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

ISA - GROUP HEADERS

ISA

ISA

Interchange Control Header

02

ISA_ISA02_NO_AUTH_NFO

String

No Authorization Information Present

02

ISA_ISA02_ADDL_DATA_ID

String

Additional Data Identification

04

ISA_ISA04_NO_SEC_NFO

String

No Security Information Present

04

ISA_ISA04_PSSWD

String

Password

06

ISA_ISA06_DUN_BRDST

String

Dun and Brandstreet

06

ISA_ISA06_DUN_BRDST_SFX

String

Duns Plus Suffix

06

ISA_ISA06_HIN

String

Health Industry Number

06

ISA_ISA06_CARR_ID

String

Carrier Identification Number as assigned by Health Care Financing Administration

06

ISA_ISA06_HCFA_FIIN

String

Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration

06

ISA_ISA06_HCFA_ID

String

Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration

06

ISA_ISA06_TAX_ID

String

US Federal Tax Identification Number

06

ISA_ISA06_NAIC_CD

String

National Association of Insurance Commissioners Company Code

06

ISA_ISA06_MUTLY_DEF

String

Mutually Defined

08

ISA_ISA08_DUN_BRDST

String

Dun and Brandstreet

08

ISA_ISA08_DUN_BRDST_SFX

String

Duns Plus Suffix

08

ISA_ISA08_HIN

String

Health Industry Number

08

ISA_ISA08_CARR_ID

String

Carrier Identification Number as assigned by Health Care Financing Administration

08

ISA_ISA08_HCFA_FIIN

String

Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration

08

ISA_ISA08_HCFA_ID

String

Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration

08

ISA_ISA08_TAX_ID

String

US Federal Tax Identification Number

08

ISA_ISA08_NAIC_CD

String

National Association of Insurance Commissioners Company Code

08

ISA_ISA08_MUTLY_DEF

String

Mutually Defined

09

ISA_ISA09_INTCHG_DT

Date (YYMMDD)

Interchange Date

10

ISA_ISA10_INTCHG_TM

Time (HHMM)

Interchange Time

11

ISA_ISA11_REPTN_SEP

String

Repetition Separator

12

ISA_ISA12_ICN_VERS_NR

String

Interchang Control Version Number

13

ISA_ISA13_ICN

Integer

Interchange Control Number

14

ISA_ISA14_ACK_REQ

String

Acknowledgment Requested

15

ISA_ISA15_ICN_USG_IND

String

Interchange Usage Indicator

16

ISA_ISA16_COMP_ELE_SEP

String

Component Element Separator

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 (YYYYMMDD)

Date

05

GSHDR_GS05_TM

Time (HHMM)

Time

05

GSHDR_GS05_TM8

Time (HHMMSSCC)

