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 1 025 AAA Request Validation S 9 030 2100A - Information Source Name 030 NM1 Information Source Name R 1 040 REF Information Source Additional Identification S 9 080 PER Information Source Contact Information S 3 085 AAA Request Validation S 9 040 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 9 085 AAA Information Receiver Request Validation S 9 040 2000C - Subscriber Level 010 HL Subscriber Level R 1 020 TRN Subscriber Trace Number S 3 030 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 1 080 PER Subscriber Contact Information S 3 085 AAA Subscriber Request Validation S 9 100 DMG Subscriber Demographic Information S 1 110 INS Subscriber Relationship S 1 120 DTP Subscriber Date S 9 130 2110C - Subscriber Eligibility or Benefit Information 130 EB Subscriber Eligibility or Benefit Information R 1 135 HSD Health Care Services Delivery S 9 140 REF Subscriber Additional Identification S 9 150 DTP Subscriber Eligibility/Benefit Date S 20 160 AAA Subscriber Request Validation S 9 250 MSG Message Text S 10 260 2115C - Subscriber Eligibility or Benefit Additional Information 260 III Subscriber Eligibility or Benefit Additional Information R 1 330 LS Loop Header S 1 340 2120C - Subscriber Benefit Related Entity Name 340 NM1 Subscriber Benefit Related Entity Name R 1 360 N3 Subscriber Benefit Related Entity Address S 1 370 N4 Subscriber Benefit Related City/State/ZIP Code S 1 380 PER Subscriber Benefit Related Entity Contact Information S 3 390 PRV Subscriber Benefit Related Provider Information S 1 400 LE Loop Trailer S 1 040 2000D - Dependent Level 010 HL Dependent Level R 1 020 TRN Dependent Trace Number S 3 030 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 1 080 PER Dependent Contact Information S 3 085 AAA Dependent Request Validation S 9 100 DMG Dependent Demographic Information S 1 110 INS Dependent Relationship S 1 120 DTP Dependent Date S 9 130 2110D - Dependent Eligibility or Benefit Information 130 EB Dependent Eligibility or Benefit Information R 1 135 HSD Health Care Services Delivery S 9 140 REF Dependent Additional Identification S 9 150 DTP Dependent Eligibility/Benefit Date S 20 160 AAA Dependent Request Validation S 9 250 MSG Message Text S 10 260 2115D - Dependent Eligibility or Benefit Additional Information 260 III Dependent Eligibility or Benefit Additional Information R 1 330 LS Dependent Eligibility or Benefit Information S 1 340 2120D - Dependent Benefit Related Entity Name 340 NM1 Dependent Benefit Related Entity Name R 1 360 N3 Dependent Benefit Related Entity Address S 1 370 N4 Dependent Benefit Related Entity City/State/ZIP Code S 1 380 PER Dependent Benefit Related Entity Contact Information S 3 390 PRV Dependent Benefit Related Provider Information S 1 400 LE Loop Trailer S 1 030 FOOTER - Table 3 - Footer 410 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