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

STHDR	BHT	Beginning of Hierarchical Transaction
01		STHDR_BHT01_HIER_STRUC_CD	String	Hierarchical Structure Code
02		STHDR_BHT02_TS_PURP_CD	String	Transaction Set Purpose Code
03		STHDR_BHT03_ORIG_APP_TRANS_ID	String	Originator Application Transaction Identifier
04		STHDR_BHT04_TS_CRTN_D8	Date/Time	Transaction Set Creation Date
05		STHDR_BHT05_TS_CRTN_TM	Time	Transaction Set Creation Time
06		STHDR_BHT06_CLM_ID	String	Claim Identifier

L1000A - SUBMITTER NAME

L1000A	NM1	Submitter Name
03		L1000A_NM103_PERSN_LNM	String	Person Last Name
03		L1000A_NM103_NONPSNENT_NM	String	Non-Person Entity Name
04		L1000A_NM104_SBM_FNM	String	Submitter First Name
05		L1000A_NM105_SBM_MNM	String	Submitter Middle Name or Initial
09		L1000A_NM109_SBM_ID	String	Submitter Identifier

L1000A	PER	Submitter EDI Contact Information	Iterated: [01-02]
02		L1000A_nnPER02_SBM_CON_NM	String	Submitter Contact Name
04		L1000A_nnPER04_EMAIL	String	Electronic Mail
04		L1000A_nnPER04_FAX	String	Facsimile
04		L1000A_nnPER04_PHN_NR	String	Telephone
06		L1000A_nnPER06_EMAIL	String	Electronic Mail
06		L1000A_nnPER06_PHN_EXT	String	Telephone Extension
06		L1000A_nnPER06_FAX	String	Facsimile
06		L1000A_nnPER06_PHN_NR	String	Telephone
08		L1000A_nnPER08_EMAIL	String	Electronic Mail
08		L1000A_nnPER08_PHN_EXT	String	Telephone Extension
08		L1000A_nnPER08_FAX	String	Facsimile
08		L1000A_nnPER08_PHN_NR	String	Telephone

L1000B - RECEIVER NAME

L1000B	NM1	Receiver Name
03		L1000B_NM103_RCV_NM	String	Receiver Name
09		L1000B_NM109_RCV_PRI_ID	String	Receiver Primary Identifier

L2000A - BILLING PROVIDER HIERARCHICAL LEVEL

L2000A	HL	Billing Provider Hierarchical Level
01		L2000A_HL01_HIER_ID_NR	String	Hierarchical ID Number

L2000A	PRV	Billing Provider Specialty Information
03		L2000A_PRV03_PVR_TAX_CD	String	Provider Taxonomy Code

L2000A	CUR	Foreign Currency Information
02		L2000A_CUR02_CURRNCY_CD	String	Currency Code

L2010AA - BILLING PROVIDER NAME

L2010AA	NM1	Billing Provider Name
03		L2010AA_NM103_BILL_PVR_ORG_NM	String	Billing Provider Organizational Name
09		L2010AA_NM109_BILL_PVR_ID	String	Billing Provider Identifier

L2010AA	N3	Billing Provider Address
01		L2010AA_N301_BILL_PROV_ADDR	String	Billing Provider Address Line
02		L2010AA_N302_BILL_PROV_ADDR	String	Billing Provider Address Line

L2010AA	N4	Billing Provider City, State, ZIP Code
01		L2010AA_N401_BILL_PVR_CITY	String	Billing Provider City Name
02		L2010AA_N402_BILL_PVR_STAT	String	Billing Provider State or Province Code
03		L2010AA_N403_BILL_PVR_ZIP	String	Billing Provider Postal Zone or ZIP Code
04		L2010AA_N404_CNTRY_CD	String	Country Code
07		L2010AA_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010AA	REF	Billing Provider Tax Identification
02		L2010AA_REF_EMPLR_ID_NR	String	Employer?s Identification Number

L2010AA	PER	Billing Provider Contact Information	Iterated: [01-02]
02		L2010AA_nnPER02_BL_PVR_CONT_NM	String	Billing Provider Contact Name
04		L2010AA_nnPER04_EMAIL	String	Electronic Mail
04		L2010AA_nnPER04_FAX	String	Facsimile
04		L2010AA_nnPER04_PHN_NR	String	Telephone
06		L2010AA_nnPER06_EMAIL	String	Electronic Mail
06		L2010AA_nnPER06_PHN_EXT	String	Telephone Extension
06		L2010AA_nnPER06_FAX	String	Facsimile
06		L2010AA_nnPER06_PHN_NR	String	Telephone
08		L2010AA_nnPER08_EMAIL	String	Electronic Mail
08		L2010AA_nnPER08_PHN_EXT	String	Telephone Extension
08		L2010AA_nnPER08_FAX	String	Facsimile
08		L2010AA_nnPER08_PHN_NR	String	Telephone

L2010AB - PAY-TO ADDRESS NAME

L2010AB

NM1

Pay-to Address Name

L2010AB	N3	Pay-to Address - ADDRESS
01		L2010AB_N301_PAY2_ADDR	String	Pay-To Address Line
02		L2010AB_N302_PAY2_ADDR	String	Pay-To Address Line

L2010AB	N4	Pay-To Address City, State, ZIP Code
01		L2010AB_N401_PAY2_CITY	String	Pay-to Address City Name
02		L2010AB_N402_PAY2_STAT	String	Pay-to Address State Code
03		L2010AB_N403_PAY2_ZIP	String	Pay-to Address Postal Zone or ZIP Code
04		L2010AB_N404_CNTRY_CD	String	Country Code
07		L2010AB_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010AC - PAY-TO PLAN NAME

L2010AC	NM1	Pay-To Plan Name
03		L2010AC_NM103_PAY2_PLN_ORG_NM	String	Pay-To Plan Organizational Name
09		L2010AC_NM109_PAYR_ID	String	Payor Identification
09		L2010AC_NM109_HCFA_PLAN_ID	String	Centers for Medicare and Medicaid Services PlanID

L2010AC	N3	Pay-to Plan Address
01		L2010AC_N301_PAY2_PLN_ADDR	String	Pay-To Plan Address Line
02		L2010AC_N302_PAY2_PLN_ADDR	String	Pay-To Plan Address Line

L2010AC	N4	Pay-To Plan City, State, ZIP Code
01		L2010AC_N401_PAY2_PLN_CITY	String	Pay-To Plan City Name
02		L2010AC_N402_PAY2_PLN_STAT	String	Pay-To Plan State or Province Code
03		L2010AC_N403_PAY2_PLN_ZIP	String	Pay-To Plan Postal Zone or ZIP Code
04		L2010AC_N404_CNTRY_CD	String	Country Code
07		L2010AC_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010AC	REF	Pay-to Plan Secondary Identification
02		L2010AC_REF_PYR_ID	String	Payer Identification Number
02		L2010AC_REF_CLM_OFC_NR	String	Claim Office Number
02		L2010AC_REF_NAIC	String	National Association of Insurance Commissioners (NAIC) Code

L2010AC	REF	Pay-To Plan Tax Identification Number
02		L2010AC_REF_EMPLR_ID_NR	String	Employer?s Identification Number

L2000B - SUBSCRIBER HIERARCHICAL LEVEL

L2000B	HL	Subscriber Hierarchical Level
01		L2000B_HL01_HIER_ID_NR	String	Hierarchical ID Number
02		L2000B_HL02_HIER_PARNT_ID_NR	String	Hierarchical Parent ID Number
04		L2000B_HL04_HL_CHLD_CD	String	Hierarchical Child Code

L2000B	SBR	Subscriber Information
01		L2000B_SBR01_PYR_RESP_SEQ_NR	String	Payer Responsibility Sequence Number Code
02		L2000B_SBR02_IND_RELAT_CD	String	Individual Relationship Code
03		L2000B_SBR03_SBR_POLCY_NR	String	Subscriber Group or Policy Number
04		L2000B_SBR04_SBR_GRP_NM	String	Subscriber Group Name
09		L2000B_SBR09_CLM_FIL_IND_CD	String	Claim Filing Indicator Code

L2010BA - SUBSCRIBER NAME

L2010BA	NM1	Subscriber Name
03		L2010BA_NM103_PERSN_LNM	String	Person Last Name
03		L2010BA_NM103_NONPSNENT_NM	String	Non-Person Entity Name
04		L2010BA_NM104_SBR_FNM	String	Subscriber First Name
05		L2010BA_NM105_SBR_MNM	String	Subscriber Middle Name or Initial
07		L2010BA_NM107_SBR_SFX	String	Subscriber Name Suffix
09		L2010BA_NM109_UNQ_HLTH_ID	String	Standard Unique Health Identifier for each Individual in the United States
09		L2010BA_NM109_MEM_ID_NR	String	Member Identification Number

