Chiapas EDI 2012 Mapping Guide

5010_834 5010 Benefit Enrollment and Maintenance - Code:T0

ISA - GROUP HEADERS

Loop	Segment	Segment Name	Chiapas Gate Mapping
OEISA	ISA	Interchange Control Header
OEISA	ISA02	No Authorization Information Present	OEISA_S01_ISA02_AUTH_NFO_OVL_NO_AUTH_NFO
OEISA	ISA02	Additional Data Identification	OEISA_S01_ISA02_AUTH_NFO_OVL_ADDL_ID
OEISA	ISA04	No Security Information Present	OEISA_S01_ISA04_SEC_NFO_OVL_NO_SEC_NFO
OEISA	ISA04	Password	OEISA_S01_ISA04_SEC_NFO_OVL_PASSWD
OEISA	ISA06	Dun and Brandstreet	OEISA_S01_ISA06_SENDR_ID_OVL_DUNS_ID
OEISA	ISA06	Duns Plus Suffix	OEISA_S01_ISA06_SENDR_ID_OVL_DUNS_SUFFX_ID
OEISA	ISA06	Health Industry Number	OEISA_S01_ISA06_SENDR_ID_OVL_HIN_ID
OEISA	ISA06	Carrier Identification Number as assigned by Health Care Financing Administration	OEISA_S01_ISA06_SENDR_ID_OVL_HCFA_CARR_ID
OEISA	ISA06	Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration	OEISA_S01_ISA06_SENDR_ID_OVL_HCFA_FIIN_ID
OEISA	ISA06	Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration	OEISA_S01_ISA06_SENDR_ID_OVL_HCFA_MEDCR_ID
OEISA	ISA06	US Federal Tax Identification Number	OEISA_S01_ISA06_SENDR_ID_OVL_TAX_ID
OEISA	ISA06	National Association of Insurance Commissioners Company Code	OEISA_S01_ISA06_SENDR_ID_OVL_NAIC_ID
OEISA	ISA06	Mutually Defined	OEISA_S01_ISA06_SENDR_ID_OVL_MUTLY_DEFND_ID
OEISA	ISA08	Dun and Brandstreet	OEISA_S01_ISA08_RECVR_ID_OVL_DUNS_ID
OEISA	ISA08	Duns Plus Suffix	OEISA_S01_ISA08_RECVR_ID_OVL_DUNS_SUFFX_ID
OEISA	ISA08	Health Industry Number	OEISA_S01_ISA08_RECVR_ID_OVL_HIN_ID
OEISA	ISA08	Carrier Identification Number as assigned by Health Care Financing Administration	OEISA_S01_ISA08_RECVR_ID_OVL_HCFA_CARR_ID
OEISA	ISA08	Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration	OEISA_S01_ISA08_RECVR_ID_OVL_HCFA_FIIN_ID
OEISA	ISA08	Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration	OEISA_S01_ISA08_RECVR_ID_OVL_HCFA_MEDCR_ID
OEISA	ISA08	US Federal Tax Identification Number	OEISA_S01_ISA08_RECVR_ID_OVL_TAX_ID
OEISA	ISA08	National Association of Insurance Commissioners Company Code	OEISA_S01_ISA08_RECVR_ID_OVL_NAIC_ID
OEISA	ISA08	Mutually Defined	OEISA_S01_ISA08_RECVR_ID_OVL_MUTLY_DEFND_ID
OEISA	ISA09	Interchange Date	OEISA_S01_ISA09_DT
OEISA	ISA10	Interchange Time	OEISA_S01_ISA10_TM
OEISA	ISA11	Repetition Separator	OEISA_S01_ISA11_REPTN_SEPRTR
OEISA	ISA12	Interchang Control Version Number	OEISA_S01_ISA12_VERSN_NR
OEISA	ISA13	Interchange Control Number	OEISA_S01_ISA13_ICN
OEISA	ISA14	Acknowledgment Requested	OEISA_S01_ISA14_ACK_REQ
OEISA	ISA15	Interchange Usage Indicator	OEISA_S01_ISA15_USG_IND
OEISA	ISA16	Component Element Separator	OEISA_S01_ISA16_SUBELE_SEP
OEISA	IEA	Interchange Control Trailer
OEISA	IEA01	Number of Included Functional Groups	OEISA_S03_IEA01_GS_CT
OEISA	IEA02	Interchange Control Number	OEISA_S03_IEA02_ICN

GSHDR - GROUP HEADER

Loop	Segment	Segment Name	Chiapas Gate Mapping
GSHDR	GS	Functional Group Header
GSHDR	GS01	Functional Identifier Code	GSHDR_S01_GS01_FUNCTL_ID_CD
GSHDR	GS02	Application Senders Code	GSHDR_S01_GS02_APP_SENDR_CD
GSHDR	GS03	Application Receivers Code	GSHDR_S01_GS03_APP_RECVR_CD
GSHDR	GS04	Date	GSHDR_S01_GS04_DT
GSHDR	GS05	Time	GSHDR_S01_GS05_TM
GSHDR	GS06	Group Control Number	GSHDR_S01_GS06_GCN
GSHDR	GS07	Responsible Agency Code	GSHDR_S01_GS07_RESP_AGNCY_CD
GSHDR	GE	Functional Group Trailer
GSHDR	GE01	Number of Transaction Sets Included	GSHDR_S03_GE01_TS_CT
GSHDR	GE02	Group Control Number	GSHDR_S03_GE02_GCN

STHDR - TRANSACTION SET HEADER

Loop	Segment	Segment Name	Chiapas Gate Mapping
STHDR	ST	Transaction Set Header
STHDR	ST01	Transaction Set Identifier Code	STHDR_S01_ST01_ID_CD
STHDR	ST02	Transaction Set Control Number	STHDR_S01_ST02_CONTRL_NR
STHDR	ST03	Implementation Convention Reference	STHDR_S01_ST03_IMPLMNTN_CONVNTN_REFNC
STHDR	BGN	Beginning Segment
STHDR	BGN01	Transaction Set Purpose Code	STHDR_S02_BGN01_TS_PURPS_CD
STHDR	BGN02	Transaction Set Reference Number	STHDR_S02_BGN02_TS_REF_NR
STHDR	BGN03	Transaction Set Creation Date	STHDR_S02_BGN03_TS_CREATN_DT
STHDR	BGN04	Transaction Set Creation Time	STHDR_S02_BGN04_TS_CREATN_TIM
STHDR	BGN05	Time Zone Code	STHDR_S02_BGN05_TIM_ZON_CD
STHDR	BGN06	Original Transaction Set Reference Number	STHDR_S02_BGN06_ORGNL_TS_REF_NR
STHDR	BGN08	Action Code	STHDR_S02_BGN08_ACTN_CD
STHDR	REF	Transaction Set Policy Number
STHDR	REF02	Master Policy Number	STHDR_S03_REF02_MASTR_POLCY_NR_OVL_MASTR_POLCY_NR
STHDR	DTP	File Effective Date
STHDR	DTP03	Effective (D8)	STHDR_S04_DTP03_DT_TM_PERD_OVL_EFF_D8
STHDR	DTP03	Report Start (D8)	STHDR_S04_DTP03_DT_TM_PERD_OVL_REPRT_START_D8
STHDR	DTP03	Report End (D8)	STHDR_S04_DTP03_DT_TM_PERD_OVL_REPRT_END_D8
STHDR	DTP03	Maintenance Effective (D8)	STHDR_S04_DTP03_DT_TM_PERD_OVL_MAINTNC_EFF_D8
STHDR	DTP03	Enrollment (D8)	STHDR_S04_DTP03_DT_TM_PERD_OVL_ENRLMNT_D8
STHDR	DTP03	Payment Commencement (D8)	STHDR_S04_DTP03_DT_TM_PERD_OVL_PMT_COMNCMNT_D8
STHDR	QTY	Transaction Set Control Totals
STHDR	QTY02	Dependent Total	STHDR_S05_QTY02_RECRD_TOTLS_OVL_DEPNDNT_TOTL
STHDR	QTY02	Employee Total	STHDR_S05_QTY02_RECRD_TOTLS_OVL_EMPLY_TOTL
STHDR	QTY02	Total	STHDR_S05_QTY02_RECRD_TOTLS_OVL_TOTL
STHDR	SE	Transaction Set Trailer
STHDR	SE01	Transaction Segment Count	STHDR_S10_SE01_SEG_CT
STHDR	SE02	Transaction Set Control Number	STHDR_S10_SE02_TCN

1000A - SPONSOR NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L1000A	N1	Sponsor Name
L1000A	N102	Plan Sponsor Name	L1000A_S01_N102_PLAN_SPONSR_NM
L1000A	N104	Employer’s Identification Number	L1000A_S01_N104_SPONSR_ID_OVL_EMPLYR_ID_NR
L1000A	N104	Code assigned by the organization that is the ultimate destination of the transaction set	L1000A_S01_N104_SPONSR_ID_OVL_CD_ASGND_DESTNTN_ORG
L1000A	N104	Federal Taxpayer’s Identification Number	L1000A_S01_N104_SPONSR_ID_OVL_FED_TAX_ID_NR

