_CITY	String	Member Mail City Name
02		L2100C_N402_MBR_MAIL_STAT	String	Member Mail State Code
03		L2100C_N403_MBR_MAIL_ZIP	String	Member Mail Postal Zone or ZIP Code
04		L2100C_N404_CNTRY_CD	String	Country Code
07		L2100C_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2100D - MEMBER EMPLOYER (Single Iteration)

L2100D	NM1	Member Employer
02		L2100D_xx_NM102_ENT_TYP_QUAL	String	Entity Type Qualifier
03		L2100D_xx_NM103_MBR_EMP_NM	String	Member Employer Name
04		L2100D_xx_NM104_MBR_EMPLR_FNM	String	Member Employer First Name
05		L2100D_xx_NM105_MBR_EMP_MNM	String	Member Employer Middle Name
06		L2100D_xx_NM106_MBR_EMPLR_PFX	String	Member Employer Name Prefix
07		L2100D_xx_NM107_MBR_EMP_SFX	String	Member Employer Name Suffix
09		L2100D_xx_NM109_EMPLYR_ID	String	Employer?s Identification Number
09		L2100D_xx_NM109_SSN	String	Social Security Number

L2100D	PER	Member Employer Communications Numbers
02		L2100D_xx_PER02_MBR_EMP_CM_CON	String	Member Employer Communications Contact
04		L2100D_xx_PER04_ALTRN_PHN_NR	String	Alternate Telephone
04		L2100D_xx_PER04_BPR_NR	String	Beeper Number
04		L2100D_xx_PER04_CELL_PHN	String	Cellular Phone
04		L2100D_xx_PER04_EMAIL	String	Electronic Mail
04		L2100D_xx_PER04_PHN_EXT	String	Telephone Extension
04		L2100D_xx_PER04_FAX	String	Facsimile
04		L2100D_xx_PER04_PHN_NR	String	Telephone
06		L2100D_xx_PER06_ALTRN_PHN_NR	String	Alternate Telephone
06		L2100D_xx_PER06_BPR_NR	String	Beeper Number
06		L2100D_xx_PER06_CELL_PHN	String	Cellular Phone
06		L2100D_xx_PER06_EMAIL	String	Electronic Mail
06		L2100D_xx_PER06_PHN_EXT	String	Telephone Extension
06		L2100D_xx_PER06_FAX	String	Facsimile
06		L2100D_xx_PER06_PHN_NR	String	Telephone
08		L2100D_xx_PER08_ALTRN_PHN_NR	String	Alternate Telephone
08		L2100D_xx_PER08_BPR_NR	String	Beeper Number
08		L2100D_xx_PER08_CELL_PHN	String	Cellular Phone
08		L2100D_xx_PER08_EMAIL	String	Electronic Mail
08		L2100D_xx_PER08_PHN_EXT	String	Telephone Extension
08		L2100D_xx_PER08_FAX	String	Facsimile
08		L2100D_xx_PER08_PHN_NR	String	Telephone

L2100D	N3	Member Employer Street Address
01		L2100D_xx_N301_MBR_EMP_ADDR	String	Member Employer Address Line
02		L2100D_xx_N302_MBR_EMP_ADDR	String	Member Employer Address Line

L2100D	N4	Member Employer City, State, ZIP Code
01		L2100D_xx_N401_MBR_EMP_CITY	String	Member Employer City Name
02		L2100D_xx_N402_MBR_EMP_STAT	String	Member Employer State Code
03		L2100D_xx_N403_MBR_EMP_ZIP	String	Member Employer Postal Zone or ZIP Code
04		L2100D_xx_N404_CNTRY_CD	String	Country Code
07		L2100D_xx_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2100E - MEMBER SCHOOL (Single Iteration)

