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 050 2100A - Payer Name 060 2000B - Information Receiver Level 050 2100B - Information Receiver Name 060 2000C - Service Provider Level 050 2100C - Provider Name 060 2000D - Subscriber Level 050 2100D - Subscriber Name 090 2200D - Claim Submitter Trace Number 180 2220D - Service Line Information 100 2000E - Dependent Level 050 2100E - Dependent Name 090 2200E - Claim Submitter Trace Number 180 2220E - Service Line Information 030 FOOTER - Table 3 - Footer