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 - Utilization Management Organization (UMO) Level 170 2010A - Utilization Management Organization (UMO) Name 180 2000B - Requester Level 170 2010B - Requester Name 180 2000C - Subscriber Level 170 2010CA - Subscriber Name 170 2010CB - Additional Patient Information Contact Name 180 2000D - Dependent Level 170 2010DA - Dependent Name 170 2010DB - Additional Patient Information Contact Name 180 2000E - Service Provider Level 170 2010E - Service Provider Name 180 2000F - Service Level 170 2010F - Additional Service Information Contact Name 030 FOOTER - Table 3 - Footer