L2010BA	N3	Subscriber Address
01		L2010BA_N301_SBR_ADDR	String	Subscriber Address Line
02		L2010BA_N302_SBR_ADDR	String	Subscriber Address Line

L2010BA	N4	Subscriber City, State, ZIP Code
01		L2010BA_N401_SBR_CITY	String	Subscriber City Name
02		L2010BA_N402_SBR_STAT	String	Subscriber State Code
03		L2010BA_N403_SBR_ZIP	String	Subscriber Postal Zone or ZIP Code
04		L2010BA_N404_CNTRY_CD	String	Country Code
07		L2010BA_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010BA	DMG	Subscriber Demographic Information
02		L2010BA_DMG02_SBR_DOB_D8	Date/Time	Subscriber Birth Date
03		L2010BA_DMG03_SUB_GENDR_CD	String	Subscriber Gender Code

L2010BA	REF	Subscriber Secondary Identification
02		L2010BA_REF_SSN	String	Social Security Number

L2010BA	REF	Property and Casualty Claim Number
02		L2010BA_REF_AGNCY_CLM_NR	String	Agency Claim Number

L2010BB - PAYER NAME

L2010BB	NM1	Payer Name
03		L2010BB_NM103_PYR_NM	String	Payer Name
09		L2010BB_NM109_PAYR_ID	String	Payor Identification
09		L2010BB_NM109_HCFA_PLAN_ID	String	Centers for Medicare and Medicaid Services PlanID

L2010BB	N3	Payer Address
01		L2010BB_N301_PYR_ADDR_LN	String	Payer Address Line
02		L2010BB_N302_PYR_ADDR_LN	String	Payer Address Line

L2010BB	N4	Payer City, State, ZIP Code
01		L2010BB_N401_PYR_CITY_NM	String	Payer City Name
02		L2010BB_N402_PYR_STAT	String	Payer State Code
03		L2010BB_N403_PYR_ZIP	String	Payer Postal Zone or ZIP Code
04		L2010BB_N404_CNTRY_CD	String	Country Code
07		L2010BB_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010BB	REF	Payer Secondary Identification	Iterated: [01-03]
02		L2010BB_nnREF_PYR_ID	String	Payer Identification Number
02		L2010BB_nnREF_EMPLR_ID_NR	String	Employer?s Identification Number
02		L2010BB_nnREF_CLM_OFC_NR	String	Claim Office Number
02		L2010BB_nnREF_NAIC	String	National Association of Insurance Commissioners (NAIC) Code

L2010BB	REF	Billing Provider Secondary Identification
02		L2010BB_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2010BB_REF_LOC_NR	String	Location Number

L2000C - PATIENT HIERARCHICAL LEVEL

L2000C	HL	Patient Hierarchical Level
01		L2000C_HL01_HIER_ID_NR	String	Hierarchical ID Number
02		L2000C_HL02_HIER_PARNT_ID_NR	String	Hierarchical Parent ID Number

L2000C	PAT	Patient Information
01		L2000C_PAT01_IND_RELAT_CD	String	Individual Relationship Code

L2010CA - PATIENT NAME

L2010CA	NM1	Patient Name
03		L2010CA_NM103_PT_LNM	String	Patient Last Name
04		L2010CA_NM104_PT_FNM	String	Patient First Name
05		L2010CA_NM105_PT_MNM	String	Patient Middle Name or Initial
07		L2010CA_NM107_PT_SFX	String	Patient Name Suffix

L2010CA	N3	Patient Address
01		L2010CA_N301_PT_ADDR	String	Patient Address Line
02		L2010CA_N302_PT_ADDR	String	Patient Address Line

L2010CA	N4	Patient City, State, ZIP Code
01		L2010CA_N401_PT_CITY	String	Patient City Name
02		L2010CA_N402_PT_STAT	String	Patient State Code
03		L2010CA_N403_PT_ZIP	String	Patient Postal Zone or ZIP Code
04		L2010CA_N404_CNTRY_CD	String	Country Code
07		L2010CA_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2010CA	DMG	Patient Demographic Information
02		L2010CA_DMG02_PT_DOB_D8	Date/Time	Patient Birth Date
03		L2010CA_DMG03_PAT_GNDR_CD	String	Patient Gender Code

L2010CA	REF	Property and Casualty Claim Number
02		L2010CA_REF_AGNCY_CLM_NR	String	Agency Claim Number

L2010CA	REF	Property and Casualty Patient Identifier
02		L2010CA_REF_MEM_ID	String	Member Identification Number
02		L2010CA_REF_SSN	String	Social Security Number

L2300 - CLAIM INFORMATION

L2300	CLM	Claim Information
01		L2300_CLM01_PT_CTL_NR	String	Patient Control Number
02		L2300_CLM02_TOT_CLM_CHG_AMT	Decimal	Total Claim Charge Amount
05	01	L2300_CLM0501_FAC_TYP_CD	String	Facility Type Code
05	03	L2300_CLM0503_CLM_FREQ_CD	String	Claim Frequency Code
07		L2300_CLM07_PLAN_PART_CD	String	Assignment or Plan Participation Code
08		L2300_CLM08_BEN_ASGT_CRT_IND	String	Benefits Assignment Certification Indicator
09		L2300_CLM09_RELS_NFO_CD	String	Release of Information Code
20		L2300_CLM20_DELAY_RSN_CD	String	Delay Reason Code

L2300

DTP

Discharge Hour

L2300	DTP	Statement Dates
03		L2300_DTP_STMNT_RD8_1	Start Date	Statement (RD8)
03		L2300_DTP_STMNT_RD8_2	End Date	Statement (RD8)

L2300	DTP	Admission Date/Hour
03		L2300_DTP_ADMSN_D8	Start Date	Admission (D8)

L2300	DTP	Date - Repricer Received Date
03		L2300_DTP_RCVD_D8	Start Date	Received (D8)

L2300	CL1	Institutional Claim Code
01		L2300_CL101_ADMSN_TYP_CD	String	Admission Type Code
02		L2300_CL102_ADMSN_SRC_CD	String	Admission Source Code
03		L2300_CL103_PT_STATS_CD	String	Patient Status Code

L2300	PWK	Claim Supplemental Information	Iterated: [01-10]
01		L2300_nnPWK01_ATT_REP_TYP_CD	String	Attachment Report Type Code
02		L2300_nnPWK02_ATT_TRANS_CD	String	Attachment Transmission Code
06		L2300_nnPWK06_ATTACH_CTL_NR	String	Attachment Control Number

L2300	CN1	Contract Information
01		L2300_CN101_CNTRCT_TYP_CD	String	Contract Type Code
02		L2300_CN102_CONTRCT_AMT	Decimal	Contract Amount
03		L2300_CN103_CONTRCT_PERC	Decimal	Contract Percentage
04		L2300_CN104_CONTRCT_CD	String	Contract Code
05		L2300_CN105_TERMS_DISCT_PERC	Decimal	Terms Discount Percentage
06		L2300_CN106_CONTRCT_VERS_ID	String	Contract Version Identifier

L2300	AMT	Patient Estimated Amount Due
02		L2300_AMT02_PAT_RESP_EST	Date Timestamp	Patient Responsibility - Estimated

L2300	REF	Service Authorization Exception Code
02		L2300_REF_SP_PMT_REF_NR	String	Special Payment Reference Number

L2300	REF	Referral Number
02		L2300_REF_REFRL_NR	String	Referral Number

L2300	REF	Prior Authorization
02		L2300_REF_PRIOR_AUTH	String	Prior Authorization Number

L2300	REF	Payer Claim Control Number
02		L2300_REF_ORIG_REF_NR	String	Original Reference Number

L2300	REF	Repriced Claim Number
02		L2300_REF_REP_CLM_ID	String	Repriced Claim Reference Number

L2300	REF	Adjusted Repriced Claim Number
02		L2300_REF_ADJ_REP_CLM_ID	String	Adjusted Repriced Claim Reference Number

L2300	REF	Investigational Device Exemption Number	Iterated: [01-05]
02		L2300_nnREF_QUAL_PRD_LST	String	Qualified Products List

L2300	REF	Claim Identifier For Transmission Intermediaries
02		L2300_REF_CLM_NR	String	Claim Number

L2300	REF	Auto Accident State
02		L2300_REF_LOC_NR	String	Location Number

L2300	REF	Medical Record Number
02		L2300_REF_MED_REC_ID	String	Medical Record Identification Number

L2300	REF	Demonstration Project Identifier
02		L2300_REF_PROJCT_CD	String	Project Code

L2300	REF	Peer Review Organization (PRO) Approval Number
02		L2300_REF_PPO_APPR_NR	String	Peer Review Organization (PRO) Approval Number

L2300	K3	File Information	Iterated: [01-10]
01		L2300_nnK301_FIXD_FMT_NFO	String	Fixed Format Information

