001		ISA_LOOP - Interchange Control Header
010	ISA	Interchange Control Header	R	1
020 GS_LOOP - Functional Group Header 010 GS Functional Group Header R 1 020 ST_LOOP - Transaction Set Header 010 ST Transaction Set Header R 1 015 HEADER - Table 1 - Header 020 BHT Beginning of Hierarchical Transaction R 1 020 DETAIL - Table 2 - Detail 010 2000A - Information Source Level 010 HL Information Source Level R 1 030 2100A - Information Source Name 030 NM1 Information Source Name R 1 040 2000B - Information Receiver Level 010 HL Information Receiver Level R 1 030 2100B - Information Receiver Name 030 NM1 Information Receiver Name R 1 040 REF Information Receiver Additional Identification S 9 060 N3 Information Receiver Address S 1 070 N4 Information Receiver City/State/Zip Code S 1 080 PER Information Receiver Contact Information S 3 090 PRV Information Receiver Provider Information S 1 040 2000C - Subscriber Level 010 HL Subscriber Level R 1 020 TRN Subscriber Trace Number S 2 030 2100C - Subscriber Name 030 NM1 Subscriber Name R 1 040 REF Subscriber Additional Identification S 9 060 N3 Subscriber Address S 1 070 N4 Subscriber City/State/ZIP Code S 1 090 PRV Provider Information S 1 100 DMG Subscriber Demographic Information S 1 110 INS Subscriber Relationship S 1 120 DTP Subscriber Date S 2 130 2110C - Subscriber Eligibility or Benefit Inquiry Information 130 EQ Subscriber Eligibility or Benefit Inquiry Information R 1 135 AMT Subscriber Spend Down Amount S 1 170 III Subscriber Eligibility or Benefit Additional Inquiry Information S 10 190 REF Subscriber Additional Information S 1 200 DTP Subscriber Eligibility/Benefit Date S 1 040 2000D - Dependent Level 010 HL Dependent Level R 1 020 TRN Dependent Trace Number S 2 030 2100D - Dependent Name 030 NM1 Dependent Name R 1 040 REF Dependent Additional Identification S 9 060 N3 Dependent Address S 1 070 N4 Dependent City/State/ZIP Code S 1 090 PRV Provider Information S 1 100 DMG Dependent Demographic Information S 1 110 INS Dependent Relationship S 1 120 DTP Dependent Date S 2 130 2110D - Dependent Eligibility or Benefit Inquiry Information 130 EQ Dependent Eligibility or Benefit Inquiry Information R 1 170 III Dependent Eligibility or Benefit Additional Inquiry Information S 10 190 REF Dependent Additional Information S 1 200 DTP Dependent Eligibility/Benefit Date S 1 030 FOOTER - Table 3 - Footer 210 SE Transaction Set Trailer R 1 030 GE Functional Group Trailer R 1
020	TA1	Interchange Acknowledgement	S	1
030	IEA	Interchange Control Trailer	R	1