L2100E	NM1	Member School
03		L2100E_xx_NM103_SCHL_NM	String	School Name

L2100E	PER	Member School Commmunications Numbers
02		L2100E_xx_PER02_MBR_SCH_CMMCON	String	Member School Communications Contact Name
04		L2100E_xx_PER04_EMAIL	String	Electronic Mail
04		L2100E_xx_PER04_PHN_EXT	String	Telephone Extension
04		L2100E_xx_PER04_FAX	String	Facsimile
04		L2100E_xx_PER04_PHN_NR	String	Telephone
06		L2100E_xx_PER06_EMAIL	String	Electronic Mail
06		L2100E_xx_PER06_PHN_EXT	String	Telephone Extension
06		L2100E_xx_PER06_FAX	String	Facsimile
06		L2100E_xx_PER06_PHN_NR	String	Telephone
08		L2100E_xx_PER08_EMAIL	String	Electronic Mail
08		L2100E_xx_PER08_PHN_EXT	String	Telephone Extension
08		L2100E_xx_PER08_FAX	String	Facsimile
08		L2100E_xx_PER08_PHN_NR	String	Telephone

L2100E	N3	Member School Street Address
01		L2100E_xx_N301_SCHL_ADDR	String	School Address Line
02		L2100E_xx_N302_SCHL_ADDR	String	School Address Line

L2100E	N4	Member School City, State, ZIP Code
01		L2100E_xx_N401_MBR_SCH_CITY	String	Member School City Name
02		L2100E_xx_N402_MBR_SCH_STAT	String	Member School State Code
03		L2100E_xx_N403_MBR_SCH_ZIP	String	Member School Postal Zone or ZIP Code
04		L2100E_xx_N404_CNTRY_CD	String	Country Code
07		L2100E_xx_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2100F - CUSTODIAL PARENT

L2100F	NM1	Custodial Parent
03		L2100F_NM103_CUST_PAR_LNM	String	Custodial Parent Last Name
04		L2100F_NM104_CUST_PAR_FNM	String	Custodial Parent First Name
05		L2100F_NM105_CUST_PAR_MNM	String	Custodial Parent Middle Name
06		L2100F_NM106_CUST_PAR_PFX	String	Custodial Parent Name Prefix
07		L2100F_NM107_CUST_PAR_SFX	String	Custodial Parent Name Suffix
09		L2100F_NM109_SSN	String	Social Security Number
09		L2100F_NM109_MUTLY_DEFND	String	Mutually Defined

L2100F	PER	Custodial Parent Communications Numbers
04		L2100F_PER04_ALTRN_PHN_NR	String	Alternate Telephone
04		L2100F_PER04_BPR_NR	String	Beeper Number
04		L2100F_PER04_CELL_PHN	String	Cellular Phone
04		L2100F_PER04_EMAIL	String	Electronic Mail
04		L2100F_PER04_PHN_EXT	String	Telephone Extension
04		L2100F_PER04_FAX	String	Facsimile
04		L2100F_PER04_HM_PHN_NR	String	Home Phone Number
04		L2100F_PER04_PHN_NR	String	Telephone
04		L2100F_PER04_WRK_PHN_NR	String	Work Phone Number
06		L2100F_PER06_ALTRN_PHN_NR	String	Alternate Telephone
06		L2100F_PER06_BPR_NR	String	Beeper Number
06		L2100F_PER06_CELL_PHN	String	Cellular Phone
06		L2100F_PER06_EMAIL	String	Electronic Mail
06		L2100F_PER06_PHN_EXT	String	Telephone Extension
06		L2100F_PER06_FAX	String	Facsimile
06		L2100F_PER06_HM_PHN_NR	String	Home Phone Number
06		L2100F_PER06_PHN_NR	String	Telephone
06		L2100F_PER06_WRK_PHN_NR	String	Work Phone Number
08		L2100F_PER08_ALTRN_PHN_NR	String	Alternate Telephone
08		L2100F_PER08_BPR_NR	String	Beeper Number
08		L2100F_PER08_CELL_PHN	String	Cellular Phone
08		L2100F_PER08_EMAIL	String	Electronic Mail
08		L2100F_PER08_PHN_EXT	String	Telephone Extension
08		L2100F_PER08_HM_PHN_NR	String	Home Phone Number
08		L2100F_PER08_PHN_NR	String	Telephone
08		L2100F_PER08_WRK_PHN_NR	String	Work Phone Number