L2300	NTE	Claim Note	Iterated: [01-10]
02		L2300_nnNTE02_ALLRGS	String	Allergies
02		L2300_nnNTE02_GOALS_DISCHG_PLN	String	Goals, Rehabilitation Potential, or Discharge Plans
02		L2300_nnNTE02_DIAG_DESC	String	Diagnosis Description
02		L2300_nnNTE02_DME_SUPP	String	Durable Medical Equipment (DME) and Supplies
02		L2300_nnNTE02_MEDCTN	String	Medications
02		L2300_nnNTE02_NUTRTL_REQ	String	Nutritional Requirements
02		L2300_nnNTE02_ORD_DISC_TMTS	String	Orders for Disciplines and Treatments
02		L2300_nnNTE02_RSN_HOMBND	String	Functional Limitations, Reason Homebound, or Both
02		L2300_nnNTE02_RSN_PAT_LV_HM	String	Reasons Patient Leaves Home
02		L2300_nnNTE02_TIME_RSN_PT	String	Times and Reasons Patient Not at Home
02		L2300_nnNTE02_UNSL_HM_SOC_ENV	String	Unusual Home, Social Environment, or Both
02		L2300_nnNTE02_SAFTY_MSRS	String	Safety Measures
02		L2300_nnNTE02_SUPP_PLAN_TMNT	String	Supplementary Plan of Treatment
02		L2300_nnNTE02_UPDTD_NFO	String	Updated Information

L2300	NTE	Billing Note
02		L2300_NTE02_BILL_NOT_TXT	String	Billing Note Text

L2300	CRC	EPSDT Referral	Segment Suffix:
02		L2300_CRCA02_CERT_COND_CD_IND	String	Certification Condition Code Applies Indicator
03		L2300_CRCA03_CONDTN_IND	String	Condition Indicator
04		L2300_CRCA04_CONDTN_IND	String	Condition Indicator
05		L2300_CRCA05_CONDTN_IND	String	Condition Indicator

L2300	HI	Principal Diagnosis
01	02	L2300_HI0102_ICD10_PRIN_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis
01	02	L2300_HI0102_ICD9_PRIN_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis
01	09	L2300_HI0109_PRSNT_ADMN_IND	String	Present on Admission Indicator

L2300	HI	Admitting Diagnosis
01	02	L2300_HI0102_ICD10_ADMTG_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis
01	02	L2300_HI0102_ICD9_ADMTG_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis

L2300	HI	Patient?s Reason For Visit	Segment Suffix:
01	02	L2300_HIB0102_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
01	02	L2300_HIB0102_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
02	02	L2300_HIB0202_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
02	02	L2300_HIB0202_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit
03	02	L2300_HIB0302_ICD10_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Patient?s Reason for Visit
03	02	L2300_HIB0302_ICD9_RSN_VISIT	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Patient?s Reason for Visit

L2300	HI	External Cause of Injury	Segment Suffix:
01	02	L2300_HIC0102_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
01	02	L2300_HIC0102_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
01	09	L2300_HIC0109_PRSNT_ADMN_IND	String	Present on Admission Indicator
02	02	L2300_HIC0202_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
02	02	L2300_HIC0202_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
02	09	L2300_HIC0209_PRSNT_ADMN_IND	String	Present on Admission Indicator
03	02	L2300_HIC0302_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
03	02	L2300_HIC0302_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
03	09	L2300_HIC0309_PRSNT_ADMN_IND	String	Present on Admission Indicator
04	02	L2300_HIC0402_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
04	02	L2300_HIC0402_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
04	09	L2300_HIC0409_PRSNT_ADMN_IND	String	Present on Admission Indicator
05	02	L2300_HIC0502_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
05	02	L2300_HIC0502_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
05	09	L2300_HIC0509_PRSNT_ADMN_IND	String	Present on Admission Indicator
06	02	L2300_HIC0602_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
06	02	L2300_HIC0602_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
06	09	L2300_HIC0609_PRSNT_ADMN_IND	String	Present on Admission Indicator
07	02	L2300_HIC0702_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
07	02	L2300_HIC0702_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
07	09	L2300_HIC0709_PRSNT_ADMN_IND	String	Present on Admission Indicator
08	02	L2300_HIC0802_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
08	02	L2300_HIC0802_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
08	09	L2300_HIC0809_PRSNT_ADMN_IND	String	Present on Admission Indicator
09	02	L2300_HIC0902_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
09	02	L2300_HIC0902_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
09	09	L2300_HIC0909_PRSNT_ADMN_IND	String	Present on Admission Indicator
10	02	L2300_HIC1002_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
10	02	L2300_HIC1002_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
10	09	L2300_HIC1009_PRSNT_ADMN_IND	String	Present on Admission Indicator
11	02	L2300_HIC1102_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
11	02	L2300_HIC1102_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
11	09	L2300_HIC1109_PRSNT_ADMN_IND	String	Present on Admission Indicator
12	02	L2300_HIC1202_ICD10_EXT_INJRY	String	International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury
12	02	L2300_HIC1202_ICD9_ECODE	String	International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes)
12	09	L2300_HIC1209_PRSNT_ADMN_IND	String	Present on Admission Indicator

L2300	HI	Diagnosis Related Group (DRG) Information	Segment Suffix:
01	02	L2300_HID0102_DRG	String	Diagnosis Related Group (DRG)

L2300	HI	Other Diagnosis Information	Segment Suffix: Iterated: [01-02]
01	02	L2300_nnHIE0102_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
01	02	L2300_nnHIE0102_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
01	09	L2300_nnHIE0109_PRSNT_ADMN_IND	String	Present on Admission Indicator
02	02	L2300_nnHIE0202_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
02	02	L2300_nnHIE0202_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
02	09	L2300_nnHIE0209_PRSNT_ADMN_IND	String	Present on Admission Indicator
03	02	L2300_nnHIE0302_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
03	02	L2300_nnHIE0302_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
03	09	L2300_nnHIE0309_PRSNT_ADMN_IND	String	Present on Admission Indicator
04	02	L2300_nnHIE0402_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
04	02	L2300_nnHIE0402_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
04	09	L2300_nnHIE0409_PRSNT_ADMN_IND	String	Present on Admission Indicator
05	02	L2300_nnHIE0502_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
05	02	L2300_nnHIE0502_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
05	09	L2300_nnHIE0509_PRSNT_ADMN_IND	String	Present on Admission Indicator
06	02	L2300_nnHIE0602_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
06	02	L2300_nnHIE0602_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
06	09	L2300_nnHIE0609_PRSNT_ADMN_IND	String	Present on Admission Indicator
07	02	L2300_nnHIE0702_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
07	02	L2300_nnHIE0702_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
07	09	L2300_nnHIE0709_PRSNT_ADMN_IND	String	Present on Admission Indicator
08	02	L2300_nnHIE0802_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
08	02	L2300_nnHIE0802_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
08	09	L2300_nnHIE0809_PRSNT_ADMN_IND	String	Present on Admission Indicator
09	02	L2300_nnHIE0902_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
09	02	L2300_nnHIE0902_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
09	09	L2300_nnHIE0909_PRSNT_ADMN_IND	String	Present on Admission Indicator
10	02	L2300_nnHIE1002_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
10	02	L2300_nnHIE1002_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
10	09	L2300_nnHIE1009_PRSNT_ADMN_IND	String	Present on Admission Indicator
11	02	L2300_nnHIE1102_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
11	02	L2300_nnHIE1102_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
11	09	L2300_nnHIE1109_PRSNT_ADMN_IND	String	Present on Admission Indicator
12	02	L2300_nnHIE1202_ICD10_DIAG	String	International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis
12	02	L2300_nnHIE1202_ICD9_DIAG	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis
12	09	L2300_nnHIE1209_PRSNT_ADMN_IND	String	Present on Admission Indicator

L2300	HI	Principal Procedure Information	Segment Suffix:
01	02	L2300_HIF0102_ICD10_PRIN_PROC	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Principal Procedure
01	02	L2300_HIF0102_ICD9_PRN_PROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Procedure Codes
01	02	L2300_HIF0102_ABC_CD	String	Advanced Billing Concepts (ABC) Codes
01	04	L2300_HIF0104_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD

