(C) Copyright 2012 Chiapas EDI Technologies, Inc.
5010_999_A1 5010 999 Acknowledgment - Code:Z1
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 | TA1 | Transaction Acknowledgment | |
| OEISA | TA101 | Interchange Control Number | OEISA_S02_TA101_ICN |
| OEISA | TA102 | Interchange Date | OEISA_S02_TA102_ICHG_DT |
| OEISA | TA103 | Interchange Time | OEISA_S02_TA103_ICHG_TM |
| OEISA | TA104 | Interchange Acknowledgment Code | OEISA_S02_TA104_ICHG_ACK_CD |
| OEISA | TA105 | Interchange Note Code | OEISA_S02_TA105_ICN_NT_CD |
| OEISA | IEA | Interchange Control Trailer | |
| OEISA | IEA01 | Number of Included Functional Groups | OEISA_S04_IEA01_GS_CT |
| OEISA | IEA02 | Interchange Control Number | OEISA_S04_IEA02_ICN |
GSHDR - GROUP HEADER
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| GSHDR | Qualified Loop | ||
| GSHDR | Version / Release ID Code | GSHDR_005010X231 | |
| GSHDR | Version / Release ID Code | GSHDR_005010X231A1 | |
| GSHDR | GS | Functional Group Header | |
| GSHDR | GS01 | Functional Identifier Code | GSHDR_XX_S01_GS01_FUNCTL_ID_CD |
| GSHDR | GS02 | Application Senders Code | GSHDR_XX_S01_GS02_APP_SENDR_CD |
| GSHDR | GS03 | Application Receivers Code | GSHDR_XX_S01_GS03_APP_RECVR_CD |
| GSHDR | GS04 | Date | GSHDR_XX_S01_GS04_DT |
| GSHDR | GS05 | Time | GSHDR_XX_S01_GS05_TM |
| GSHDR | GS06 | Group Control Number | GSHDR_XX_S01_GS06_GCN |
| GSHDR | GS07 | Responsible Agency Code | GSHDR_XX_S01_GS07_RESP_AGNCY_CD |
| GSHDR | GE | Functional Group Trailer | |
| GSHDR | GE01 | Number of Transaction Sets Included | GSHDR_XX_S03_GE01_TS_CT |
| GSHDR | GE02 | Group Control Number | GSHDR_XX_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 Guide Version Name | STHDR_S01_ST03_IMPLMNTN_GUID_VERSN_NM |
| STHDR | AK1 | Functional Group Response | |
| STHDR | AK101 | Functional Identifier Code | STHDR_S02_AK101_FUNCTNL_ID_CD |
| STHDR | AK102 | Group Control Number | STHDR_S02_AK102_GCN |
| STHDR | AK103 | Version Release/Industry Identifier Code | STHDR_S02_AK103_VERS_RELS_ID_CD |
| STHDR | AK9 | Functional Group Response Trailer | |
| STHDR | AK901 | Functional Group Acknowledge Code | STHDR_S04_AK901_FUNCTL_GRP_ACK_CD |
| STHDR | AK902 | Number of Transaction Sets Included | STHDR_S04_AK902_NR_TS |
| STHDR | AK903 | Number of Received TS | STHDR_S04_AK903_NR_RECV_TS |
| STHDR | AK904 | Number of Accepted TS | STHDR_S04_AK904_NR_ACCPTD_TS |
| STHDR | AK905 | Functional Group Syntax Error Code | STHDR_S04_AK905_FUNCTL_GRP_SYNTAX_ERR_CD |
| STHDR | AK906 | Functional Group Syntax Error Code | STHDR_S04_AK906_FUNCTL_GRP_SYNTAX_ERR_CD |
| STHDR | AK907 | Functional Group Syntax Error Code | STHDR_S04_AK907_FUNCTL_GRP_SYNTAX_ERR_CD |
| STHDR | AK908 | Functional Group Syntax Error Code | STHDR_S04_AK908_FUNCTL_GRP_SYNTAX_ERR_CD |
| STHDR | AK909 | Functional Group Syntax Error Code | STHDR_S04_AK909_FUNCTL_GRP_SYNTAX_ERR_CD |
| STHDR | SE | Transaction Set Trailer | |
| STHDR | SE01 | Transaction Segment Count | STHDR_S05_SE01_SEG_CT |
| STHDR | SE02 | Transaction Set Control Number | STHDR_S05_SE02_TCN |
2000 - TRANSACTION SET RESPONSE
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2000 | AK2 | Transaction Set Response | |
| L2000 | AK201 | Version | L2000_S01_AK201_TS |
| L2000 | AK202 | Transaction Set Control Number | L2000_S01_AK202_TCN |