L2100F	N3	Custodial Parent Street Address
01		L2100F_N301_CUST_PAR_ADDR	String	Custodial Parent Address Line
02		L2100F_N302_CUST_PAR_ADDR	String	Custodial Parent Address Line

L2100F	N4	Custodial Parent City, State, ZIP Code
01		L2100F_N401_CUST_PAR_CITY	String	Custodial Parent City Name
02		L2100F_N402_CUST_PAR_STAT	String	Custodial Parent State Code
03		L2100F_N403_CUST_PAR_ZIP	String	Custodial Parent Postal Zone or ZIP Code
04		L2100F_N404_CNTRY_CD	String	Country Code
07		L2100F_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2100G - RESPONSIBLE PERSON (Value Qualified)

Mapping Prefix: L2100G_6Y - Case Manager

Mapping Prefix: L2100G_9K - Key Person

Mapping Prefix: L2100G_E1 - Person or Other Entity Legally Responsible for a Child

Mapping Prefix: L2100G_EI - Executor of Estate

Mapping Prefix: L2100G_EXS - Ex-spouse

Mapping Prefix: L2100G_GB - Other Insured

Mapping Prefix: L2100G_GD - Guardian

Mapping Prefix: L2100G_J6 - Power of Attorney

Mapping Prefix: L2100G_LR - Legal Representative

Mapping Prefix: L2100G_QD - Responsible Party

Mapping Prefix: L2100G_S1 - Parent

Mapping Prefix: L2100G_TZ - Significant Other

Mapping Prefix: L2100G_X4 - Spouse

L2100G	NM1	Responsible Person
03		L2100G_yy_NM103_RSP_PARTY_LNM	String	Responsible Party Last or Organization Name
04		L2100G_yy_NM104_RESP_PRTY_FNAM	String	Responsible Party First Name
05		L2100G_yy_NM105_RESP_MNM	String	Responsible Party Middle Name
06		L2100G_yy_NM106_RSP_PRTY_PFX	String	Responsible Party Name Prefix
07		L2100G_yy_NM107_RSP_PARTY_SFX	String	Responsible Party Suffix Name
09		L2100G_yy_NM109_SSN	String	Social Security Number
09		L2100G_yy_NM109_MUTLY_DEFND	String	Mutually Defined

L2100G	PER	Responsible Person Communications Numbers
04		L2100G_yy_PER04_ALTRN_PHN_NR	String	Alternate Telephone
04		L2100G_yy_PER04_BPR_NR	String	Beeper Number
04		L2100G_yy_PER04_CELL_PHN	String	Cellular Phone
04		L2100G_yy_PER04_EMAIL	String	Electronic Mail
04		L2100G_yy_PER04_PHN_EXT	String	Telephone Extension
04		L2100G_yy_PER04_FAX	String	Facsimile
04		L2100G_yy_PER04_HM_PHN_NR	String	Home Phone Number
04		L2100G_yy_PER04_PHN_NR	String	Telephone
04		L2100G_yy_PER04_WRK_PHN_NR	String	Work Phone Number
06		L2100G_yy_PER06_ALTRN_PHN_NR	String	Alternate Telephone
06		L2100G_yy_PER06_BPR_NR	String	Beeper Number
06		L2100G_yy_PER06_CELL_PHN	String	Cellular Phone
06		L2100G_yy_PER06_EMAIL	String	Electronic Mail
06		L2100G_yy_PER06_PHN_EXT	String	Telephone Extension
06		L2100G_yy_PER06_FAX	String	Facsimile
06		L2100G_yy_PER06_HM_PHN_NR	String	Home Phone Number
06		L2100G_yy_PER06_PHN_NR	String	Telephone
06		L2100G_yy_PER06_WRK_PHN_NR	String	Work Phone Number
08		L2100G_yy_PER08_ALTRN_PHN_NR	String	Alternate Telephone
08		L2100G_yy_PER08_BPR_NR	String	Beeper Number
08		L2100G_yy_PER08_CELL_PHN	String	Cellular Phone
08		L2100G_yy_PER08_EMAIL	String	Electronic Mail
08		L2100G_yy_PER08_PHN_EXT	String	Telephone Extension
08		L2100G_yy_PER08_FAX	String	Facsimile
08		L2100G_yy_PER08_HM_PHN_NR	String	Home Phone Number
08		L2100G_yy_PER08_PHN_NR	String	Telephone
08		L2100G_yy_PER08_WRK_PHN_NR	String	Work Phone Number