L2300	HI	Other Procedure Information	Segment Suffix: Iterated: [01-02]
01	02	L2300_nnHIG0102_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
01	02	L2300_nnHIG0102_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
01	04	L2300_nnHIG0104_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
02	02	L2300_nnHIG0202_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
02	02	L2300_nnHIG0202_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
02	04	L2300_nnHIG0204_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
03	02	L2300_nnHIG0302_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
03	02	L2300_nnHIG0302_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
03	04	L2300_nnHIG0304_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
04	02	L2300_nnHIG0402_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
04	02	L2300_nnHIG0402_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
04	04	L2300_nnHIG0404_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
05	02	L2300_nnHIG0502_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
05	02	L2300_nnHIG0502_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
05	04	L2300_nnHIG0504_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
06	02	L2300_nnHIG0602_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
06	02	L2300_nnHIG0602_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
06	04	L2300_nnHIG0604_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
07	02	L2300_nnHIG0702_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
07	02	L2300_nnHIG0702_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
07	04	L2300_nnHIG0704_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
08	02	L2300_nnHIG0802_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
08	02	L2300_nnHIG0802_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
08	04	L2300_nnHIG0804_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
09	02	L2300_nnHIG0902_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
09	02	L2300_nnHIG0902_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
09	04	L2300_nnHIG0904_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
10	02	L2300_nnHIG1002_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
10	02	L2300_nnHIG1002_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
10	04	L2300_nnHIG1004_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
11	02	L2300_nnHIG1102_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
11	02	L2300_nnHIG1102_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
11	04	L2300_nnHIG1104_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
12	02	L2300_nnHIG1202_ICD10_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes
12	02	L2300_nnHIG1202_ICD9_OPROC_CD	String	International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes
12	04	L2300_nnHIG1204_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD

L2300	HI	Occurrence Span Information	Segment Suffix: Iterated: [01-02]
01	02	L2300_nnHIH0102_OCCRNC_SPAN	String	Occurrence Span
01	04	L2300_nnHIH0104__RD8_1_D8	String	Span Start Date
01	04	L2300_nnHIH0104__RD8_2_D8	String	Span End Date
02	02	L2300_nnHIH0202_OCCRNC_SPAN	String	Occurrence Span
02	04	L2300_nnHIH0204__RD8_1_D8	String	Span Start Date
02	04	L2300_nnHIH0204__RD8_2_D8	String	Span End Date
03	02	L2300_nnHIH0302_OCCRNC_SPAN	String	Occurrence Span
03	04	L2300_nnHIH0304__RD8_1_D8	String	Span Start Date
03	04	L2300_nnHIH0304__RD8_2_D8	String	Span End Date
04	02	L2300_nnHIH0402_OCCRNC_SPAN	String	Occurrence Span
04	04	L2300_nnHIH0404__RD8_1_D8	String	Span Start Date
04	04	L2300_nnHIH0404__RD8_2_D8	String	Span End Date
05	02	L2300_nnHIH0502_OCCRNC_SPAN	String	Occurrence Span
05	04	L2300_nnHIH0504__RD8_1_D8	String	Span Start Date
05	04	L2300_nnHIH0504__RD8_2_D8	String	Span End Date
06	02	L2300_nnHIH0602_OCCRNC_SPAN	String	Occurrence Span
06	04	L2300_nnHIH0604__RD8_1_D8	String	Span Start Date
06	04	L2300_nnHIH0604__RD8_2_D8	String	Span End Date
07	02	L2300_nnHIH0702_OCCRNC_SPAN	String	Occurrence Span
07	04	L2300_nnHIH0704__RD8_1_D8	String	Span Start Date
07	04	L2300_nnHIH0704__RD8_2_D8	String	Span End Date
08	02	L2300_nnHIH0802_OCCRNC_SPAN	String	Occurrence Span
08	04	L2300_nnHIH0804__RD8_1_D8	String	Span Start Date
08	04	L2300_nnHIH0804__RD8_2_D8	String	Span End Date
09	02	L2300_nnHIH0902_OCCRNC_SPAN	String	Occurrence Span
09	04	L2300_nnHIH0904__RD8_1_D8	String	Span Start Date
09	04	L2300_nnHIH0904__RD8_2_D8	String	Span End Date
10	02	L2300_nnHIH1002_OCCRNC_SPAN	String	Occurrence Span
10	04	L2300_nnHIH1004__RD8_1_D8	String	Span Start Date
10	04	L2300_nnHIH1004__RD8_2_D8	String	Span End Date
11	02	L2300_nnHIH1102_OCCRNC_SPAN	String	Occurrence Span
11	04	L2300_nnHIH1104__RD8_1_D8	String	Span Start Date
11	04	L2300_nnHIH1104__RD8_2_D8	String	Span End Date
12	02	L2300_nnHIH1202_OCCRNC_SPAN	String	Occurrence Span
12	04	L2300_nnHIH1204__RD8_1_D8	String	Span Start Date
12	04	L2300_nnHIH1204__RD8_2_D8	String	Span End Date

L2300	HI	Occurrence Information	Segment Suffix: Iterated: [01-02]
01	02	L2300_nnHII0102_OCCRNC	String	Occurrence
01	04	L2300_nnHII0104_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
02	02	L2300_nnHII0202_OCCRNC	String	Occurrence
02	04	L2300_nnHII0204_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
03	02	L2300_nnHII0302_OCCRNC	String	Occurrence
03	04	L2300_nnHII0304_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
04	02	L2300_nnHII0402_OCCRNC	String	Occurrence
04	04	L2300_nnHII0404_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
05	02	L2300_nnHII0502_OCCRNC	String	Occurrence
05	04	L2300_nnHII0504_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
06	02	L2300_nnHII0602_OCCRNC	String	Occurrence
06	04	L2300_nnHII0604_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
07	02	L2300_nnHII0702_OCCRNC	String	Occurrence
07	04	L2300_nnHII0704_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
08	02	L2300_nnHII0802_OCCRNC	String	Occurrence
08	04	L2300_nnHII0804_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
09	02	L2300_nnHII0902_OCCRNC	String	Occurrence
09	04	L2300_nnHII0904_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
10	02	L2300_nnHII1002_OCCRNC	String	Occurrence
10	04	L2300_nnHII1004_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
11	02	L2300_nnHII1102_OCCRNC	String	Occurrence
11	04	L2300_nnHII1104_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD
12	02	L2300_nnHII1202_OCCRNC	String	Occurrence
12	04	L2300_nnHII1204_D8_D8	Date/Time	Date Expressed in Format CCYYMMDD

L2300	HI	Value Information	Segment Suffix: Iterated: [01-02]
01	02	L2300_nnHIJ0102_VALUE	String	Value
01	05	L2300_nnHIJ0105_VAL_CD_AMT	Decimal	Value Code Amount
02	02	L2300_nnHIJ0202_VALUE	String	Value
02	05	L2300_nnHIJ0205_VAL_CD_AMT	String	Value Code Amount
03	02	L2300_nnHIJ0302_VALUE	String	Value
03	05	L2300_nnHIJ0305_VAL_CD_AMT	Decimal	Value Code Amount
04	02	L2300_nnHIJ0402_VALUE	String	Value
04	05	L2300_nnHIJ0405_VAL_CD_AMT	Decimal	Value Code Amount
05	02	L2300_nnHIJ0502_VALUE	String	Value
05	05	L2300_nnHIJ0505_VAL_CD_AMT	Decimal	Value Code Amount
06	02	L2300_nnHIJ0602_VALUE	String	Value
06	05	L2300_nnHIJ0605_VAL_CD_AMT	Decimal	Value Code Amount
07	02	L2300_nnHIJ0702_VALUE	String	Value
07	05	L2300_nnHIJ0705_VAL_CD_AMT	Decimal	Value Code Amount
08	02	L2300_nnHIJ0802_VALUE	String	Value
08	05	L2300_nnHIJ0805_VAL_CD_AMT	Decimal	Value Code Amount
09	02	L2300_nnHIJ0902_VALUE	String	Value
09	05	L2300_nnHIJ0905_VAL_CD_AMT	Decimal	Value Code Amount
10	02	L2300_nnHIJ1002_VALUE	String	Value
10	05	L2300_nnHIJ1005_VAL_CD_AMT	Decimal	Value Code Amount
11	02	L2300_nnHIJ1102_VALUE	String	Value
11	05	L2300_nnHIJ1105_VAL_CD_AMT	Decimal	Value Code Amount
12	02	L2300_nnHIJ1202_VALUE	String	Value
12	05	L2300_nnHIJ1205_VAL_CD_AMT	Decimal	Value Code Amount

L2300	HI	Condition Information	Segment Suffix: Iterated: [01-02]
01	02	L2300_nnHIA0102_COND	String	Condition
02	02	L2300_nnHIA0202_COND	String	Condition
03	02	L2300_nnHIA0302_COND	String	Condition
04	02	L2300_nnHIA0402_COND	String	Condition
05	02	L2300_nnHIA0502_COND	String	Condition
06	02	L2300_nnHIA0602_COND	String	Condition
07	02	L2300_nnHIA0702_COND	String	Condition
08	02	L2300_nnHIA0802_COND	String	Condition
09	02	L2300_nnHIA0902_COND	String	Condition
10	02	L2300_nnHIA1002_COND	String	Condition
11	02	L2300_nnHIA1102_COND	String	Condition
12	02	L2300_nnHIA1202_COND	String	Condition