1000B - PAYER

Loop	Segment	Segment Name	Chiapas Gate Mapping
L1000B	N1	Payer
L1000B	N102	Insurer Name	L1000B_S01_N102_INSR_NM
L1000B	N104	Code assigned by the organization that is the ultimate destination of the transaction set	L1000B_S01_N104_INSR_ID_CD_OVL_CD_ASGND_DESTNTN_ORG
L1000B	N104	Federal Taxpayer’s Identification Number	L1000B_S01_N104_INSR_ID_CD_OVL_FED_TAX_ID_NR
L1000B	N104	Centers for Medicare and Medicaid Services PlanID	L1000B_S01_N104_INSR_ID_CD_OVL_MDCR_MDCD_SVCS_PLAND

1000C - TPA/BROKER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
1000C		Qualified Loop
L1000C		Broker or Sales Office	L1000C_BO
L1000C		Third Party Administrator (TPA)	L1000C_TV
L1000C	N1	TPA/Broker Name
L1000C	N102	TPA or Broker Name	L1000C_XX_S01_N102_BROKR_NM
L1000C	N104	Code assigned by the organization that is the ultimate destination of the transaction set	L1000C_XX_S01_N104_TPA_BROKR_ID_CD_OVL_CD_ASGND_DESTNTN_ORG
L1000C	N104	Federal Taxpayer’s Identification Number	L1000C_XX_S01_N104_TPA_BROKR_ID_CD_OVL_FED_TAX_ID_NR
L1000C	N104	Centers for Medicare and Medicaid Services PlanID	L1000C_XX_S01_N104_TPA_BROKR_ID_CD_OVL_MDCR_MDCD_SVCS_PLAND

1100C - TPA/BROKER ACCOUNT INFORMATION

Loop	Segment	Segment Name	Chiapas Gate Mapping
L1100C	ACT	TPA/Broker Account Information
L1100C	ACT01	TPA or Broker Account Number	L1100C_S01_ACT01_TPA_BROKR_ACNT_NR
L1100C	ACT06	TPA or Broker Account Number	L1100C_S01_ACT06_TPA_BROKR_ACNT_NR

2000 - MEMBER LEVEL DETAIL

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2000	INS	Member Level Detail
L2000	INS01	Member Indicator	L2000_S01_INS01_MEM_IND
L2000	INS02	Individual Relationship Code	L2000_S01_INS02_INDVDL_REL_CD
L2000	INS03	Maintenance Type Code	L2000_S01_INS03_MAINTNC_TYPE_CD
L2000	INS04	Maintenance Reason Code	L2000_S01_INS04_MAINTNC_RSN_CD
L2000	INS05	Benefit Status Code	L2000_S01_INS05_BENFT_STATS_CD
L2000	INS06-01	Medicare Plan Code	L2000_S01_INS06_01_MEDCR_PLAN_CD
L2000	INS06-02	Medicare Eligibility Reason Code	L2000_S01_INS06_02_MEDCR_ELIG_RSN_CD
L2000	INS07	Consolidated Omnibus Budget Reconciliation Act implementation guide, do not send.	L2000_S01_INS07_COBRA_IMPLMNTN_GUID
L2000	INS08	Employment Status Code	L2000_S01_INS08_EMPLYMNT_STATS_CD
L2000	INS09	Student Status Code	L2000_S01_INS09_STUDNT_STATS_CD
L2000	INS10	Handicap Indicator	L2000_S01_INS10_HANDCP_IND
L2000	INS12	Date Expressed in Format CCYYMMDD	L2000_S01_INS12_MEM_INDVDL_DEATH_DT_OVL_DT_CCYYMMDD
L2000	INS13	Confidentiality Code	L2000_S01_INS13_CONFDNTLTY_CD
L2000	INS17	Birth Sequence Number	L2000_S01_INS17_BIRTH_SEQNC_NR
L2000	REF	Subscriber Identifier
L2000	REF02	Subscriber Number	L2000_S02_REF02_SUB_ID_OVL_SUB_NR
L2000	REF	Member Policy Number
L2000	REF02	Group or Policy Number	L2000_S03_REF02_MEM_GRP_POLCY_NR_OVL_GRP_POLCY_NR
L2000	REF	Member Supplemental Identifier
L2000	REF02	Client Reporting Category	L2000_S04_REF02_SUPP_ID_OVL_CLIENT_REPRTNG_CATGRY
L2000	REF02	Client Number	L2000_S04_REF02_SUPP_ID_OVL_CLIENT_NR
L2000	REF02	Case Number	L2000_S04_REF02_SUPP_ID_OVL_CAS_NR
L2000	REF02	Personal Identification Number (PIN)	L2000_S04_REF02_SUPP_ID_OVL_PIN
L2000	REF02	Cross Reference Number	L2000_S04_REF02_SUPP_ID_OVL_CROS_REF_NR
L2000	REF02	Personal ID Number	L2000_S04_REF02_SUPP_ID_OVL_PERSNL_ID_NR
L2000	REF02	National Council for Prescription Drug Programs Pharmacy Number	L2000_S04_REF02_SUPP_ID_OVL_NATL_COUNCL_RX_DRUG_PROG_PHAMRCY_NR
L2000	REF02	Department/Agency Number	L2000_S04_REF02_SUPP_ID_OVL_DEPRTMNT_GNCY_NR
L2000	REF02	Health Insurance Claim (HIC) Number	L2000_S04_REF02_SUPP_ID_OVL_HIC_NR
L2000	REF02	Position Code	L2000_S04_REF02_SUPP_ID_OVL_POSTN_CD
L2000	REF02	Prior Identifier Number	L2000_S04_REF02_SUPP_ID_OVL_PRI_ID_NR
L2000	REF02	Unit Number	L2000_S04_REF02_SUPP_ID_OVL_UNT_NR
L2000	REF02	Mutually Defined	L2000_S04_REF02_SUPP_ID_OVL_MUTLY_DEFND
L2000	DTP	Member Level Dates
L2000	DTP03	Received (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_RECVD_D8
L2000	DTP03	Retirement (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_RETRMNT_D8
L2000	DTP03	Initial Disability Period Return To Work (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_INTL_DISBLTY_PERD_RETRN_TO_WORK_D8
L2000	DTP03	Initial Disability Period Last Day Worked (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_INTL_DISBLTY_PERD_LAST_DAY_WORKD_D8
L2000	DTP03	Enrollment Signature Date (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_ENRLMNT_SIGNTR_DT_D8
L2000	DTP03	Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_COBRA_QUAL_EVNT_D8
L2000	DTP03	Maintenance Effective (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_MAINTNC_EFF_D8
L2000	DTP03	Employment Begin (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_EMPLYMNT_BEGN_D8
L2000	DTP03	Employment End (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_EMPLYMNT_END_D8
L2000	DTP03	Medicare Begin (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_MEDCR_BEGN_D8
L2000	DTP03	Medicare End (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_MEDCR_END_D8
L2000	DTP03	Consolidated Omnibus Budget Reconciliation Act (COBRA) Begin (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_COBRA_BGN_D8
L2000	DTP03	Consolidated Omnibus Budget Reconciliation Act (COBRA) End (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_COBRA_END_D8
L2000	DTP03	Education Begin (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_EDCTN_BEGN_D8
L2000	DTP03	Education End (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_EDCTN_END_D8
L2000	DTP03	Eligibility Begin (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_ELIG_BEGN_D8
L2000	DTP03	Eligibility End (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_ELIG_END_D8
L2000	DTP03	Adjusted Hire (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_ADJSTD_HIR_D8
L2000	DTP03	Credited Service Begin (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_CREDTD_SVC_BEGN_D8
L2000	DTP03	Credited Service End (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_CREDTD_SVC_END_D8
L2000	DTP03	Plan Participation Suspension (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_PLAN_PARTCPTN_SUSPNSN_D8
L2000	DTP03	Rehire (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_REHR_D8
L2000	DTP03	Medicaid Begin (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_MEDCD_BEGN_D8
L2000	DTP03	Medicaid End (D8)	L2000_S05_DTP03_STATS_NFO_EFF_DT_OVL_MEDCD_END_D8

