001

ISA_LOOP - Interchange Control Header

020 GS_LOOP - Functional Group Header 020 ST_LOOP - Transaction Set Header 015 HEADER - Table 1 - Header 020 DETAIL - Table 2 - Detail 010 2000A - Information Source Level 030 2100A - Information Source Name 040 2000B - Information Receiver Level 030 2100B - Information Receiver Name 040 2000C - Subscriber Level 030 2100C - Subscriber Name 130 2110C - Subscriber Eligibility or Benefit Information 260 2115C - Subscriber Eligibility or Benefit Additional Information 340 2120C - Subscriber Benefit Related Entity Name 040 2000D - Dependent Level 030 2100D - Dependent Name 130 2110D - Dependent Eligibility or Benefit Information 260 2115D - Dependent Eligibility or Benefit Additional Information 340 2120D - Dependent Benefit Related Entity Name 030 FOOTER - Table 3 - Footer