L2300	HI	Treatment Code Information	Segment Suffix: Iterated: [01-02]
01	02	L2300_nnHIL0102_TMT_CD	String	Treatment Codes
02	02	L2300_nnHIL0202_TMT_CD	String	Treatment Codes
03	02	L2300_nnHIL0302_TMT_CD	String	Treatment Codes
04	02	L2300_nnHIL0402_TMT_CD	String	Treatment Codes
05	02	L2300_nnHIL0502_TMT_CD	String	Treatment Codes
06	02	L2300_nnHIL0602_TMT_CD	String	Treatment Codes
07	02	L2300_nnHIL0702_TMT_CD	String	Treatment Codes
08	02	L2300_nnHIL0802_TMT_CD	String	Treatment Codes
09	02	L2300_nnHIL0902_TMT_CD	String	Treatment Codes
10	02	L2300_nnHIL1002_TMT_CD	String	Treatment Codes
11	02	L2300_nnHIL1102_TMT_CD	String	Treatment Codes
12	02	L2300_nnHIL1202_TMT_CD	String	Treatment Codes

L2300	HCP	Claim Pricing/Repricing Information
01		L2300_HCP01_PRIC_METHD	String	Pricing Methodology
02		L2300_HCP02_REPRCD_ALLWD_AMT	Decimal	Repriced Allowed Amount
03		L2300_HCP03_REPRCD_SAVNG_AMT	Decimal	Repriced Saving Amount
04		L2300_HCP04_REPRCNG_ORG_ID	String	Repricing Organization Identifier
05		L2300_HCP05_REPRCD_PERDIEM_AMT	Decimal	Repricing Per Diem or Flat Rate Amount
06		L2300_HCP06_REP_APP_DRG_CD	String	Repriced Approved DRG Code
07		L2300_HCP07_REPR_APPR_AMT	Decimal	Repriced Approved Amount
08		L2300_HCP08_REPR_APPR_REV_CD	String	Repriced Approved Revenue Code
12		L2300_HCP12_DAYS	Decimal	Days
12		L2300_HCP12_UN	Decimal	Unit
13		L2300_HCP13_REJ_RSN_CD	String	Reject Reason Code
14		L2300_HCP14_POLCY_COMP_CD	String	Policy Compliance Code
15		L2300_HCP15_EXCPTN_CD	String	Exception Code

L2310A - ATTENDING PROVIDER NAME

L2310A	NM1	Attending Provider Name
03		L2310A_NM103_ATT_PVR_LNM	String	Attending Provider Last Name
04		L2310A_NM104_ATT_PVR_FNM	String	Attending Provider First Name
05		L2310A_NM105_ATT_PVR_MNM	String	Attending Provider Middle Name or Initial
07		L2310A_NM107_ATT_PVR_SFX	String	Attending Provider Name Suffix
09		L2310A_NM109_ATT_PVR_PRI_ID	String	Attending Provider Primary Identifier

L2310A	PRV	Attending Provider Specialty Information
03		L2310A_PRV03_PVR_TAX_CD	String	Provider Taxonomy Code

L2310A	REF	Attending Provider Secondary Identification
02		L2310A_REF_STAT_LIC_NR	String	State License Number
02		L2310A_REF_UPIN	String	Provider UPIN Number
02		L2310A_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2310A_REF_LOC_NR	String	Location Number

L2310B - OPERATING PHYSICIAN NAME

L2310B	NM1	Operating Physician Name
03		L2310B_NM103_OPER_PHYS_LNM	String	Operating Physician Last Name
04		L2310B_NM104_OPER_PHYS_FNM	String	Operating Physician First Name
05		L2310B_NM105_OPER_PHYS_MNM	String	Operating Physician Middle Name or Initial
07		L2310B_NM107_OPER_PHYS_SFX	String	Operating Physician Name Suffix
09		L2310B_NM109_OPER_PHYS_PRI_ID	String	Operating Physician Primary Identifier

L2310B	REF	Operating Physician Secondary Identification
02		L2310B_REF_STAT_LIC_NR	String	State License Number
02		L2310B_REF_UPIN	String	Provider UPIN Number
02		L2310B_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2310B_REF_LOC_NR	String	Location Number

L2310C - OTHER OPERATING PHYSICIAN NAME

L2310C	NM1	Other Operating Physician Name
03		L2310C_NM103_OOPER_PHYS_LNM	String	Other Operating Physician Last Name
04		L2310C_NM104_OOPER_PHYS_FNM	String	Other Operating Physician First Name
05		L2310C_NM105_OOPER_PHYS_MNM	String	Other Operating Physician Middle Name or Initial
07		L2310C_NM107_OOPER_PHYS_SFX	String	Other Operating Physician Name Suffix
09		L2310C_NM109_OOPER_PHYS_ID	String	Other Operating Physician Identifier

L2310C	REF	Other Operating Physician Secondary Identification
02		L2310C_REF_STAT_LIC_NR	String	State License Number
02		L2310C_REF_UPIN	String	Provider UPIN Number
02		L2310C_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2310C_REF_LOC_NR	String	Location Number

L2310D - RENDERING PROVIDER NAME

L2310D	NM1	Rendering Provider Name
03		L2310D_NM103_REND_PVR_LNM	String	Rendering Provider Last Name
04		L2310D_NM104_REND_PVR_FNM	String	Rendering Provider First Name
05		L2310D_NM105_REND_PVR_MNM	String	Rendering Provider Middle Name or Initial
07		L2310D_NM107_REND_PROV_SFX	String	Rendering Provider Name Suffix
09		L2310D_NM109_REND_PROV_ID	String	Rendering Provider Identifier

L2310D	REF	Rendering Provider Secondary Identification
02		L2310D_REF_STAT_LIC_NR	String	State License Number
02		L2310D_REF_UPIN	String	Provider UPIN Number
02		L2310D_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2310D_REF_LOC_NR	String	Location Number

L2310E - SERVICE FACILITY LOCATION NAME

L2310E	NM1	Service Facility Location Name
03		L2310E_NM103_LAB_FAC_NM	String	Laboratory or Facility Name
09		L2310E_NM109_LAB_FAC_PRI_ID	String	Laboratory or Facility Primary Identifier

L2310E	N3	Service Facility Location Address
01		L2310E_N301_LAB_FAC_ADDR	String	Laboratory or Facility Address Line
02		L2310E_N302_LAB_FAC_ADDR	String	Laboratory or Facility Address Line

L2310E	N4	Service Facility Location City, State, ZIP Code
01		L2310E_N401_LAB_FAC_CITY	String	Laboratory or Facility City Name
02		L2310E_N402_LAB_FAC_STAT	String	Laboratory or Facility State or Province Code
03		L2310E_N403_LAB_ZIP	String	Laboratory or Facility Postal Zone or ZIP Code
04		L2310E_N404_CNTRY_CD	String	Country Code
07		L2310E_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2310E	REF	Service Facility Location Secondary Identification
02		L2310E_REF_STAT_LIC_NR	String	State License Number
02		L2310E_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2310E_REF_LOC_NR	String	Location Number

L2310F - REFERRING PROVIDER NAME

L2310F	NM1	Referring Provider Name
03		L2310F_NM103_REF_PVR_LNM	String	Referring Provider Last Name
04		L2310F_NM104_REF_PVR_FNM	String	Referring Provider First Name
05		L2310F_NM105_REF_PVR_MNM	String	Referring Provider Middle Name or Initial
07		L2310F_NM107_REF_PVR_SFX	String	Referring Provider Name Suffix
09		L2310F_NM109_REF_PVR_ID	String	Referring Provider Identifier

L2310F	REF	Referring Provider Secondary Identification
02		L2310F_REF_STAT_LIC_NR	String	State License Number
02		L2310F_REF_UPIN	String	Provider UPIN Number
02		L2310F_REF_PVR_COMM_NR	String	Provider Commercial Number

L2320 - OTHER SUBSCRIBER INFORMATION (Single Iteration)

L2320	SBR	Other Subscriber Information
01		L2320_xx_SBR01_PYR_RESP_SEQ_NR	String	Payer Responsibility Sequence Number Code
02		L2320_xx_SBR02_IND_RELAT_CD	String	Individual Relationship Code
03		L2320_xx_SBR03_INS_GRP_PLCY_NR	String	Insured Group or Policy Number
04		L2320_xx_SBR04_OINS_GRP_NM	String	Other Insured Group Name
09		L2320_xx_SBR09_CLM_FIL_IND_CD	String	Claim Filing Indicator Code