2100A - MEMBER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
2100A		Qualified Loop
L2100A		Corrected Insured	L2100A_74
L2100A		Insured or Subscriber	L2100A_IL
L2100A	NM1	Member Name
L2100A	NM103	Person	L2100A_XX_S01_NM103_MEM_LNAME_OVL_PERSN
L2100A	NM104	Member First Name	L2100A_XX_S01_NM104_MEM_FNAME
L2100A	NM105	Member Middle Name	L2100A_XX_S01_NM105_MEM_MNAME
L2100A	NM106	Member Name Prefix	L2100A_XX_S01_NM106_NM_PREFX
L2100A	NM107	Member Name Suffix	L2100A_XX_S01_NM107_NM_SUFX
L2100A	NM109	Social Security Number	L2100A_XX_S01_NM109_MEM_ID_OVL_SSN
L2100A	NM109	Mutually Defined	L2100A_XX_S01_NM109_MEM_ID_OVL_MUTLY_DEFND
L2100A	PER	Member Communications Numbers
L2100A	PER01	Contact Function Code	L2100A_XX_S02_PER01_CONTCT_FUNCTN_CD
L2100A	PER04	Alternate Telephone	L2100A_XX_S02_PER04_COMM_NR_OVL_ALTRNT_TELPHN
L2100A	PER04	Beeper Number	L2100A_XX_S02_PER04_COMM_NR_OVL_BEPR_NR
L2100A	PER04	Cellular Phone	L2100A_XX_S02_PER04_COMM_NR_OVL_CELR_PHON
L2100A	PER04	Electronic Mail	L2100A_XX_S02_PER04_COMM_NR_OVL_EMAIL
L2100A	PER04	Telephone Extension	L2100A_XX_S02_PER04_COMM_NR_OVL_PHN_EXTNS
L2100A	PER04	Facsimile	L2100A_XX_S02_PER04_COMM_NR_OVL_FACSML
L2100A	PER04	Home Phone Number	L2100A_XX_S02_PER04_COMM_NR_OVL_HOM_PHON_NR
L2100A	PER04	Telephone	L2100A_XX_S02_PER04_COMM_NR_OVL_TELPHN
L2100A	PER04	Work Phone Number	L2100A_XX_S02_PER04_COMM_NR_OVL_WORK_PHON_NR
L2100A	PER06	Alternate Telephone	L2100A_XX_S02_PER06_COMM_NR_OVL_ALTRNT_TELPHN
L2100A	PER06	Beeper Number	L2100A_XX_S02_PER06_COMM_NR_OVL_BEPR_NR
L2100A	PER06	Cellular Phone	L2100A_XX_S02_PER06_COMM_NR_OVL_CELR_PHON
L2100A	PER06	Electronic Mail	L2100A_XX_S02_PER06_COMM_NR_OVL_EMAIL
L2100A	PER06	Telephone Extension	L2100A_XX_S02_PER06_COMM_NR_OVL_PHN_EXTNS
L2100A	PER06	Facsimile	L2100A_XX_S02_PER06_COMM_NR_OVL_FACSML
L2100A	PER06	Home Phone Number	L2100A_XX_S02_PER06_COMM_NR_OVL_HOM_PHON_NR
L2100A	PER06	Telephone	L2100A_XX_S02_PER06_COMM_NR_OVL_TELPHN
L2100A	PER06	Work Phone Number	L2100A_XX_S02_PER06_COMM_NR_OVL_WORK_PHON_NR
L2100A	PER08	Alternate Telephone	L2100A_XX_S02_PER08_COMM_NR_OVL_ALTRNT_TELPHN
L2100A	PER08	Beeper Number	L2100A_XX_S02_PER08_COMM_NR_OVL_BEPR_NR
L2100A	PER08	Cellular Phone	L2100A_XX_S02_PER08_COMM_NR_OVL_CELR_PHON
L2100A	PER08	Electronic Mail	L2100A_XX_S02_PER08_COMM_NR_OVL_EMAIL
L2100A	PER08	Telephone Extension	L2100A_XX_S02_PER08_COMM_NR_OVL_PHN_EXTNS
L2100A	PER08	Facsimile	L2100A_XX_S02_PER08_COMM_NR_OVL_FACSML
L2100A	PER08	Home Phone Number	L2100A_XX_S02_PER08_COMM_NR_OVL_HOM_PHON_NR
L2100A	PER08	Telephone	L2100A_XX_S02_PER08_COMM_NR_OVL_TELPHN
L2100A	PER08	Work Phone Number	L2100A_XX_S02_PER08_COMM_NR_OVL_WORK_PHON_NR
L2100A	N3	Member Residence Street Address
L2100A	N301	Member Address Line	L2100A_XX_S03_N301_ADRS_LIN
L2100A	N302	Member Address Line	L2100A_XX_S03_N302_ADRS_LIN
L2100A	N4	Member City, State, ZIP Code
L2100A	N401	Member City Name	L2100A_XX_S04_N401_CITY_NM
L2100A	N402	Member State Code	L2100A_XX_S04_N402_STAT_CD
L2100A	N403	Member Postal Zone or Zip Code	L2100A_XX_S04_N403_MEM_POSTL_ZON_ZIP_CD
L2100A	N404	Country Code	L2100A_XX_S04_N404_CNTRY_CD
L2100A	N406	Area	L2100A_XX_S04_N406_LOC_ID_OVL_AR
L2100A	N406	County/Parish	L2100A_XX_S04_N406_LOC_ID_OVL_COUNTY_PRSH
L2100A	N407	Country Subdivision Code	L2100A_XX_S04_N407_COUNTRY_SUBDVSN_CD
L2100A	DMG	Member Demographics
L2100A	DMG02	Date Expressed in Format CCYYMMDD	L2100A_XX_S05_DMG02_BIRTH_DT_OVL_DT_CCYYMMDD
L2100A	DMG03	Gender Code	L2100A_XX_S05_DMG03_GENDR_CD
L2100A	DMG04	Marital Status Code	L2100A_XX_S05_DMG04_MARTL_STATS_CD
L2100A	DMG05-01	Race or Ethnicity Code	L2100A_XX_S05_DMG05_01_RAC_ETHNCTY_CD
L2100A	DMG05-03	Classification of Race or Ethnicity	L2100A_XX_S05_DMG05_03_RAC_ETHNCTY_CD_OVL_CLASFCTN_RAC_ETHNCTY
L2100A	DMG06	Citizenship Status Code	L2100A_XX_S05_DMG06_CITZNSHP_STATS_CD
L2100A	DMG11	Race or Ethnicity Collection Code	L2100A_XX_S05_DMG11_RAC_ETHNCTY_COLCTN_CD_OVL_RAC_ETHNCTY_COLCTN_CD
L2100A	EC	Employment Class
L2100A	EC01	Employment Class Code	L2100A_XX_S06_EC01_CLAS_CD
L2100A	EC02	Employment Class Code	L2100A_XX_S06_EC02_CLAS_CD
L2100A	EC03	Employment Class Code	L2100A_XX_S06_EC03_CLAS_CD
L2100A	ICM	Member Income
L2100A	ICM02	Year-to-Date	L2100A_XX_S07_ICM02_WAG_AMT_OVL_YEARTDT
L2100A	ICM02	Single	L2100A_XX_S07_ICM02_WAG_AMT_OVL_SINGL
L2100A	ICM02	Hourly	L2100A_XX_S07_ICM02_WAG_AMT_OVL_HOURLY
L2100A	ICM02	Quarterly	L2100A_XX_S07_ICM02_WAG_AMT_OVL_QUARTRLY
L2100A	ICM02	Semiannual	L2100A_XX_S07_ICM02_WAG_AMT_OVL_SEMNL
L2100A	ICM02	Unknown	L2100A_XX_S07_ICM02_WAG_AMT_OVL_UNKNWN
L2100A	ICM02	Weekly	L2100A_XX_S07_ICM02_WAG_AMT_OVL_WEKLY
L2100A	ICM02	Biweekly	L2100A_XX_S07_ICM02_WAG_AMT_OVL_BIWKLY
L2100A	ICM02	Semimonthly	L2100A_XX_S07_ICM02_WAG_AMT_OVL_SEMNTHLY
L2100A	ICM02	Monthly	L2100A_XX_S07_ICM02_WAG_AMT_OVL_MONTHLY
L2100A	ICM02	Daily	L2100A_XX_S07_ICM02_WAG_AMT_OVL_DAILY
L2100A	ICM02	Annual	L2100A_XX_S07_ICM02_WAG_AMT_OVL_ANL
L2100A	ICM02	Two Calendar Months	L2100A_XX_S07_ICM02_WAG_AMT_OVL_TWO_CALNDR_MONTHS
L2100A	ICM02	Lump-Sum Separation Allowance	L2100A_XX_S07_ICM02_WAG_AMT_OVL_LUMPSM_SEPRTN_ALWNC
L2100A	ICM03	Work Hours Count	L2100A_XX_S07_ICM03_WORK_HOURS_CT
L2100A	ICM04	Location Identification Code	L2100A_XX_S07_ICM04_LOC_ID_CD
L2100A	ICM05	Salary Grade Code	L2100A_XX_S07_ICM05_SALRY_GRAD_CD
L2100A	AMT	Member Policy Amounts
L2100A	AMT02	Co-insurance - Actual	L2100A_XX_S08_AMT02_CONTRCT_AMT_OVL_CONSRNC_ACTL
L2100A	AMT02	Co-Payment Amount	L2100A_XX_S08_AMT02_CONTRCT_AMT_OVL_COPYMNT_AMT
L2100A	AMT02	Deductible Amount	L2100A_XX_S08_AMT02_CONTRCT_AMT_OVL_DEDCTBL_AMT
L2100A	AMT02	Expected Expenditure Amount	L2100A_XX_S08_AMT02_CONTRCT_AMT_OVL_EXPCTD_EXPNDTR_AMT
L2100A	AMT02	Other Unlisted Amount	L2100A_XX_S08_AMT02_CONTRCT_AMT_OVL_OTHR_UNLSTD_AMT
L2100A	AMT02	Premium Amount	L2100A_XX_S08_AMT02_CONTRCT_AMT_OVL_PREM_AMT
L2100A	AMT02	Spend Down	L2100A_XX_S08_AMT02_CONTRCT_AMT_OVL_SPEND_DOWN
L2100A	HLH	Member Health Information
L2100A	HLH01	Health Related Code	L2100A_XX_S09_HLH01_RELTD_CD
L2100A	HLH02	Member Height	L2100A_XX_S09_HLH02_MEM_HEIGHT
L2100A	HLH03	Member Weight	L2100A_XX_S09_HLH03_MEM_WEIGHT
L2100A	LUI	Member Language
L2100A	LUI02	NISO Z39.53 Language Codes	L2100A_XX_S10_LUI02_LANG_CD_OVL_NIS_Z3953_LANG_CD
L2100A	LUI02	ISO 639 Language Codes	L2100A_XX_S10_LUI02_LANG_CD_OVL_IS_639_LANG_CD
L2100A	LUI03	Language Description	L2100A_XX_S10_LUI03_LANG_DESCRPTN
L2100A	LUI04	Language Use Indicator	L2100A_XX_S10_LUI04_LANG_US_IND