L2100G	N3	Responsible Person Street Address
01		L2100G_yy_N301_RSP_PRTY_ADDR	String	Responsible Party Address Line
02		L2100G_yy_N302_RSP_PRTY_ADDR	String	Responsible Party Address Line

L2100G	N4	Responsible Person City, State, ZIP Code
01		L2100G_yy_N401_RSP_PERS_CITY	String	Responsible Person City Name
02		L2100G_yy_N402_RSP_PERS_STAT	String	Responsible Person State Code
03		L2100G_yy_N403_RESP_PRSN_ZIP	String	Responsible Person Postal Zone or ZIP Code
04		L2100G_yy_N404_CNTRY_CD	String	Country Code
07		L2100G_yy_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2100H - DROP OFF LOCATION

L2100H	NM1	Drop Off Location
03		L2100H_NM103_NM_LAST_ORG_NM	String	Name Last or Organization Name
04		L2100H_NM104_FNM	String	Name First
05		L2100H_NM105_NM_MID	String	Name Middle
06		L2100H_NM106_PFX	String	Name Prefix
07		L2100H_NM107_SFX	String	Name Suffix

L2100H	N3	Drop Off Location Street Address
01		L2100H_N301_DROPOFF_LOC_ADDR	String	Drop Off Location Address Line
02		L2100H_N302_DROPOFF_LOC_ADDR	String	Drop Off Location Address Line

L2100H	N4	Drop Off Location City, State, ZIP Code
01		L2100H_N401_DROPOFF_LOC_CITY	String	Drop Off Location City Name
02		L2100H_N402_DROPOFF_LOC_STAT	String	Drop Off Location State Code
03		L2100H_N403_DROPOFF_LOC_ZIP	String	Drop Off Location Postal Zone or ZIP Code
04		L2100H_N404_CNTRY_CD	String	Country Code
07		L2100H_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2200 - DISABILITY INFORMATION

L2200	DSB	Disability Information
01		L2200_DSB01_DISABTY_TYP_CD	String	Disability Type Code
08		L2200_DSB08_ICD9_DIAG	String	International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) - Diagnosis
08		L2200_DSB08_MUTLY_DEF	String	Mutually Defined

L2200	DTP	Disability Eligibility Dates
03		L2200_DTP_DIS_BGN_D8	Start Date	Initial Disability Period Start (D8)
03		L2200_DTP_DIS_END_D8	Start Date	Initial Disability Period End (D8)

L2300 - HEALTH COVERAGE

L2300	HD	Health Coverage
01		L2300_HD01_MAINT_TYP_CD	String	Maintenance Type Code
03		L2300_HD03_INS_LIN_CD	String	Insurance Line Code
04		L2300_HD04_PLN_CVG_DSC	String	Plan Coverage Description
05		L2300_HD05_COVG_LVL_CD	String	Coverage Level Code
09		L2300_HD09_LAT_ENRL_IND	String	Late Enrollment Indicator