L2320	CAS	Claim Level Adjustments	Iterated: [01-05]
01		L2320_xx_nnCAS01_CLMADJ_GRP_CD	String	Claim Adjustment Group Code
02		L2320_xx_nnCAS02_ADJ_RSN_CD	String	Adjustment Reason Code
03		L2320_xx_nnCAS03_ADJ_AMT	Decimal	Adjustment Amount
04		L2320_xx_nnCAS04_ADJ_QTY	Decimal	Adjustment Quantity
05		L2320_xx_nnCAS05_ADJ_RSN_CD	String	Adjustment Reason Code
06		L2320_xx_nnCAS06_ADJ_AMT	Decimal	Adjustment Amount
07		L2320_xx_nnCAS07_ADJ_QTY	Decimal	Adjustment Quantity
08		L2320_xx_nnCAS08_ADJ_RSN_CD	String	Adjustment Reason Code
09		L2320_xx_nnCAS09_ADJ_AMT	Decimal	Adjustment Amount
10		L2320_xx_nnCAS10_ADJ_QTY	Decimal	Adjustment Quantity
11		L2320_xx_nnCAS11_ADJ_RSN_CD	String	Adjustment Reason Code
12		L2320_xx_nnCAS12_ADJ_AMT	Decimal	Adjustment Amount
13		L2320_xx_nnCAS13_ADJ_QTY	Decimal	Adjustment Quantity
14		L2320_xx_nnCAS14_ADJ_RSN_CD	String	Adjustment Reason Code
15		L2320_xx_nnCAS15_ADJ_AMT	Decimal	Adjustment Amount
16		L2320_xx_nnCAS16_ADJ_QTY	Decimal	Adjustment Quantity
17		L2320_xx_nnCAS17_ADJ_RSN_CD	String	Adjustment Reason Code
18		L2320_xx_nnCAS18_ADJ_AMT	Decimal	Adjustment Amount
19		L2320_xx_nnCAS19_ADJ_QTY	Decimal	Adjustment Quantity

L2320	AMT	Coordination of Benefits (COB) Payer Paid Amount
02		L2320_xx_AMT02_PAYR_AMT_PD	Date Timestamp	Payor Amount Paid

L2320	AMT	Remaining Patient Liability
02		L2320_xx_AMT02_AMT_OWED	Date Timestamp	Amount Owed

L2320	AMT	Coordination of Benefits (COB) Total Non-Covered Amount
02		L2320_xx_AMT02_NONCVD_CHG_ACTL	Date Timestamp	Noncovered Charges - Actual

L2320	OI	Other Insurance Coverage Information
03		L2320_xx_OI03_BEN_ASGT_CRT_IND	String	Benefits Assignment Certification Indicator
06		L2320_xx_OI06_RELS_NFO_CD	String	Release of Information Code

L2320	MIA	Inpatient Adjudication Information
01		L2320_xx_MIA01_COV_DAYS_VST_CT	Decimal	Covered Days or Visits Count
03		L2320_xx_MIA03_LFTM_PSYCH_DAYS	Decimal	Lifetime Psychiatric Days Count
04		L2320_xx_MIA04_CLM_DRG_AMT	Decimal	Claim DRG Amount
05		L2320_xx_MIA05_CLM_PMT_RMK_CD	String	Claim Payment Remark Code
06		L2320_xx_MIA06_CLM_DIS_SHR_AMT	Decimal	Claim Disproportionate Share Amount
07		L2320_xx_MIA07_CLM_MSP_PSS_AMT	Decimal	Claim MSP Pass-through Amount
08		L2320_xx_MIA08_CLM_PPS_CAP_AMT	Decimal	Claim PPS Capital Amount
09		L2320_xx_MIA09_PPS_FSP_DRG_AMT	Decimal	PPS-Capital FSP DRG Amount
10		L2320_xx_MIA10_PPS_HSP_DRG_AMT	Decimal	PPS-Capital HSP DRG Amount
11		L2320_xx_MIA11_PPS_DSH_DRG_AMT	Decimal	PPS-Capital DSH DRG Amount
12		L2320_xx_MIA12_OLD_CAP_AMT	Decimal	Old Capital Amount
13		L2320_xx_MIA13_PPS_CAP_IME_AMT	Decimal	PPS-Capital IME amount
14		L2320_xx_MIA14_PPS_OPRS_DRGAMT	Decimal	PPS-Operating Hospital Specific DRG Amount
15		L2320_xx_MIA15_COST_RPT_DAY_CT	Decimal	Cost Report Day Count
16		L2320_xx_MIA16_PPS_FED_DRG_AMT	Decimal	PPS-Operating Federal Specific DRG Amount
17		L2320_xx_MIA17_CLM_CAP_OUT_AMT	Decimal	Claim PPS Capital Outlier Amount
18		L2320_xx_MIA18_CLM_IND_TCH_AMT	Decimal	Claim Indirect Teaching Amount
19		L2320_xx_MIA19_NONPAY_PROF_BLL	Decimal	Non-Payable Professional Component Billed
20		L2320_xx_MIA20_CLM_PMT_RMK_CD	String	Claim Payment Remark Code
21		L2320_xx_MIA21_CLM_PMT_RMK_CD	String	Claim Payment Remark Code
22		L2320_xx_MIA22_CLM_PMT_RMK_CD	String	Claim Payment Remark Code
23		L2320_xx_MIA23_CLM_PMT_RMK_CD	String	Claim Payment Remark Code
24		L2320_xx_MIA24_PPS_EXCPTN_AMT	Decimal	PPS-Capital Exception Amount

L2320	MOA	Outpatient Adjudication Information
01		L2320_xx_MOA01_REIMBRSMT_RT	Decimal	Reimbursement Rate
02		L2320_xx_MOA02_HCPCS_PAYBL_AMT	Decimal	HCPCS Payable Amount
03		L2320_xx_MOA03_CLM_PMT_RMK_CD	String	Claim Payment Remark Code
04		L2320_xx_MOA04_CLM_PMT_RMK_CD	String	Claim Payment Remark Code
05		L2320_xx_MOA05_CLM_PMT_RMK_CD	String	Claim Payment Remark Code
06		L2320_xx_MOA06_CLM_PMT_RMK_CD	String	Claim Payment Remark Code
07		L2320_xx_MOA07_CLM_PMT_RMK_CD	String	Claim Payment Remark Code
08		L2320_xx_MOA08_ESRD_PMT_AMT	Decimal	End Stage Renal Disease Payment Amount
09		L2320_xx_MOA09_NONPAY_PROF_BLL	String	Non-Payable Professional Component Billed

L2330A - OTHER SUBSCRIBER NAME (Inherited Loop Iteration)

L2330A	NM1	Other Subscriber Name
03		L2330A_xx_NM103_PERSN_LNM	String	Person Last Name
03		L2330A_xx_NM103_NONPSNENT_NM	String	Non-Person Entity Name
04		L2330A_xx_NM104_OINS_FNM	String	Other Insured First Name
05		L2330A_xx_NM105_OINS_MNM	String	Other Insured Middle Name
07		L2330A_xx_NM107_OINS_SFX	String	Other Insured Name Suffix
09		L2330A_xx_NM109_UNQ_HLTH_ID	String	Standard Unique Health Identifier for each Individual in the United States
09		L2330A_xx_NM109_MEM_ID_NR	String	Member Identification Number

L2330A	N3	Other Subscriber Address
01		L2330A_xx_N301_OINS_ADDR	String	Other Insured Address Line
02		L2330A_xx_N302_OINS_ADDR	String	Other Insured Address Line

L2330A	N4	Other Subscriber City, State, ZIP Code
01		L2330A_xx_N401_OINS_CITY	String	Other Insured City Name
02		L2330A_xx_N402_OINS_STAT	String	Other Insured State Code
03		L2330A_xx_N403_OINS_ZIP	String	Other Insured Postal Zone or ZIP Code
04		L2330A_xx_N404_CNTRY_CD	String	Country Code
07		L2330A_xx_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2330A	REF	Other Subscriber Secondary Identification	Iterated: [01-02]
02		L2330A_xx_nnREF_SSN	String	Social Security Number

L2330B - OTHER PAYER NAME (Inherited Loop Iteration)

L2330B	NM1	Other Payer Name
03		L2330B_xx_NM103_OPYR_LSTORG_NM	String	Other Payer Last or Organization Name
09		L2330B_xx_NM109_PAYR_ID	String	Payor Identification
09		L2330B_xx_NM109_HCFA_PLAN_ID	String	Centers for Medicare and Medicaid Services PlanID

L2330B	N3	Other Payer Address
01		L2330B_xx_N301_OPYR_ADDR	String	Other Payer Address Line
02		L2330B_xx_N302_OPYR_ADDR	String	Other Payer Address Line

L2330B	N4	Other Payer City, State, ZIP Code
01		L2330B_xx_N401_OPYR_CITY_NM	String	Other Payer City Name
02		L2330B_xx_N402_OPYR_STAT	String	Other Payer State Code
03		L2330B_xx_N403_OPYR_POSTL_ZIP	String	Other Payer Postal Zone or ZIP Code
04		L2330B_xx_N404_CNTRY_CD	String	Country Code
07		L2330B_xx_N407_CNTRY_SUBDV_CD	String	Country Subdivision Code