2100B - INCORRECT MEMBER NAME

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2100B	NM1	Incorrect Member Name
L2100B	NM103	Person	L2100B_S01_NM103_PRI_INCRCT_MEM_LNAME_OVL_PERSN
L2100B	NM104	Prior Incorrect Member First Name	L2100B_S01_NM104_PRI_INCRCT_MEM_FNAME
L2100B	NM105	Prior Incorrect Member Middle Name	L2100B_S01_NM105_PRI_INCRCT_MEM_MNAME
L2100B	NM106	Prior Incorrect Member Name Prefix	L2100B_S01_NM106_PRI_INCRCT_MEM_NM_PREFX
L2100B	NM107	Prior Incorrect Member Name Suffix	L2100B_S01_NM107_PRI_INCRCT_MEM_NM_SUFX
L2100B	NM109	Social Security Number	L2100B_S01_NM109_PRI_INCRCT_INSRD_ID_OVL_SSN
L2100B	NM109	Mutually Defined	L2100B_S01_NM109_PRI_INCRCT_INSRD_ID_OVL_MUTLY_DEFND
L2100B	DMG	Incorrect Member Demographics
L2100B	DMG02	Date Expressed in Format CCYYMMDD	L2100B_S02_DMG02_PRI_INCRCT_INSRD_BIRTH_DT_OVL_DT_CCYYMMDD
L2100B	DMG03	Prior Incorrect Insured Gender Code	L2100B_S02_DMG03_PRI_INCRCT_INSRD_GENDR_CD
L2100B	DMG04	Marital Status Code	L2100B_S02_DMG04_MARTL_STATS_CD
L2100B	DMG05-01	Race or Ethnicity Code	L2100B_S02_DMG05_01_RAC_ETHNCTY_CD
L2100B	DMG05-02	Code List Qualifier Code	L2100B_S02_DMG05_02_CD_LIST_QUAL_CD
L2100B	DMG05-03	Race or Ethnicity Code	L2100B_S02_DMG05_03_RAC_ETHNCTY_CD
L2100B	DMG06	Citizenship Status Code	L2100B_S02_DMG06_CITZNSHP_STATS_CD
L2100B	DMG10	Code List Qualifier Code	L2100B_S02_DMG10_CD_LIST_QUAL_CD
L2100B	DMG11	Race or Ethnicity Collection Code	L2100B_S02_DMG11_RAC_ETHNCTY_COLCTN_CD

2100C - MEMBER MAILING ADDRESS

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2100C	NM1	Member Mailing Address
L2100C	NM102	Entity Type Qualifier	L2100C_S01_NM102_ENTY_TYPE_QUAL
L2100C	N3	Member Mail Street Address
L2100C	N301	Member Address Line	L2100C_S02_N301_ADRS_LIN
L2100C	N302	Member Address Line	L2100C_S02_N302_ADRS_LIN
L2100C	N4	Member Mail City, State, ZIP Code
L2100C	N401	Member Mail City Name	L2100C_S03_N401_MEM_MAIL_CITY_NM
L2100C	N402	Member Mail State Code	L2100C_S03_N402_MEM_MAIL_STAT_CD
L2100C	N403	Member Mail Postal Zone or ZIP Code	L2100C_S03_N403_POSTL_ZON_ZIP_CD
L2100C	N404	Country Code	L2100C_S03_N404_CNTRY_CD
L2100C	N407	Country Subdivision Code	L2100C_S03_N407_COUNTRY_SUBDVSN_CD

2100D - MEMBER EMPLOYER

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2100D	NM1	Member Employer
L2100D	NM102	Entity Type Qualifier	L2100D_S01_NM102_ENTY_TYPE_QUAL
L2100D	NM103	Member Employer Name	L2100D_S01_NM103_EMPLYR_NM
L2100D	NM104	Member Employer First Name	L2100D_S01_NM104_EMPLYR_FNAME
L2100D	NM105	Member Employer Middle Name	L2100D_S01_NM105_EMPLYR_MNAME
L2100D	NM106	Member Employer Name Prefix	L2100D_S01_NM106_MEM_EMPLYR_NM_PREFX
L2100D	NM107	Member Employer Name Suffix	L2100D_S01_NM107_MEM_EMPLYR_NM_SUFX
L2100D	NM109	Employer’s Identification Number	L2100D_S01_NM109_EMPLYR_ID_OVL_EMPLYR_ID_NR
L2100D	NM109	Social Security Number	L2100D_S01_NM109_EMPLYR_ID_OVL_SSN
L2100D	PER	Member Employer Communications Numbers
L2100D	PER01	Contact Function Code	L2100D_S02_PER01_CONTCT_FUNCTN_CD
L2100D	PER02	Member Employer Communications Contact	L2100D_S02_PER02_MEM_EMPLYR_COMM_CONTCT
L2100D	PER04	Alternate Telephone	L2100D_S02_PER04_COMM_NR_OVL_ALTRNT_TELPHN
L2100D	PER04	Beeper Number	L2100D_S02_PER04_COMM_NR_OVL_BEPR_NR
L2100D	PER04	Cellular Phone	L2100D_S02_PER04_COMM_NR_OVL_CELR_PHON
L2100D	PER04	Electronic Mail	L2100D_S02_PER04_COMM_NR_OVL_EMAIL
L2100D	PER04	Telephone Extension	L2100D_S02_PER04_COMM_NR_OVL_PHN_EXTNS
L2100D	PER04	Facsimile	L2100D_S02_PER04_COMM_NR_OVL_FACSML
L2100D	PER04	Telephone	L2100D_S02_PER04_COMM_NR_OVL_TELPHN
L2100D	PER06	Alternate Telephone	L2100D_S02_PER06_COMM_NR_OVL_ALTRNT_TELPHN
L2100D	PER06	Beeper Number	L2100D_S02_PER06_COMM_NR_OVL_BEPR_NR
L2100D	PER06	Cellular Phone	L2100D_S02_PER06_COMM_NR_OVL_CELR_PHON
L2100D	PER06	Electronic Mail	L2100D_S02_PER06_COMM_NR_OVL_EMAIL
L2100D	PER06	Telephone Extension	L2100D_S02_PER06_COMM_NR_OVL_PHN_EXTNS
L2100D	PER06	Facsimile	L2100D_S02_PER06_COMM_NR_OVL_FACSML
L2100D	PER06	Telephone	L2100D_S02_PER06_COMM_NR_OVL_TELPHN
L2100D	PER08	Alternate Telephone	L2100D_S02_PER08_COMM_NR_OVL_ALTRNT_TELPHN
L2100D	PER08	Beeper Number	L2100D_S02_PER08_COMM_NR_OVL_BEPR_NR
L2100D	PER08	Cellular Phone	L2100D_S02_PER08_COMM_NR_OVL_CELR_PHON
L2100D	PER08	Electronic Mail	L2100D_S02_PER08_COMM_NR_OVL_EMAIL
L2100D	PER08	Telephone Extension	L2100D_S02_PER08_COMM_NR_OVL_PHN_EXTNS
L2100D	PER08	Facsimile	L2100D_S02_PER08_COMM_NR_OVL_FACSML
L2100D	PER08	Telephone	L2100D_S02_PER08_COMM_NR_OVL_TELPHN
L2100D	N3	Member Employer Street Address
L2100D	N301	Member Employer Address Line	L2100D_S03_N301_MEM_EMPLYR_ADRS_LIN
L2100D	N302	Member Employer Address Line	L2100D_S03_N302_MEM_EMPLYR_ADRS_LIN
L2100D	N4	Member Employer City, State, ZIP Code
L2100D	N401	Member Employer City Name	L2100D_S04_N401_MEM_EMPLYR_CITY_NM
L2100D	N402	Member Employer State Code	L2100D_S04_N402_MEM_EMPLYR_STAT_CD
L2100D	N403	Member Employer Postal Zone or ZIP Code	L2100D_S04_N403_POSTL_ZON_ZIP_CD
L2100D	N404	Country Code	L2100D_S04_N404_CNTRY_CD
L2100D	N407	Country Subdivision Code	L2100D_S04_N407_COUNTRY_SUBDVSN_CD