Time

06

GSHDR_GS06_GCN

Integer

Group Control Number

07

GSHDR_GS07_RESP_AGNCY_CD

String

Responsible Agency Code

STHDR - TRANSACTION SET HEADER

STHDR

ST

Transaction Set Header

02

STHDR_ST02_TCN

String

Transaction Set Control Number

03

STHDR_ST03_IMP_GUID_VERS_NM

String

Implementation Guide Version Name

STHDR

AK1

Functional Group Response

01

STHDR_AK101_FUNC_ID_CD

String

Functional Identifier Code

02

STHDR_AK102_GCN

Integer

Group Control Number

03

STHDR_AK103_VERS_IND_ID_CD

String

Version Release/Industry Identifier Code

L2000 - TRANSACTION SET RESPONSE

L2000

AK2

Transaction Set Response

01

L2000_AK201_VERS

String

Version

02

L2000_AK202_TCN

String

Transaction Set Control Number

03

L2000_AK203_IMP_CONV_REF

String

Implementation Convention Reference

L2100 - ERROR IDENTIFICATION

L2100

IK3

Error Identification

01

L2100_IK301_SEG_ID_CD

String

Segment ID Code

02

L2100_IK302_SEG_POS_IN_TS

Integer

Segment Position in Transaction Set

03

L2100_IK303_LOOP_ID_CD

String

Loop Identifier Code

04

L2100_IK304_IMP_SEG_ERR_CD

String

Implementation Segment Syntax Error Code

L2100

CTX

Segment Context

02

L2100_nnCTX02_SEG_ID_CD

String

Segment ID Code

03

L2100_nnCTX03_SEG_POS

Integer

Segment Position in TS

04

L2100_nnCTX04_LOOP_ID_CD

String

Loop ID Code

05

01

L2100_nnCTX0501_ELE_POS_SEG

Integer

Element Position in Segment

05

02

L2100_nnCTX0502_CMP_DT_ELE_POS

Integer

Composite Data Element Position in Composite

05

03

L2100_nnCTX0503_REP_DT_ELE_POS

Integer

Repeating Data Element Position

06

L2100_nnCTX06_REF_IN_SEG

Integer

Reference in Segment

L2100

CTX

Business Unit Identifier

01

01

L2100_CTX0101_CONTXT_NM

String

Context Name

01

02

L2100_CTX0102_CONTXT_REF

String

Context Reference

L2110 - IMPLEMENTATION DATA ELEMENT NOTE

L2110

IK4

Implementation Data Element Note

01

01

L2110_IK40101_ELE_POS_SEG

Integer

Element Position in Segment

01

02

L2110_IK40102_CMP_ELE_POS_COMP

Integer

Component Data Element Position in Composite

01

03

L2110_IK40103_REP_DT_ELE_POS

Integer

Repeating Data Element Position

02

L2110_IK402_DATA_ELE_REF_NR

Integer

Data Element Reference Number

03

L2110_IK403_IMP_DAT_ELE_SYN_CD

String

Implementation Data Element Syntax Error Code

04

L2110_IK404_COPY_BAD_DATA_ELE

String

Copy of Bad Data Element

L2110

CTX

Element Context

02

L2110_CTX02_SEG_ID_CD

String

Segment ID Code

03

L2110_CTX03_SEG_POS_IN_TS

Integer

Segment Position in Transaction Set

04

L2110_CTX04_LOOP_ID_CD

Integer

Loop Identifier Code

05

01

L2110_CTX0501_ELE_POS_SEG

Integer

Element Position in Segment

05

02

L2110_CTX0502_CMP_ELE_POS_COMP

Integer

Component Data Element Position in Composite

05

03

L2110_CTX0503_REP_DT_ELE_POS

Integer

Repeating Data Element Position

06

L2110_CTX06_DATA_ELE_REF_NR

Integer

Data Element Reference Number

L2000

IK5

Transaction Set Response Trailer

01

L2000_IK501_TRANS_STAT

String

Transaction Status

02

L2000_IK502_IMP_TS_ERR_CD

String

Implementation Transaction Set Syntax Error Code

03

L2000_IK503_IMP_TS_ERR_CD

String

Implementation Transaction Set Syntax Error Code

04

L2000_IK504_IMP_TS_ERR_CD

String

Implementation Transaction Set Syntax Error Code

05

L2000_IK505_IMP_TS_ERR_CD

String

Implementation Transaction Set Syntax Error Code

06

L2000_IK506_IMP_TS_ERR_CD

String

Implementation Transaction Set Syntax Error Code

STHDR

AK9

Functional Group Response Trailer

01

STHDR_AK901_FUNC_GRP_ACK_CD

String

Functional Group Acknowledge Code

02

STHDR_AK902_NR_TS_INCLUDED

Integer

Number of Transaction Sets Included

03

STHDR_AK903_NR_REVD_TS

Integer

Number of Received TS

04

STHDR_AK904_NR_ACCPTD_TS

Integer

Number of Accepted TS

05

STHDR_AK905_FUNC_GRP_SYN_ERR

String

Functional Group Syntax Error Code

06

STHDR_AK906_FUNC_GRP_SYN_ERR

String

Functional Group Syntax Error Code

07

STHDR_AK907_FUNC_GRP_SYN_ERR

String

Functional Group Syntax Error Code

08

STHDR_AK908_FUNC_GRP_SYN_ERR

String

Functional Group Syntax Error Code

09

STHDR_AK909_FUNC_GRP_SYN_ERR

String

Functional Group Syntax Error 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

ISA

TA1

Transaction Acknowledgment

01

ISA_TA101_ICN

Integer

Interchange Control Number

02

ISA_TA102_INTCHG_DT

Date (YYMMDD)

Interchange Date

03

ISA_TA103_INTCHG_TM

Time (HHMM)

Interchange Time

04

ISA_TA104_ICN_ACK_CD

String

Interchange Acknowledgment Code

05

ISA_TA105_ICN_NOT_CD

String

Interchange Note Code

ISA

IEA

Interchange Control Trailer

01

ISA_IEA01_NR_INC_FUNC_GRP

Integer

Number of Included Functional Groups

02

ISA_IEA02_ICN

Integer

Interchange Control Number