L2300	DTP	Health Coverage Dates
03		L2300_DTP_ENRL_SIG_D8	Start Date	Enrollment Signature Date (D8)
03		L2300_DTP_ENRL_SIG_RD8_1	Start Date	Enrollment Signature Date (D8)
03		L2300_DTP_ENRL_SIG_RD8_2	End Date	Enrollment Signature Date (D8)
03		L2300_DTP_MNT_EFF_D8	Start Date	Maintenance Effective (D8)
03		L2300_DTP_MNT_EFF_RD8_1	Start Date	Maintenance Effective (D8)
03		L2300_DTP_MNT_EFF_RD8_2	End Date	Maintenance Effective (D8)
03		L2300_DTP_PRM_PD_END_D8	Start Date	Premium Paid to Date End (D8)
03		L2300_DTP_PRM_PD_END_RD8_1	Start Date	Premium Paid to Date End (D8)
03		L2300_DTP_PRM_PD_END_RD8_2	End Date	Premium Paid to Date End (D8)
03		L2300_DTP_BNFT_BGN_D8	Start Date	Benefit Begin (D8)
03		L2300_DTP_BNFT_BGN_RD8_1	Start Date	Benefit Begin (D8)
03		L2300_DTP_BNFT_BGN_RD8_2	End Date	Benefit Begin (D8)
03		L2300_DTP_BNFT_END_D8	Start Date	Benefit End (D8)
03		L2300_DTP_BNFT_END_RD8_1	Start Date	Benefit End (D8)
03		L2300_DTP_BNFT_END_RD8_2	End Date	Benefit End (D8)
03		L2300_DTP_PRM_PD_D8	Start Date	Last Premium Paid Date (D8)
03		L2300_DTP_PRM_PD_RD8_1	Start Date	Last Premium Paid Date (D8)
03		L2300_DTP_PRM_PD_RD8_2	End Date	Last Premium Paid Date (D8)
03		L2300_DTP_PRV_PERD_D8	Start Date	Previous Period (D8)
03		L2300_DTP_PRV_PERD_RD8_1	Start Date	Previous Period (D8)
03		L2300_DTP_PRV_PERD_RD8_2	End Date	Previous Period (D8)

L2300	AMT	Health Coverage Policy
02		L2300_AMT02_COINS_ACTL	Date Timestamp	Co-insurance - Actual
02		L2300_AMT02_COPAY_AMT	Date Timestamp	Co-Payment Amount
02		L2300_AMT02_DED_AMT	Date Timestamp	Deductible Amount
02		L2300_AMT02_EXP_EXP_AMT	Date Timestamp	Expected Expenditure Amount
02		L2300_AMT02_OTH_UNLS_AMT	Date Timestamp	Other Unlisted Amount
02		L2300_AMT02_PREM_AMT	Date Timestamp	Premium Amount
02		L2300_AMT02_SPENDOWN	Date Timestamp	Spend Down

L2300	REF	Health Coverage Policy Number
02		L2300_REF_CLT_RPT_CAT	String	Client Reporting Category
02		L2300_REF_GRP_POLCY_NR	String	Group or Policy Number
02		L2300_REF_PMT_CAT	String	Payment Category
02		L2300_REF_CLSS_CONT	String	Class of Contract Code
02		L2300_REF_COVG_NR	String	Service Contract (Coverage) Number
02		L2300_REF_MDCL_ASST_CAT	String	Medical Assistance Category
02		L2300_REF_PROG_ID	String	Program Identification Number
02		L2300_REF_RAT_CD_NR	String	Rate code number
02		L2300_REF_INT_CTL_NR	String	Internal Control Number
02		L2300_REF_ISSR_NR	String	Issuer Number
02		L2300_REF_SP_PROG_CD	String	Special Program Code
02		L2300_REF_SVC_AREA_CD	String	Service Area Code
02		L2300_REF_CNTY_CD	String	County Code
02		L2300_REF_MUTLY_DEF	String	Mutually Defined

L2300	REF	Prior Coverage Months
02		L2300_REF_UNIT_NR	String	Unit Number

L2300	IDC	Identification Card	Iterated: [01-03]
01		L2300_nnIDC01_PLN_CVG_DSC	String	Plan Coverage Description
02		L2300_nnIDC02_ID_TYP_CD	String	Identification Card Type Code
03		L2300_nnIDC03_ID_CRD_CT	Decimal	Identification Card Count
04		L2300_nnIDC04_ACTN_CD	String	Action Code

L2310 - PROVIDER INFORMATION

L2310	LX	Provider Information
01		L2310_LX01_ASSGD_NR	Integer	Assigned Number

L2310	NM1	Provider Name
01		L2310_NM101_ENTY_ID_CD	String	Entity Identifier Code
02		L2310_NM102_ENT_TYP_QUAL	String	Entity Type Qualifier
03		L2310_NM103_PVR_LNM	String	Provider Last or Organization Name
04		L2310_NM104_PVR_FNM	String	Provider First Name
05		L2310_NM105_PVR_MNM	String	Provider Middle Name
06		L2310_NM106_PVR_PFX	String	Provider Name Prefix
07		L2310_NM107_PVR_SFX	String	Provider Name Suffix
09		L2310_NM109_SSN	String	Social Security Number
09		L2310_NM109_TAX_ID	String	Federal Taxpayer?s Identification Number
09		L2310_NM109_SVC_PROV_NR	String	Service Provider Number
09		L2310_NM109_NPI	String	Centers for Medicare and Medicaid Services National Provider Identifier
10		L2310_NM110_ENTY_REL_CD	String	Entity Relationship Code