2100E - MEMBER SCHOOL

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2100E	NM1	Member School
L2100E	NM103	Non-Person Entity	L2100E_S01_NM103_SCHOL_NM_OVL_NONPRSN_ENTY
L2100E	PER	Member School Commmunications Numbers
L2100E	PER01	Contact Function Code	L2100E_S02_PER01_CONTCT_FUNCTN_CD
L2100E	PER02	Member School Communications Contact Name	L2100E_S02_PER02_CONTCT_NM
L2100E	PER04	Electronic Mail	L2100E_S02_PER04_COMM_NR_OVL_EMAIL
L2100E	PER04	Telephone Extension	L2100E_S02_PER04_COMM_NR_OVL_PHN_EXTNS
L2100E	PER04	Facsimile	L2100E_S02_PER04_COMM_NR_OVL_FACSML
L2100E	PER04	Telephone	L2100E_S02_PER04_COMM_NR_OVL_TELPHN
L2100E	PER06	Electronic Mail	L2100E_S02_PER06_COMM_NR_OVL_EMAIL
L2100E	PER06	Telephone Extension	L2100E_S02_PER06_COMM_NR_OVL_PHN_EXTNS
L2100E	PER06	Facsimile	L2100E_S02_PER06_COMM_NR_OVL_FACSML
L2100E	PER06	Telephone	L2100E_S02_PER06_COMM_NR_OVL_TELPHN
L2100E	PER08	Electronic Mail	L2100E_S02_PER08_COMM_NR_OVL_EMAIL
L2100E	PER08	Telephone Extension	L2100E_S02_PER08_COMM_NR_OVL_PHN_EXTNS
L2100E	PER08	Facsimile	L2100E_S02_PER08_COMM_NR_OVL_FACSML
L2100E	PER08	Telephone	L2100E_S02_PER08_COMM_NR_OVL_TELPHN
L2100E	N3	Member School Street Address
L2100E	N301	School Address Line	L2100E_S03_N301_ADRS_LIN
L2100E	N302	School Address Line	L2100E_S03_N302_ADRS_LIN
L2100E	N4	Member School City, State, ZIP Code
L2100E	N401	Member School City Name	L2100E_S04_N401_MEM_SCHOL_CITY_NM
L2100E	N402	Member School State Code	L2100E_S04_N402_MEM_SCHOL_STAT_CD
L2100E	N403	Member School Postal Zone or ZIP Code	L2100E_S04_N403_POSTL_ZON_ZIP_CD
L2100E	N404	Country Code	L2100E_S04_N404_CNTRY_CD
L2100E	N407	Country Subdivision Code	L2100E_S04_N407_COUNTRY_SUBDVSN_CD

2100F - CUSTODIAL PARENT

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2100F	NM1	Custodial Parent
L2100F	NM103	Person	L2100F_S01_NM103_PARNT_LNAME_OVL_PERSN
L2100F	NM104	Custodial Parent First Name	L2100F_S01_NM104_PARNT_FNAME
L2100F	NM105	Custodial Parent Middle Name	L2100F_S01_NM105_PARNT_MNAME
L2100F	NM106	Custodial Parent Name Prefix	L2100F_S01_NM106_CUSTDL_PARNT_NM_PREFX
L2100F	NM107	Custodial Parent Name Suffix	L2100F_S01_NM107_CUSTDL_PARNT_NM_SUFX
L2100F	NM109	Social Security Number	L2100F_S01_NM109_PARNT_ID_OVL_SSN
L2100F	NM109	Mutually Defined	L2100F_S01_NM109_PARNT_ID_OVL_MUTLY_DEFND
L2100F	PER	Custodial Parent Communications Numbers
L2100F	PER01	Contact Function Code	L2100F_S02_PER01_CONTCT_FUNCTN_CD
L2100F	PER04	Alternate Telephone	L2100F_S02_PER04_COMM_NR_OVL_ALTRNT_TELPHN
L2100F	PER04	Beeper Number	L2100F_S02_PER04_COMM_NR_OVL_BEPR_NR
L2100F	PER04	Cellular Phone	L2100F_S02_PER04_COMM_NR_OVL_CELR_PHON
L2100F	PER04	Electronic Mail	L2100F_S02_PER04_COMM_NR_OVL_EMAIL
L2100F	PER04	Telephone Extension	L2100F_S02_PER04_COMM_NR_OVL_PHN_EXTNS
L2100F	PER04	Facsimile	L2100F_S02_PER04_COMM_NR_OVL_FACSML
L2100F	PER04	Home Phone Number	L2100F_S02_PER04_COMM_NR_OVL_HOM_PHON_NR
L2100F	PER04	Telephone	L2100F_S02_PER04_COMM_NR_OVL_TELPHN
L2100F	PER04	Work Phone Number	L2100F_S02_PER04_COMM_NR_OVL_WORK_PHON_NR
L2100F	PER06	Alternate Telephone	L2100F_S02_PER06_COMM_NR_OVL_ALTRNT_TELPHN
L2100F	PER06	Beeper Number	L2100F_S02_PER06_COMM_NR_OVL_BEPR_NR
L2100F	PER06	Cellular Phone	L2100F_S02_PER06_COMM_NR_OVL_CELR_PHON
L2100F	PER06	Electronic Mail	L2100F_S02_PER06_COMM_NR_OVL_EMAIL
L2100F	PER06	Telephone Extension	L2100F_S02_PER06_COMM_NR_OVL_PHN_EXTNS
L2100F	PER06	Facsimile	L2100F_S02_PER06_COMM_NR_OVL_FACSML
L2100F	PER06	Home Phone Number	L2100F_S02_PER06_COMM_NR_OVL_HOM_PHON_NR
L2100F	PER06	Telephone	L2100F_S02_PER06_COMM_NR_OVL_TELPHN
L2100F	PER06	Work Phone Number	L2100F_S02_PER06_COMM_NR_OVL_WORK_PHON_NR
L2100F	PER08	Alternate Telephone	L2100F_S02_PER08_COMM_NR_OVL_ALTRNT_TELPHN
L2100F	PER08	Beeper Number	L2100F_S02_PER08_COMM_NR_OVL_BEPR_NR
L2100F	PER08	Cellular Phone	L2100F_S02_PER08_COMM_NR_OVL_CELR_PHON
L2100F	PER08	Electronic Mail	L2100F_S02_PER08_COMM_NR_OVL_EMAIL
L2100F	PER08	Telephone Extension	L2100F_S02_PER08_COMM_NR_OVL_PHN_EXTNS
L2100F	PER08	Home Phone Number	L2100F_S02_PER08_COMM_NR_OVL_HOM_PHON_NR
L2100F	PER08	Telephone	L2100F_S02_PER08_COMM_NR_OVL_TELPHN
L2100F	PER08	Work Phone Number	L2100F_S02_PER08_COMM_NR_OVL_WORK_PHON_NR
L2100F	N3	Custodial Parent Street Address
L2100F	N301	Custodial Parent Address Line	L2100F_S03_N301_CUSTDL_PARNT_ADRS_LIN
L2100F	N302	Custodial Parent Address Line	L2100F_S03_N302_CUSTDL_PARNT_ADRS_LIN
L2100F	N4	Custodial Parent City, State, ZIP Code
L2100F	N401	Custodial Parent City Name	L2100F_S04_N401_CUSTDL_PARNT_CITY_NM
L2100F	N402	Custodial Parent State Code	L2100F_S04_N402_CUSTDL_PARNT_STAT_CD
L2100F	N403	Custodial Parent Postal Zone or ZIP Code	L2100F_S04_N403_POSTL_ZON_ZIP_CD
L2100F	N404	Country Code	L2100F_S04_N404_CNTRY_CD
L2100F	N407	Country Subdivision Code	L2100F_S04_N407_COUNTRY_SUBDVSN_CD