L2330B	DTP	Claim Check or Remittance Date
03		L2330B_xx_DTP_CLM_PD_D8	Start Date	Date Claim Paid (D8)

L2330B	REF	Other Payer Secondary Identifier	Iterated: [01-02]
02		L2330B_xx_nnREF_PYR_ID	String	Payer Identification Number
02		L2330B_xx_nnREF_EMPLR_ID_NR	String	Employer?s Identification Number
02		L2330B_xx_nnREF_CLM_OFC_NR	String	Claim Office Number
02		L2330B_xx_nnREF_NAIC	String	National Association of Insurance Commissioners (NAIC) Code

L2330B	REF	Other Payer Prior Authorization Number
02		L2330B_xx_REF_PRIOR_AUTH	String	Prior Authorization Number

L2330B	REF	Other Payer Referral Number
02		L2330B_xx_REF_REFRL_NR	String	Referral Number

L2330B	REF	Other Payer Claim Adjustment Indicator
02		L2330B_xx_REF_SIGNL_CD	String	Signal Code

L2330B	REF	Other Payer Claim Control Number
02		L2330B_xx_REF_ORIG_REF_NR	String	Original Reference Number

L2330C - OTHER PAYER ATTENDING PROVIDER (Inherited Loop Iteration)

L2330C

NM1

Other Payer Attending Provider

L2330C	REF	Other Payer Attending Provider Secondary Identification
02		L2330C_xx_REF_STAT_LIC_NR	String	State License Number
02		L2330C_xx_REF_UPIN	String	Provider UPIN Number
02		L2330C_xx_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2330C_xx_REF_LOC_NR	String	Location Number

L2330D - OTHER PAYER OPERATING PHYSICIAN (Inherited Loop Iteration)

L2330D

NM1

Other Payer Operating Physician

L2330D	REF	Other Payer Operating Physician Secondary Identification
02		L2330D_xx_REF_STAT_LIC_NR	String	State License Number
02		L2330D_xx_REF_UPIN	String	Provider UPIN Number
02		L2330D_xx_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2330D_xx_REF_LOC_NR	String	Location Number

L2330E - OTHER PAYER OTHER OPERATING PHYSICIAN (Inherited Loop Iteration)

L2330E

NM1

Other Payer Other Operating Physician

L2330E	REF	Other Payer Other Operating Physician Secondary Identification
02		L2330E_xx_REF_STAT_LIC_NR	String	State License Number
02		L2330E_xx_REF_UPIN	String	Provider UPIN Number
02		L2330E_xx_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2330E_xx_REF_LOC_NR	String	Location Number

L2330F - OTHER PAYER SERVICE FACILITY LOCATION (Inherited Loop Iteration)

L2330F

NM1

Other Payer Service Facility Location

L2330F	REF	Other Payer Service Facility Location Secondary Identification
02		L2330F_xx_REF_STAT_LIC_NR	String	State License Number
02		L2330F_xx_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2330F_xx_REF_LOC_NR	String	Location Number

L2330G - OTHER PAYER RENDERING PROVIDER NAME (Inherited Loop Iteration)

L2330G

NM1

Other Payer Rendering Provider Name

L2330G	REF	Other Payer Rendering Provider Secondary Identification
02		L2330G_xx_REF_STAT_LIC_NR	String	State License Number
02		L2330G_xx_REF_UPIN	String	Provider UPIN Number
02		L2330G_xx_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2330G_xx_REF_LOC_NR	String	Location Number

L2330H - OTHER PAYER REFERRING PROVIDER (Inherited Loop Iteration)

L2330H

NM1

Other Payer Referring Provider

L2330H	REF	Other Payer Referring Provider Secondary Identification
02		L2330H_xx_REF_STAT_LIC_NR	String	State License Number
02		L2330H_xx_REF_UPIN	String	Provider UPIN Number
02		L2330H_xx_REF_PVR_COMM_NR	String	Provider Commercial Number

L2330I - OTHER PAYER BILLING PROVIDER (Inherited Loop Iteration)

L2330I

NM1

Other Payer Billing Provider

L2330I	REF	Other Payer Billing Provider Secondary Identification
02		L2330I_xx_REF_PVR_COMM_NR	String	Provider Commercial Number
02		L2330I_xx_REF_LOC_NR	String	Location Number

L2400 - SERVICE LINE NUMBER

L2400	LX	Service Line Number
01		L2400_LX01_ASSGD_NR	Integer	Assigned Number

L2400	SV2	Institutional Service Line
01		L2400_SV201_SVC_LIN_REV_CD	String	Service Line Revenue Code
02	02	L2400_SV20202_JS_PRC_SPY_CD	String	Jurisdiction Specific Procedure and Supply Codes
02	02	L2400_SV20202_HCPCS_CD	String	Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes
02	02	L2400_SV20202_HIPPA_SNF_RT_CD	String	Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code
02	02	L2400_SV20202_HIC_PRD_SVCCD	String	Home Infusion EDI Coalition (HIEC) Product/Service Code
02	02	L2400_SV20202_ABC_CD	String	Advanced Billing Concepts (ABC) Codes
02	03	L2400_SV20203_PROC_MOD	String	Procedure Modifier
02	04	L2400_SV20204_PROC_MOD	String	Procedure Modifier
02	05	L2400_SV20205_PROC_MOD	String	Procedure Modifier
02	06	L2400_SV20206_PROC_MOD	String	Procedure Modifier
02	07	L2400_SV20207_DESCR	String	Description
03		L2400_SV203_LIN_ITM_CHG_AMT	Decimal	Line Item Charge Amount
05		L2400_SV205_DAYS	Decimal	Days
05		L2400_SV205_UN	Decimal	Unit
07		L2400_SV207_LIN_ITM_DENY_CHG	Decimal	Line Item Denied Charge or Non-Covered Charge

L2400	PWK	Line Supplemental Information	Iterated: [01-10]
01		L2400_nnPWK01_ATT_REP_TYP_CD	String	Attachment Report Type Code
02		L2400_nnPWK02_ATT_TRANS_CD	String	Attachment Transmission Code
06		L2400_nnPWK06_ATTACH_CTL_NR	String	Attachment Control Number

L2400	DTP	Date - Service Date
03		L2400_DTP_SVC_D8	Start Date	Service (D8)
03		L2400_DTP_SVC_RD8_1	Start Date	Service (D8)
03		L2400_DTP_SVC_RD8_2	End Date	Service (D8)

L2400	REF	Line Item Control Number
02		L2400_REF_PRV_CTL_NR	String	Provider Control Number

L2400	REF	Repriced Line Item Reference Number
02		L2400_REF_REP_LIN_ITM	String	Repriced Line Item Reference Number

L2400	REF	Adjusted Repriced Line Item Reference Number
02		L2400_REF_ADJ_REP_LIN_ITM	String	Adjusted Repriced Line Item Reference Number

L2400	AMT	Service Tax Amount
02		L2400_AMT02_GDS_SVCS_TAX	Date Timestamp	Goods and Services Tax

L2400	AMT	Facility Tax Amount
02		L2400_AMT02_MISC_TAX	Date Timestamp	Miscellaneous Taxes

L2400	NTE	Third Party Organization Notes
02		L2400_NTE02_LIN_NOT_TXT	String	Line Note Text

L2400	HCP	Line Pricing/Repricing Information
01		L2400_HCP01_PRIC_METHD	String	Pricing Methodology
02		L2400_HCP02_MONTRY_AMT	Decimal	Monetary Amount
03		L2400_HCP03_MONTRY_AMT	Decimal	Monetary Amount
04		L2400_HCP04_REF_ID	String	Reference Identification
05		L2400_HCP05_RATE	Decimal	Rate
06		L2400_HCP06_REF_ID	String	Reference Identification
07		L2400_HCP07_MONTRY_AMT	Decimal	Monetary Amount
08		L2400_HCP08_PROD_SVC_ID	String	Product or Service ID
10		L2400_HCP10_JS_PRC_SPY_CD	String	Jurisdiction Specific Procedure and Supply Codes
10		L2400_HCP10_HCPCS_CD	String	Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes
10		L2400_HCP10_HIPPA_SNF_RT_CD	String	Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code
10		L2400_HCP10_HIC_PRD_SVCCD	String	Home Infusion EDI Coalition (HIEC) Product/Service Code
10		L2400_HCP10_ABC_CD	String	Advanced Billing Concepts (ABC) Codes
12		L2400_HCP12_DAYS	Decimal	Days
12		L2400_HCP12_UN	Decimal	Unit
13		L2400_HCP13_REJ_RSN_CD	String	Reject Reason Code
14		L2400_HCP14_POLCY_COMP_CD	String	Policy Compliance Code
15		L2400_HCP15_EXCPTN_CD	String	Exception Code