L2310	N3	Provider Address	Iterated: [01-02]
01		L2310_nnN301_PVR_ADDR	String	Provider Address Line
02		L2310_nnN302_PVR_ADDR	String	Provider Address Line

L2310	N4	Provider City, State, ZIP Code
01		L2310_N401_PVR_CITY	String	Provider City Name
02		L2310_N402_PVR_STAT	String	Provider State Code
03		L2310_N403_PVR_ZIP	String	Provider Postal Zone or ZIP Code
04		L2310_N404_CNTRY_CD	String	Country Code
07		L2310_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2310	PER	Provider Communications Numbers	Iterated: [01-02]
04		L2310_nnPER04_ALTRN_PHN_NR	String	Alternate Telephone
04		L2310_nnPER04_BPR_NR	String	Beeper Number
04		L2310_nnPER04_CELL_PHN	String	Cellular Phone
04		L2310_nnPER04_EMAIL	String	Electronic Mail
04		L2310_nnPER04_PHN_EXT	String	Telephone Extension
04		L2310_nnPER04_FAX	String	Facsimile
04		L2310_nnPER04_HM_PHN_NR	String	Home Phone Number
04		L2310_nnPER04_PHN_NR	String	Telephone
04		L2310_nnPER04_WRK_PHN_NR	String	Work Phone Number
06		L2310_nnPER06_ALTRN_PHN_NR	String	Alternate Telephone
06		L2310_nnPER06_BPR_NR	String	Beeper Number
06		L2310_nnPER06_CELL_PHN	String	Cellular Phone
06		L2310_nnPER06_EMAIL	String	Electronic Mail
06		L2310_nnPER06_PHN_EXT	String	Telephone Extension
06		L2310_nnPER06_FAX	String	Facsimile
06		L2310_nnPER06_HM_PHN_NR	String	Home Phone Number
06		L2310_nnPER06_PHN_NR	String	Telephone
06		L2310_nnPER06_WRK_PHN_NR	String	Work Phone Number
08		L2310_nnPER08_ALTRN_PHN_NR	String	Alternate Telephone
08		L2310_nnPER08_BPR_NR	String	Beeper Number
08		L2310_nnPER08_CELL_PHN	String	Cellular Phone
08		L2310_nnPER08_EMAIL	String	Electronic Mail
08		L2310_nnPER08_PHN_EXT	String	Telephone Extension
08		L2310_nnPER08_FAX	String	Facsimile
08		L2310_nnPER08_HM_PHN_NR	String	Home Phone Number
08		L2310_nnPER08_PHN_NR	String	Telephone
08		L2310_nnPER08_WRK_PHN_NR	String	Work Phone Number

L2310	PLA	Provider Change Reason
03		L2310_PLA03_PVR_EFF_D8	Date/Time	Provider Effective Date
05		L2310_PLA05_MAINT_RSN_CD	String	Maintenance Reason Code

L2320 - COORDINATION OF BENEFITS (Single Iteration)

L2320	COB	Coordination of Benefits
01		L2320_xx_COB01_PYR_RESP_SEQ_NR	String	Payer Responsibility Sequence Number Code
02		L2320_xx_COB02_MBR_GRP_POL_NR	String	Member Group or Policy Number
03		L2320_xx_COB03_COB_CD	String	Coordination of Benefits Code
04		L2320_xx_COB04_Enn_SVC_TYP_CD	String	Service Type Code

L2320	REF	Additional Coordination of Benefits Identifiers
02		L2320_xx_REF_ACCT_SFX	String	Account Suffix Code
02		L2320_xx_REF_GRP_NR	String	Group Number
02		L2320_xx_REF_SSN	String	Social Security Number
02		L2320_xx_REF_MUTLY_DEF	String	Mutually Defined