2100G - RESPONSIBLE PERSON

Loop	Segment	Segment Name	Chiapas Gate Mapping
2100G		Qualified Loop
L2100G		Case Manager	L2100G_6Y
L2100G		Key Person	L2100G_9K
L2100G		Person or Other Entity Legally Responsible for a Child	L2100G_E1
L2100G		Executor of Estate	L2100G_EI
L2100G		Ex-spouse	L2100G_EXS
L2100G		Other Insured	L2100G_GB
L2100G		Guardian	L2100G_GD
L2100G		Power of Attorney	L2100G_J6
L2100G		Legal Representative	L2100G_LR
L2100G		Responsible Party	L2100G_QD
L2100G		Parent	L2100G_S1
L2100G		Significant Other	L2100G_TZ
L2100G		Spouse	L2100G_X4
L2100G	NM1	Responsible Person
L2100G	NM103	Person	L2100G_XX_S01_NM103_RESPNSBL_PARTY_LAST_ORG_NM_OVL_PERSN
L2100G	NM104	Responsible Party First Name	L2100G_XX_S01_NM104_PARTY_FNAME
L2100G	NM105	Responsible Party Middle Name	L2100G_XX_S01_NM105_PARTY_MNAME
L2100G	NM106	Responsible Party Name Prefix	L2100G_XX_S01_NM106_RESPNSBL_PARTY_NM_PREFX
L2100G	NM107	Responsible Party Suffix Name	L2100G_XX_S01_NM107_RESPNSBL_PARTY_SUFX_NM
L2100G	NM109	Social Security Number	L2100G_XX_S01_NM109_PARTY_ID_OVL_SSN
L2100G	NM109	Mutually Defined	L2100G_XX_S01_NM109_PARTY_ID_OVL_MUTLY_DEFND
L2100G	PER	Responsible Person Communications Numbers
L2100G	PER01	Contact Function Code	L2100G_XX_S02_PER01_CONTCT_FUNCTN_CD
L2100G	PER04	Alternate Telephone	L2100G_XX_S02_PER04_COMM_NR_OVL_ALTRNT_TELPHN
L2100G	PER04	Beeper Number	L2100G_XX_S02_PER04_COMM_NR_OVL_BEPR_NR
L2100G	PER04	Cellular Phone	L2100G_XX_S02_PER04_COMM_NR_OVL_CELR_PHON
L2100G	PER04	Electronic Mail	L2100G_XX_S02_PER04_COMM_NR_OVL_EMAIL
L2100G	PER04	Telephone Extension	L2100G_XX_S02_PER04_COMM_NR_OVL_PHN_EXTNS
L2100G	PER04	Facsimile	L2100G_XX_S02_PER04_COMM_NR_OVL_FACSML
L2100G	PER04	Home Phone Number	L2100G_XX_S02_PER04_COMM_NR_OVL_HOM_PHON_NR
L2100G	PER04	Telephone	L2100G_XX_S02_PER04_COMM_NR_OVL_TELPHN
L2100G	PER04	Work Phone Number	L2100G_XX_S02_PER04_COMM_NR_OVL_WORK_PHON_NR
L2100G	PER06	Alternate Telephone	L2100G_XX_S02_PER06_COMM_NR_OVL_ALTRNT_TELPHN
L2100G	PER06	Beeper Number	L2100G_XX_S02_PER06_COMM_NR_OVL_BEPR_NR
L2100G	PER06	Cellular Phone	L2100G_XX_S02_PER06_COMM_NR_OVL_CELR_PHON
L2100G	PER06	Electronic Mail	L2100G_XX_S02_PER06_COMM_NR_OVL_EMAIL
L2100G	PER06	Telephone Extension	L2100G_XX_S02_PER06_COMM_NR_OVL_PHN_EXTNS
L2100G	PER06	Facsimile	L2100G_XX_S02_PER06_COMM_NR_OVL_FACSML
L2100G	PER06	Home Phone Number	L2100G_XX_S02_PER06_COMM_NR_OVL_HOM_PHON_NR
L2100G	PER06	Telephone	L2100G_XX_S02_PER06_COMM_NR_OVL_TELPHN
L2100G	PER06	Work Phone Number	L2100G_XX_S02_PER06_COMM_NR_OVL_WORK_PHON_NR
L2100G	PER08	Alternate Telephone	L2100G_XX_S02_PER08_COMM_NR_OVL_ALTRNT_TELPHN
L2100G	PER08	Beeper Number	L2100G_XX_S02_PER08_COMM_NR_OVL_BEPR_NR
L2100G	PER08	Cellular Phone	L2100G_XX_S02_PER08_COMM_NR_OVL_CELR_PHON
L2100G	PER08	Electronic Mail	L2100G_XX_S02_PER08_COMM_NR_OVL_EMAIL
L2100G	PER08	Telephone Extension	L2100G_XX_S02_PER08_COMM_NR_OVL_PHN_EXTNS
L2100G	PER08	Facsimile	L2100G_XX_S02_PER08_COMM_NR_OVL_FACSML
L2100G	PER08	Home Phone Number	L2100G_XX_S02_PER08_COMM_NR_OVL_HOM_PHON_NR
L2100G	PER08	Telephone	L2100G_XX_S02_PER08_COMM_NR_OVL_TELPHN
L2100G	PER08	Work Phone Number	L2100G_XX_S02_PER08_COMM_NR_OVL_WORK_PHON_NR
L2100G	N3	Responsible Person Street Address
L2100G	N301	Responsible Party Address Line	L2100G_XX_S03_N301_RESPNSBL_PARTY_ADRS_LIN
L2100G	N302	Responsible Party Address Line	L2100G_XX_S03_N302_RESPNSBL_PARTY_ADRS_LIN
L2100G	N4	Responsible Person City, State, ZIP Code
L2100G	N401	Responsible Person City Name	L2100G_XX_S04_N401_RESPNSBL_PERSN_CITY_NM
L2100G	N402	Responsible Person State Code	L2100G_XX_S04_N402_RESPNSBL_PERSN_STAT_CD
L2100G	N403	Responsible Person Postal Zone or ZIP Code	L2100G_XX_S04_N403_POSTL_ZON_ZIP_CD
L2100G	N404	Country Code	L2100G_XX_S04_N404_CNTRY_CD
L2100G	N407	Country Subdivision Code	L2100G_XX_S04_N407_COUNTRY_SUBDVSN_CD

2100H - DROP OFF LOCATION

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2100H	NM1	Drop Off Location
L2100H	NM102	Entity Type Qualifier	L2100H_S01_NM102_ENTY_TYPE_QUAL
L2100H	NM103	Name Last or Organization Name	L2100H_S01_NM103_NM_LAST_ORG_NM
L2100H	NM104	Name First	L2100H_S01_NM104_NM_1ST
L2100H	NM105	Name Middle	L2100H_S01_NM105_NM_MIDL
L2100H	NM106	Name Prefix	L2100H_S01_NM106_NM_PREFX
L2100H	NM107	Name Suffix	L2100H_S01_NM107_NM_SUFX
L2100H	N3	Drop Off Location Street Address
L2100H	N301	Drop Off Location Address Line	L2100H_S02_N301_DROP_LOC_ADRS_LIN
L2100H	N302	Drop Off Location Address Line	L2100H_S02_N302_DROP_LOC_ADRS_LIN
L2100H	N4	Drop Off Location City, State, ZIP Code
L2100H	N401	Drop Off Location City Name	L2100H_S03_N401_DROP_LOC_CITY_NM
L2100H	N402	Drop Off Location State Code	L2100H_S03_N402_DROP_LOC_STAT_CD
L2100H	N403	Drop Off Location Postal Zone or ZIP Code	L2100H_S03_N403_POSTL_ZON_ZIP_CD
L2100H	N404	Country Code	L2100H_S03_N404_CNTRY_CD
L2100H	N407	Country Subdivision Code	L2100H_S03_N407_COUNTRY_SUBDVSN_CD

2200 - DISABILITY INFORMATION

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2200	DSB	Disability Information
L2200	DSB01	Disability Type Code	L2200_S01_DSB01_TYPE_CD
L2200	DSB08	International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) -	L2200_S01_DSB08_DIAG_CD_OVL_ICD9CM
L2200	DSB08	Mutually Defined	L2200_S01_DSB08_DIAG_CD_OVL_MUTLY_DEFND
L2200	DTP	Disability Eligibility Dates
L2200	DTP03	Initial Disability Period Start (D8)	L2200_S02_DTP03_ELIG_DT_OVL_INTL_DISBLTY_PERD_START_D8
L2200	DTP03	Initial Disability Period End (D8)	L2200_S02_DTP03_ELIG_DT_OVL_INTL_DISBLTY_PERD_END_D8

2300 - HEALTH COVERAGE

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2300	HD	Health Coverage
L2300	HD01	Maintenance Type Code	L2300_S01_HD01_MAINTNC_TYPE_CD
L2300	HD03	Insurance Line Code	L2300_S01_HD03_INS_LIN_CD
L2300	HD04	Plan Coverage Description	L2300_S01_HD04_PLAN_COVG_DESCRPTN
L2300	HD05	Coverage Level Code	L2300_S01_HD05_COVG_LEVL_CD
L2300	HD09	Late Enrollment Indicator	L2300_S01_HD09_LAT_ENRLMNT_IND
L2300	DTP	Health Coverage Dates
L2300	DTP03	Enrollment Signature Date (D8)	L2300_S02_DTP03_COVG_PERD_OVL_ENRLMNT_SIGNTR_DT_D8
L2300	DTP03	Maintenance Effective (D8)	L2300_S02_DTP03_COVG_PERD_OVL_MAINTNC_EFF_D8
L2300	DTP03	Premium Paid to Date End (D8)	L2300_S02_DTP03_COVG_PERD_OVL_PREM_PD_TO_DAT_END_D8
L2300	DTP03	Benefit Begin (D8)	L2300_S02_DTP03_COVG_PERD_OVL_BENFT_BEGN_D8
L2300	DTP03	Benefit End (D8)	L2300_S02_DTP03_COVG_PERD_OVL_BENFT_END_D8
L2300	DTP03	Last Premium Paid Date (D8)	L2300_S02_DTP03_COVG_PERD_OVL_LAST_PREM_PD_DT_D8
L2300	DTP03	Previous Period (D8)	L2300_S02_DTP03_COVG_PERD_OVL_PREVS_PERD_D8
L2300	DTP03	Enrollment Signature Date (RD8)	L2300_S02_DTP03_COVG_PERD_OVL_ENRLMNT_SIGNTR_DT_RD8
L2300	DTP03	Maintenance Effective (RD8)	L2300_S02_DTP03_COVG_PERD_OVL_MAINTNC_EFF_RD8
L2300	DTP03	Premium Paid to Date End (RD8)	L2300_S02_DTP03_COVG_PERD_OVL_PREM_PD_TO_DAT_END_RD8
L2300	DTP03	Benefit Begin (RD8)	L2300_S02_DTP03_COVG_PERD_OVL_BENFT_BEGN_RD8
L2300	DTP03	Benefit End (RD8)	L2300_S02_DTP03_COVG_PERD_OVL_BENFT_END_RD8
L2300	DTP03	Last Premium Paid Date (RD8)	L2300_S02_DTP03_COVG_PERD_OVL_LAST_PREM_PD_DT_RD8
L2300	DTP03	Previous Period (RD8)	L2300_S02_DTP03_COVG_PERD_OVL_PREVS_PERD_RD8
L2300	AMT	Health Coverage Policy
L2300	AMT02	Co-insurance - Actual	L2300_S03_AMT02_CONTRCT_AMT_OVL_CONSRNC_ACTL
L2300	AMT02	Co-Payment Amount	L2300_S03_AMT02_CONTRCT_AMT_OVL_COPYMNT_AMT
L2300	AMT02	Deductible Amount	L2300_S03_AMT02_CONTRCT_AMT_OVL_DEDCTBL_AMT
L2300	AMT02	Expected Expenditure Amount	L2300_S03_AMT02_CONTRCT_AMT_OVL_EXPCTD_EXPNDTR_AMT
L2300	AMT02	Other Unlisted Amount	L2300_S03_AMT02_CONTRCT_AMT_OVL_OTHR_UNLSTD_AMT
L2300	AMT02	Premium Amount	L2300_S03_AMT02_CONTRCT_AMT_OVL_PREM_AMT
L2300	AMT02	Spend Down	L2300_S03_AMT02_CONTRCT_AMT_OVL_SPEND_DOWN
L2300	REF	Health Coverage Policy Number
L2300	REF02	Client Reporting Category	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_CLIENT_REPRTNG_CATGRY
L2300	REF02	Group or Policy Number	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_GRP_POLCY_NR
L2300	REF02	Payment Category	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_PMT_CATGRY
L2300	REF02	Class of Contract Code	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_CLAS_CONTRCT_CD
L2300	REF02	Service Contract (Coverage) Number	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_SVC_CONTRCT_COVG_NR
L2300	REF02	Medical Assistance Category	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_MEDCL_ASTNC_CATGRY
L2300	REF02	Program Identification Number	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_PROGRM_ID_NR
L2300	REF02	Rate code number	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_RAT_COD_NR
L2300	REF02	Internal Control Number	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_INTRNL_CONTRL_NR
L2300	REF02	Issuer Number	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_ISR_NR
L2300	REF02	Special Program Code	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_SPECL_PROGRM_CD
L2300	REF02	Service Area Code	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_SVC_AR_CD
L2300	REF02	County Code	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_COUNTY_CD
L2300	REF02	Mutually Defined	L2300_S04_REF02_MEM_GRP_POLCY_NR_OVL_MUTLY_DEFND
L2300	REF	Prior Coverage Months
L2300	REF02	Unit Number	L2300_S05_REF02_PRI_COVG_MONTH_CT_OVL_UNT_NR
L2300	IDC	Identification Card
L2300	IDC01	Plan Coverage Description	L2300_S06_IDC01_PLAN_COVG_DESCRPTN
L2300	IDC02	Identification Card Type Code	L2300_S06_IDC02_ID_CARD_TYPE_CD
L2300	IDC03	Identification Card Count	L2300_S06_IDC03_CARD_CT
L2300	IDC04	Action Code	L2300_S06_IDC04_ACTN_CD

