| 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 Organizational (UMO) Name |
|
| 180 |
2000B - Requester Level |
| 170 |
2010B - Requester Name |
|
| 180 |
2000C - Subscriber Level |
| 170 |
2010CA - Subscriber Name |
|
| 180 |
2000D - Dependent Level |
| 170 |
2010DA - Dependent Name |
|
| 180 |
2000E - Service Provider Level |
| 170 |
2010E - Service Provider Name |
|
| 180 |
2000F - Service Level |
|
|
|
|
|
|
|
| 030 |
FOOTER - Table 3 - Footer |
|