L2410 - DRUG IDENTIFICATION

L2410	LIN	Drug Identification
03		L2410_LIN03_NDC	String	National Drug Code

L2410	CTP	Drug Quantity
04		L2410_CTP04_NATL_DRG_UNIT_CT	Decimal	National Drug Unit Count
05	01	L2410_CTP0501_CD_QUAL	String	Code Qualifier

L2410	REF	Prescription or Compound Drug Association Number
02		L2410_REF_LNK_SEQ_NR	String	Link Sequence Number
02		L2410_REF_PHRM_RX_NR	String	Pharmacy Prescription Number

L2420A - OPERATING PHYSICIAN NAME

L2420A	NM1	Operating Physician Name
03		L2420A_NM103_OPER_PHYS_LNM	String	Operating Physician Last Name
04		L2420A_NM104_OPER_PHYS_FNM	String	Operating Physician First Name
05		L2420A_NM105_OPER_PHYS_MNM	String	Operating Physician Middle Name or Initial
07		L2420A_NM107_OPER_PHYS_SFX	String	Operating Physician Name Suffix
09		L2420A_NM109_OPER_PHYS_PRI_ID	String	Operating Physician Primary Identifier

L2420A	REF	Operating Physician Secondary Identification	Iterated: [01-20]
02		L2420A_nnREF_STAT_LIC_NR	String	State License Number
02		L2420A_nnREF_UPIN	String	Provider UPIN Number
02		L2420A_nnREF_PVR_COMM_NR	String	Provider Commercial Number
02		L2420A_nnREF_LOC_NR	String	Location Number
04	02	L2420A_nnREF0402_PYR_ID	String	Payer Identification Number

L2420B - OTHER OPERATING PHYSICIAN NAME

L2420B	NM1	Other Operating Physician Name
03		L2420B_NM103_OOPER_PHYS_LNM	String	Other Operating Physician Last Name
04		L2420B_NM104_OOPER_PHYS_FNM	String	Other Operating Physician First Name
05		L2420B_NM105_OOPER_PHYS_MNM	String	Other Operating Physician Middle Name or Initial
07		L2420B_NM107_OOPER_PHYS_SFX	String	Other Operating Physician Name Suffix
09		L2420B_NM109_OOPER_PHYS_ID	String	Other Operating Physician Identifier

L2420B	REF	Other Operating Physician Secondary Identification	Iterated: [01-20]
02		L2420B_nnREF_STAT_LIC_NR	String	State License Number
02		L2420B_nnREF_UPIN	String	Provider UPIN Number
02		L2420B_nnREF_PVR_COMM_NR	String	Provider Commercial Number
02		L2420B_nnREF_LOC_NR	String	Location Number
04	02	L2420B_nnREF0402_PYR_ID	String	Payer Identification Number

L2420C - RENDERING PROVIDER NAME

L2420C	NM1	Rendering Provider Name
03		L2420C_NM103_REND_PVR_LNM	String	Rendering Provider Last Name
04		L2420C_NM104_REND_PVR_FNM	String	Rendering Provider First Name
05		L2420C_NM105_REND_PVR_MNM	String	Rendering Provider Middle Name or Initial
07		L2420C_NM107_REND_PROV_SFX	String	Rendering Provider Name Suffix
09		L2420C_NM109_REND_PROV_ID	String	Rendering Provider Identifier

L2420C	REF	Rendering Provider Secondary Identification	Iterated: [01-20]
02		L2420C_nnREF_STAT_LIC_NR	String	State License Number
02		L2420C_nnREF_UPIN	String	Provider UPIN Number
02		L2420C_nnREF_PVR_COMM_NR	String	Provider Commercial Number
02		L2420C_nnREF_LOC_NR	String	Location Number
04	02	L2420C_nnREF0402_PYR_ID	String	Payer Identification Number

L2420D - REFERRING PROVIDER NAME

L2420D	NM1	Referring Provider Name
03		L2420D_NM103_REF_PVR_LNM	String	Referring Provider Last Name
04		L2420D_NM104_REF_PVR_FNM	String	Referring Provider First Name
05		L2420D_NM105_REF_PVR_MNM	String	Referring Provider Middle Name or Initial
07		L2420D_NM107_REF_PVR_SFX	String	Referring Provider Name Suffix
09		L2420D_NM109_REF_PVR_ID	String	Referring Provider Identifier

L2420D	REF	Referring Provider Secondary Identification	Iterated: [01-20]
02		L2420D_nnREF_STAT_LIC_NR	String	State License Number
02		L2420D_nnREF_UPIN	String	Provider UPIN Number
02		L2420D_nnREF_PVR_COMM_NR	String	Provider Commercial Number
04	02	L2420D_nnREF0402_PYR_ID	String	Payer Identification Number

L2430 - LINE ADJUDICATION INFORMATION (Single Iteration)

L2430	SVD	Line Adjudication Information
01		L2430_xx_SVD01_OPYR_PRI_ID	String	Other Payer Primary Identifier
02		L2430_xx_SVD02_SVC_LIN_PD_AMT	Decimal	Service Line Paid Amount
03	02	L2430_xx_SVD0302_JS_PRC_SPY_CD	String	Jurisdiction Specific Procedure and Supply Codes
03	02	L2430_xx_SVD0302_HCPCS_CD	String	Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes
03	02	L2430_xx_SVD0302_HPPS	String	Health Insurance Prospective Payment System
03	02	L2430_xx_SVD0302_HIC_PRD_SVCCD	String	Home Infusion EDI Coalition (HIEC) Product/Service
03	02	L2430_xx_SVD0302_ABC_CD	String	Advanced Billing Concepts (ABC) Codes
03	03	L2430_xx_SVD0303_PROC_MOD	String	Procedure Modifier
03	04	L2430_xx_SVD0304_PROC_MOD	String	Procedure Modifier
03	05	L2430_xx_SVD0305_PROC_MOD	String	Procedure Modifier
03	06	L2430_xx_SVD0306_PROC_MOD	String	Procedure Modifier
03	07	L2430_xx_SVD0307_PROC_CD_DESC	String	Procedure Code Description
04		L2430_xx_SVD04_SVC_LIN_REV_CD	String	Service Line Revenue Code
05		L2430_xx_SVD05_PD_SVC_UN_CT	Decimal	Paid Service Unit Count
06		L2430_xx_SVD06_BUNDL_LIN_NR	Integer	Bundled Line Number

L2430	CAS	Line Adjustment	Iterated: [01-05]
01		L2430_xx_nnCAS01_CLMADJ_GRP_CD	String	Claim Adjustment Group Code
02		L2430_xx_nnCAS02_ADJ_RSN_CD	String	Adjustment Reason Code
03		L2430_xx_nnCAS03_ADJ_AMT	Decimal	Adjustment Amount
04		L2430_xx_nnCAS04_ADJ_QTY	Decimal	Adjustment Quantity
05		L2430_xx_nnCAS05_ADJ_RSN_CD	String	Adjustment Reason Code
06		L2430_xx_nnCAS06_ADJ_AMT	Decimal	Adjustment Amount
07		L2430_xx_nnCAS07_ADJ_QTY	Decimal	Adjustment Quantity
08		L2430_xx_nnCAS08_ADJ_RSN_CD	String	Adjustment Reason Code
09		L2430_xx_nnCAS09_ADJ_AMT	Decimal	Adjustment Amount
10		L2430_xx_nnCAS10_ADJ_QTY	Decimal	Adjustment Quantity
11		L2430_xx_nnCAS11_ADJ_RSN_CD	String	Adjustment Reason Code
12		L2430_xx_nnCAS12_ADJ_AMT	Decimal	Adjustment Amount
13		L2430_xx_nnCAS13_ADJ_QTY	Decimal	Adjustment Quantity
14		L2430_xx_nnCAS14_ADJ_RSN_CD	String	Adjustment Reason Code
15		L2430_xx_nnCAS15_ADJ_AMT	Decimal	Adjustment Amount
16		L2430_xx_nnCAS16_ADJ_QTY	Decimal	Adjustment Quantity
17		L2430_xx_nnCAS17_ADJ_RSN_CD	String	Adjustment Reason Code
18		L2430_xx_nnCAS18_ADJ_AMT	Decimal	Adjustment Amount
19		L2430_xx_nnCAS19_ADJ_QTY	Decimal	Adjustment Quantity

L2430	DTP	Line Check or Remittance Date
03		L2430_xx_DTP_CLM_PD_D8	Start Date	Date Claim Paid (D8)

L2430	AMT	Remaining Patient Liability
02		L2430_xx_AMT02_AMT_OWED	Date Timestamp	Amount Owed

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