2310 - PROVIDER INFORMATION

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2310	LX	Provider Information
L2310	LX01	Assigned Number	L2310_S01_LX01_ASGND_NR
L2310	NM1	Provider Name
L2310	NM101	Entity Identifier Code	L2310_S02_NM101_ENTY_ID_CD
L2310	NM102	Entity Type Qualifier	L2310_S02_NM102_ENTY_TYPE_QUAL
L2310	NM103	Provider Last or Organization Name	L2310_S02_NM103_PROV_LAST_ORG_NM
L2310	NM104	Provider First Name	L2310_S02_NM104_PROV_FNAME
L2310	NM105	Provider Middle Name	L2310_S02_NM105_PROV_MNAME
L2310	NM106	Provider Name Prefix	L2310_S02_NM106_NM_PREFX
L2310	NM107	Provider Name Suffix	L2310_S02_NM107_NM_SUFX
L2310	NM109	Social Security Number	L2310_S02_NM109_PROV_ID_OVL_SSN
L2310	NM109	Federal Taxpayer’s Identification Number	L2310_S02_NM109_PROV_ID_OVL_FED_TAX_ID_NR
L2310	NM109	Service Provider Number	L2310_S02_NM109_PROV_ID_OVL_SVC_PROV_NR
L2310	NM109	Centers for Medicare and Medicaid Services National Provider Identifier	L2310_S02_NM109_PROV_ID_OVL_MDCR_MDCD_SVCS_NATNL_PROV_ID
L2310	NM110	Entity Relationship Code	L2310_S02_NM110_ENTY_REL_CD
L2310	N3	Provider Address
L2310	N301	Provider Address Line	L2310_S03_N301_ADRS_LIN
L2310	N302	Provider Address Line	L2310_S03_N302_ADRS_LIN
L2310	N4	Provider City, State, ZIP Code
L2310	N401	Provider City Name	L2310_S04_N401_CITY_NM
L2310	N402	Provider State Code	L2310_S04_N402_STAT_CD
L2310	N403	Provider Postal Zone or ZIP Code	L2310_S04_N403_PROV_POSTL_ZON_ZIP_CD
L2310	N404	Country Code	L2310_S04_N404_CNTRY_CD
L2310	N407	Country Subdivision Code	L2310_S04_N407_COUNTRY_SUBDVSN_CD
L2310	PER	Provider Communications Numbers
L2310	PER01	Contact Function Code	L2310_S05_PER01_CONTCT_FUNCTN_CD
L2310	PER04	Alternate Telephone	L2310_S05_PER04_COMM_NR_OVL_ALTRNT_TELPHN
L2310	PER04	Beeper Number	L2310_S05_PER04_COMM_NR_OVL_BEPR_NR
L2310	PER04	Cellular Phone	L2310_S05_PER04_COMM_NR_OVL_CELR_PHON
L2310	PER04	Electronic Mail	L2310_S05_PER04_COMM_NR_OVL_EMAIL
L2310	PER04	Telephone Extension	L2310_S05_PER04_COMM_NR_OVL_PHN_EXTNS
L2310	PER04	Facsimile	L2310_S05_PER04_COMM_NR_OVL_FACSML
L2310	PER04	Home Phone Number	L2310_S05_PER04_COMM_NR_OVL_HOM_PHON_NR
L2310	PER04	Telephone	L2310_S05_PER04_COMM_NR_OVL_TELPHN
L2310	PER04	Work Phone Number	L2310_S05_PER04_COMM_NR_OVL_WORK_PHON_NR
L2310	PER06	Alternate Telephone	L2310_S05_PER06_COMM_NR_OVL_ALTRNT_TELPHN
L2310	PER06	Beeper Number	L2310_S05_PER06_COMM_NR_OVL_BEPR_NR
L2310	PER06	Cellular Phone	L2310_S05_PER06_COMM_NR_OVL_CELR_PHON
L2310	PER06	Electronic Mail	L2310_S05_PER06_COMM_NR_OVL_EMAIL
L2310	PER06	Telephone Extension	L2310_S05_PER06_COMM_NR_OVL_PHN_EXTNS
L2310	PER06	Facsimile	L2310_S05_PER06_COMM_NR_OVL_FACSML
L2310	PER06	Home Phone Number	L2310_S05_PER06_COMM_NR_OVL_HOM_PHON_NR
L2310	PER06	Telephone	L2310_S05_PER06_COMM_NR_OVL_TELPHN
L2310	PER06	Work Phone Number	L2310_S05_PER06_COMM_NR_OVL_WORK_PHON_NR
L2310	PER08	Alternate Telephone	L2310_S05_PER08_COMM_NR_OVL_ALTRNT_TELPHN
L2310	PER08	Beeper Number	L2310_S05_PER08_COMM_NR_OVL_BEPR_NR
L2310	PER08	Cellular Phone	L2310_S05_PER08_COMM_NR_OVL_CELR_PHON
L2310	PER08	Electronic Mail	L2310_S05_PER08_COMM_NR_OVL_EMAIL
L2310	PER08	Telephone Extension	L2310_S05_PER08_COMM_NR_OVL_PHN_EXTNS
L2310	PER08	Facsimile	L2310_S05_PER08_COMM_NR_OVL_FACSML
L2310	PER08	Home Phone Number	L2310_S05_PER08_COMM_NR_OVL_HOM_PHON_NR
L2310	PER08	Telephone	L2310_S05_PER08_COMM_NR_OVL_TELPHN
L2310	PER08	Work Phone Number	L2310_S05_PER08_COMM_NR_OVL_WORK_PHON_NR
L2310	PLA	Provider Change Reason
L2310	PLA01	Action Code	L2310_S06_PLA01_ACTN_CD
L2310	PLA02	Entity Identifier Code	L2310_S06_PLA02_ENTY_ID_CD
L2310	PLA03	Provider Effective Date	L2310_S06_PLA03_EFF_DT
L2310	PLA05	Maintenance Reason Code	L2310_S06_PLA05_MAINTNC_RSN_CD