L2320	DTP	Coordination of Benefits Eligibility Dates
03		L2320_xx_DTP_COBRA_BGN_D8	Start Date	Coordination of Benefits Begin (D8)
03		L2320_xx_DTP_COBRA_END_D8	Start Date	Coordination of Benefits End (D8)

L2330 - COORDINATION OF BENEFITS RELATED ENTITY (Inherited Loop Iteration & Value Qualified)

Mapping Prefix: L2330_xx36 - Employer

Mapping Prefix: L2330_xxGW - Group

Mapping Prefix: L2330_xxIN - Insurer

L2330	NM1	Coordination of Benefits Related Entity
03		L2330_xxyy_NM103_COB_INS_NM	String	Coordination of Benefits Insurer Name
09		L2330_xxyy_NM109_TAX_ID	String	Federal Taxpayer?s Identification Number
09		L2330_xxyy_NM109_NAIC_ID	String	National Association of Insurance Commissioners (NAIC) Identification
09		L2330_xxyy_NM109_HCFA_PLAN_ID	String	Centers for Medicare and Medicaid Services PlanID

L2330	N3	Coordination of Benefits Related Entity Address
01		L2330_xxyy_N301_ADDR_NFO	String	Address Information
02		L2330_xxyy_N302_ADDR_NFO	String	Address Information

L2330	N4	Coordination of Benefits Other Insurance Company City, State, ZIP Code
01		L2330_xxyy_N401_COB_OTH_INS	String	Coordination of Benefits Other Insurance adequate to specify a location.
02		L2330_xxyy_N402_COB_OINS	String	Coordination of Benefits Other Insurance implementation guide, do not send.
03		L2330_xxyy_N403_COB_OINS	String	Coordination of Benefits Other Insurance implementation guide, do not send.
04		L2330_xxyy_N404_CNTRY_CD	String	Country Code
07		L2330_xxyy_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2330	PER	Administrative Communications Contact
04		L2330_xxyy_PER04_COMM_NR	String	Communication Number

L2710 - MEMBER REPORTING CATEGORIES

L2710	LS	Additional Reporting Categories
01		L2710_LS01_LOOP_ID_CD	String	Loop Identifier Code

L2750 - REPORTING CATEGORY

L2750	LX	Member Reporting Categories
01		L2750_LX01_ASSGD_NR	Integer	Assigned Number

L2750	N1	Reporting Category
02		L2750_N102_MBR_REP_CAT_NM	String	Member Reporting Category Name

L2750	REF	Reporting Category Reference
02		L2750_REF_DST_NR	String	Contracting District Number
02		L2750_REF_CLT_RPT_CAT	String	Client Reporting Category
02		L2750_REF_PLAN_NR	String	Plan Number
02		L2750_REF_DIV_ID	String	Division Identifier
02		L2750_REF_UNION_NR	String	Union Number
02		L2750_REF_BRNCH_ID	String	Branch Identifier
02		L2750_REF_APP_NR	String	Application Number
02		L2750_REF_PMT_CAT	String	Payment Category
02		L2750_REF_ACCT_CAT	String	Account Category
02		L2750_REF_GEO_NR	String	Geographic Number
02		L2750_REF_LOC_NR	String	Location Number
02		L2750_REF_PROG_ID	String	Program Identification Number
02		L2750_REF_SP_PROG_CD	String	Special Program Code
02		L2750_REF_SVC_AREA_CD	String	Service Area Code
02		L2750_REF_GEO_KEY	String	Geographic Key
02		L2750_REF_MUTLY_DEF	String	Mutually Defined

L2750	DTP	Reporting Category Date
03		L2750_DTP_EFF_D8	Start Date	Effective (D8)
03		L2750_DTP_EFF_RD8_1	Start Date	Effective (D8)
03		L2750_DTP_EFF_RD8_2	End Date	Effective (D8)

L2710	LE	Additional Reporting Categories Loop Termination
01		L2710_LE01_LOOP_ID_CD	String	Loop Identifier 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