| L2000 | AK203 | Implementation Convention Reference | L2000_S01_AK203_IMPLMNTN_CONVTN_REF |
| L2000 | IK5 | Transaction Set Response Trailer | |
| L2000 | IK501 | Transaction Status | L2000_S03_IK501_TS_STATUS |
| L2000 | IK502 | Implementation Transaction Set Syntax Error Code | L2000_S03_IK502_IMP_TS_SYNTAX_ERR_CD_1 |
| L2000 | IK503 | Implementation Transaction Set Syntax Error Code | L2000_S03_IK503_IMP_TS_SYNTAX_ERR_CD_2 |
| L2000 | IK504 | Implementation Transaction Set Syntax Error Code | L2000_S03_IK504_IMP_TS_SYNTAX_ERR_CD_3 |
| L2000 | IK505 | Implementation Transaction Set Syntax Error Code | L2000_S03_IK505_IMP_TS_SYNTAX_ERR_CD_4 |
| L2000 | IK506 | Implementation Transaction Set Syntax Error Code | L2000_S03_IK506_IMP_TS_SYNTAX_ERR_CD_5 |
2100 - ERROR IDENTIFICATION
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2100 | IK3 | Error Identification | |
| L2100 | IK301 | Segment ID Code | L2100_S01_IK301_SEG_ID_CD |
| L2100 | IK302 | Segment Position in Transaction Set | L2100_S01_IK302_SEG_POS_TS |
| L2100 | IK303 | Loop Identifier Code | L2100_S01_IK303_LP_ID_CD |
| L2100 | IK304 | Implementation Segment Syntax Error Code | L2100_S01_IK304_IMP_SEG_SYNTX_ERR_CD |
| L2100 | CTX | Segment Context | |
| L2100 | CTX01 | Context Composite Element | L2100_S02_CTX01_CONTXT_COMP_ELE |
| L2100 | CTX02 | Segment ID Code | L2100_S02_CTX02_SEG_ID_CD |
| L2100 | CTX03 | Segment Position in TS | L2100_S02_CTX03_SEG_POS_TS |
| L2100 | CTX04 | Loop ID Code | L2100_S02_CTX04_LP_ID_CD |
| L2100 | CTX05-01 | Element Position in Segment | L2100_S02_CTX05_01_ELE_POS_SEG |
| L2100 | CTX05-02 | Composite Data Element Position in Composite | L2100_S02_CTX05_02_COMP_DATA_ELE_POS |
| L2100 | CTX05-03 | Repeating Data Element Position | L2100_S02_CTX05_03_REP_ELE_POS |
| L2100 | CTX06 | Reference in Segment | L2100_S02_CTX06_REF_SEG |
| L2100 | CTX | Business Unit Identifier | |
| L2100 | CTX01-01 | Context Name | L2100_S03_CTX01_01_CNTXT_NM |
| L2100 | CTX01-02 | Context Reference | L2100_S03_CTX01_02_CNTXT_REF |
2110 - IMPLEMENTATION DATA ELEMENT NOTE
| Loop | Segment | Segment Name | Chiapas Gate Mapping |
| L2110 | IK4 | Implementation Data Element Note | |
| L2110 | IK401-01 | Element Position in Segment | L2110_S01_IK401_01_ELE_POS_SEG |
| L2110 | IK401-02 | Component Data Element Position in Composite | L2110_S01_IK401_02_COMP_DATA_ELE_POS |
| L2110 | IK401-03 | Repeating Data Element Position | L2110_S01_IK401_03_REP_DATA_ELE_POS |
| L2110 | IK402 | Data Element Reference Number | L2110_S01_IK402_ELE_REF_NR |
| L2110 | IK403 | Implementation Data Element Syntax Error Code | L2110_S01_IK403_IMP_DAT_ELE_SYNTX_ERR_CD |
| L2110 | IK404 | Copy of Bad Data Element | L2110_S01_IK404_COPY_ELE |
| L2110 | CTX | Element Context | |
| L2110 | CTX01 | Context Name | L2110_S02_CTX01_CONTXT_COMP_ELE |
| L2110 | CTX02 | Segment ID Code | L2110_S02_CTX02_SEG_ID_CD |
| L2110 | CTX03 | Segment Position in Transaction Set | L2110_S02_CTX03_SEG_POS_IN_TS |
| L2110 | CTX04 | Loop Identifier Code | L2110_S02_CTX04_LP_ID_CD |
| L2110 | CTX05-01 | Element Position in Segment | L2110_S02_CTX05_01_ELE_POS_IN_SEG |
| L2110 | CTX05-02 | Component Data Element Position in Composite | L2110_S02_CTX05_02_COMP_DATA_ELE |
| L2110 | CTX05-03 | Repeating Data Element Position | L2110_S02_CTX05_03_REP_DATA_ELE_POS |
| L2110 | CTX06 | Data Element Reference Number | L2110_S02_CTX06_REF_IN_SEG |