2320 - COORDINATION OF BENEFITS

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2320	COB	Coordination of Benefits
L2320	COB01	Payer Responsibility Sequence Number Code	L2320_S01_COB01_PAYR_RESP_SEQNC_NR_CD
L2320	COB02	Member Group or Policy Number	L2320_S01_COB02_MEM_GRP_POLCY_NR
L2320	COB03	Coordination of Benefits Code	L2320_S01_COB03_COB_CD
L2320	COB04	Service Type Code	L2320_S01_COB04_SVC_TYPE_CD
L2320	REF	Additional Coordination of Benefits Identifiers
L2320	REF02	Account Suffix Code	L2320_S02_REF02_MEM_GRP_POLCY_NR_OVL_ACNT_SUFX_CD
L2320	REF02	Group Number	L2320_S02_REF02_MEM_GRP_POLCY_NR_OVL_GRP_NR
L2320	REF02	Social Security Number	L2320_S02_REF02_MEM_GRP_POLCY_NR_OVL_SSN
L2320	REF02	Mutually Defined	L2320_S02_REF02_MEM_GRP_POLCY_NR_OVL_MUTLY_DEFND
L2320	DTP	Coordination of Benefits Eligibility Dates
L2320	DTP03	Coordination of Benefits Begin (D8)	L2320_S03_DTP03_COB_DT_OVL_COB_BEGN_D8
L2320	DTP03	Coordination of Benefits End (D8)	L2320_S03_DTP03_COB_DT_OVL_COB_END_D8

2330 - COORDINATION OF BENEFITS RELATED ENTITY

Loop	Segment	Segment Name	Chiapas Gate Mapping
2330		Qualified Loop
L2330		Employer	L2330_36
L2330		Group	L2330_GW
L2330		Insurer	L2330_IN
L2330	NM1	Coordination of Benefits Related Entity
L2330	NM102	Entity Type Qualifier	L2330_XX_S01_NM102_ENTY_TYPE_QUAL
L2330	NM103	Coordination of Benefits Insurer Name	L2330_XX_S01_NM103_INSR_NM
L2330	NM109	Federal Taxpayer’s Identification Number	L2330_XX_S01_NM109_INSR_ID_OVL_FED_TAX_ID_NR
L2330	NM109	National Association of Insurance Commissioners (NAIC) Identification	L2330_XX_S01_NM109_INSR_ID_OVL_NAIC_ID
L2330	NM109	Centers for Medicare and Medicaid Services PlanID	L2330_XX_S01_NM109_INSR_ID_OVL_MDCR_MDCD_SVCS_PLAND
L2330	N3	Coordination of Benefits Related Entity Address
L2330	N301	Address Information	L2330_XX_S02_N301_ADRS_NFO
L2330	N302	Address Information	L2330_XX_S02_N302_ADRS_NFO
L2330	N4	Coordination of Benefits Other Insurance Company City, State, ZIP Code
L2330	N401	Coordination of Benefits Other Insurance adequate to specify a location.	L2330_XX_S03_N401_OTHR_INS
L2330	N402	Coordination of Benefits Other Insurance implementation guide, do not send.	L2330_XX_S03_N402_IMPLMNTN_GUID
L2330	N403	Coordination of Benefits Other Insurance implementation guide, do not send.	L2330_XX_S03_N403_IMPLMNTN_GUID
L2330	N404	Country Code	L2330_XX_S03_N404_CNTRY_CD
L2330	N407	Country Subdivision Code	L2330_XX_S03_N407_COUNTRY_SUBDVSN_CD
L2330	PER	Administrative Communications Contact
L2330	PER01	Contact Function Code	L2330_XX_S04_PER01_CONTCT_FUNCTN_CD
L2330	PER04	Telephone	L2330_XX_S04_PER04_COMM_NR_OVL_TELPHN

2320 - COORDINATION OF BENEFITS

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2320	COB	Coordination of Benefits
L2320	COB01	Payer Responsibility Sequence Number Code	L2320_S01_COB01_PAYR_RESP_SEQNC_NR_CD
L2320	COB02	Member Group or Policy Number	L2320_S01_COB02_MEM_GRP_POLCY_NR
L2320	COB03	Coordination of Benefits Code	L2320_S01_COB03_COB_CD
L2320	COB04	Service Type Code	L2320_S01_COB04_SVC_TYPE_CD
L2320	REF	Additional Coordination of Benefits Identifiers
L2320	REF02	Account Suffix Code	L2320_S02_REF02_MEM_GRP_POLCY_NR_OVL_ACNT_SUFX_CD
L2320	REF02	Group Number	L2320_S02_REF02_MEM_GRP_POLCY_NR_OVL_GRP_NR
L2320	REF02	Social Security Number	L2320_S02_REF02_MEM_GRP_POLCY_NR_OVL_SSN
L2320	REF02	Mutually Defined	L2320_S02_REF02_MEM_GRP_POLCY_NR_OVL_MUTLY_DEFND
L2320	DTP	Coordination of Benefits Eligibility Dates
L2320	DTP03	Coordination of Benefits Begin (D8)	L2320_S03_DTP03_COB_DT_OVL_COB_BEGN_D8
L2320	DTP03	Coordination of Benefits End (D8)	L2320_S03_DTP03_COB_DT_OVL_COB_END_D8

2330 - COORDINATION OF BENEFITS RELATED ENTITY

Loop	Segment	Segment Name	Chiapas Gate Mapping
2330		Qualified Loop
L2330		Employer	L2330_36
L2330		Group	L2330_GW
L2330		Insurer	L2330_IN
L2330	NM1	Coordination of Benefits Related Entity
L2330	NM102	Entity Type Qualifier	L2330_XX_S01_NM102_ENTY_TYPE_QUAL
L2330	NM103	Coordination of Benefits Insurer Name	L2330_XX_S01_NM103_INSR_NM
L2330	NM109	Federal Taxpayer’s Identification Number	L2330_XX_S01_NM109_INSR_ID_OVL_FED_TAX_ID_NR
L2330	NM109	National Association of Insurance Commissioners (NAIC) Identification	L2330_XX_S01_NM109_INSR_ID_OVL_NAIC_ID
L2330	NM109	Centers for Medicare and Medicaid Services PlanID	L2330_XX_S01_NM109_INSR_ID_OVL_MDCR_MDCD_SVCS_PLAND
L2330	N3	Coordination of Benefits Related Entity Address
L2330	N301	Address Information	L2330_XX_S02_N301_ADRS_NFO
L2330	N302	Address Information	L2330_XX_S02_N302_ADRS_NFO
L2330	N4	Coordination of Benefits Other Insurance Company City, State, ZIP Code
L2330	N401	Coordination of Benefits Other Insurance adequate to specify a location.	L2330_XX_S03_N401_OTHR_INS
L2330	N402	Coordination of Benefits Other Insurance implementation guide, do not send.	L2330_XX_S03_N402_IMPLMNTN_GUID
L2330	N403	Coordination of Benefits Other Insurance implementation guide, do not send.	L2330_XX_S03_N403_IMPLMNTN_GUID
L2330	N404	Country Code	L2330_XX_S03_N404_CNTRY_CD
L2330	N407	Country Subdivision Code	L2330_XX_S03_N407_COUNTRY_SUBDVSN_CD
L2330	PER	Administrative Communications Contact
L2330	PER01	Contact Function Code	L2330_XX_S04_PER01_CONTCT_FUNCTN_CD
L2330	PER04	Telephone	L2330_XX_S04_PER04_COMM_NR_OVL_TELPHN

2710HDR - MEMBER REPORTING SUBLOOP

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2710HDR	LS	Additional Reporting Categories
L2710HDR	LS01	Loop Identifier Code	L2710HDR_S01_LS01_LP_ID_CD
L2710HDR	LE	Additional Reporting Categories Loop Termination
L2710HDR	LE01	Loop Identifier Code	L2710HDR_S03_LE01_ID_CD

2710 - MEMBER REPORTING CATEGORIES

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2710	LX	Member Reporting Categories
L2710	LX01	Assigned Number	L2710_S01_LX01_ASGND_NR

2750 - REPORTING CATEGORY

Loop	Segment	Segment Name	Chiapas Gate Mapping
L2750	N1	Reporting Category
L2750	N102	Member Reporting Category Name	L2750_S01_N102_MEM_REPRTNG_CATGRY_NM
L2750	REF	Reporting Category Reference
L2750	REF02	Contracting District Number	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_CONTRCTNG_DISTRCT_NR
L2750	REF02	Client Reporting Category	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_CLIENT_REPRTNG_CATGRY
L2750	REF02	Plan Number	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_PLAN_NR
L2750	REF02	Division Identifier	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_DIVSN_ID
L2750	REF02	Union Number	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_UN_NR
L2750	REF02	Branch Identifier	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_BRANCH_ID
L2750	REF02	Application Number	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_APLCTN_NR
L2750	REF02	Payment Category	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_PMT_CATGRY
L2750	REF02	Account Category	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_ACNT_CATGRY
L2750	REF02	Geographic Number	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_GEOGRPHC_NR
L2750	REF02	Location Number	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_LOC_NR
L2750	REF02	Program Identification Number	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_PROGRM_ID_NR
L2750	REF02	Special Program Code	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_SPECL_PROGRM_CD
L2750	REF02	Service Area Code	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_SVC_AR_CD
L2750	REF02	Geographic Key	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_GEOGRPHC_KEY
L2750	REF02	Mutually Defined	L2750_S02_REF02_MEM_REPRTNG_CATGRY_REF_ID_OVL_MUTLY_DEFND
L2750	DTP	Reporting Category Date
L2750	DTP03	Effective (D8)	L2750_S03_DTP03_MEM_REPRTNG_CATGRY_EFF_DT_OVL_EFF_D8
L2750	DTP03	Effective (RD8)	L2750_S03_DTP03_MEM_REPRTNG_CATGRY_EFF_DT_OVL_EFF_RD8