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
005 ST Transaction Set Header R 1
010 HEADER - Table 1 - Header
010 BHT Beginning of Hierarchical Transaction R 1
015 REF Transmission Type Identification R 1
020 1000A - Submitter Name 1
020 NM1 Submitter Name R 1
025 N2 Additional Submitter Name Information S 1
045 PER Submitter EDI Contact Information R 2
020 1000B - Receiver Name 1
020 NM1 Receiver Name R 1
025 N2 Receiver Additional Name Information S 1
020 DETAIL - Table 2 - Detail
001 2000A - Billing/Pay-To Provider Hierarchical Level >1
001 HL Billing/Pay-To Provider Hierarchical Level R 1
003 PRV Billing/Pay-To Provider Specialty Information S 1
010 CUR Foreign Currency Information S 1
015 2010AA - Billing Provider Name 1
015 NM1 Billing Provider Name R 1
020 N2 Additional Billing Provider Name Information S 1
025 N3 Billing Provider Address R 1
030 N4 Billing Provider City/State/ZIP Code R 1
035 REF Billing Provider Secondary Identification S 8
035 REF Credit/Debit Card Billing Information S 8
040 PER Billing Provider Contact Information S 2
015 2010AB - Pay-To Provider Name 1
015 NM1 Pay-To Provider Name S 1
020 N2 Additional Pay-To Provider Name Information S 1
025 N3 Pay-To Provider Address R 1
030 N4 Pay-To Provider City/State/ZIP Code R 1
035 REF Pay-To Provider Secondary Identification S 5
020 2000B - Subscriber Hierarchical Level >1
001 HL Subscriber Hierarchical Level R 1
005 SBR Subscriber Information R 1
007 PAT Patient Information S 1
015 2010BA - Subscriber Name 1
015 NM1 Subscriber Name R 1
020 N2 Additional Subscriber Name Information S 1
025 N3 Subscriber Address S 1
030 N4 Subscriber City/State/ZIP Code S 1
032 DMG Subscriber Demographic Information S 1
035 REF Subscriber Secondary Identification S 4
035 REF Property and Casualty Claim Number S 1
015 2010BB - Payer Name 1
015 NM1 Payer Name R 1
020 N2 Additional Payer Name Information S 1
025 N3 Payer Address S 1
030 N4 Payer City/State/ZIP Code S 1
035 REF Payer Secondary Identification S 3
015 2010BC - Responsible Party Name 1
015 NM1 Responsible Party Name S 1
020 N2 Additional Responsible Party Name Information S 1
025 N3 Responsible Party Address R 1
030 N4 Responsible Party City/State/ZIP Code R 1
015 2010BD - Credit/Debit Card Holder Name 1
015 NM1 Credit/Debit Card Holder Name R 1
020 N2 Additional Credit/Debit Card Holder Name Information S 1
035 REF Credit/Debit Card Information S 2
130 2300 - Claim Information 100
130 CLM Claim Information R 1
135 DTP Date - Order Date S 1
135 DTP Date - Initial Treatment S 1
135 DTP Date - Referral Date S 1
135 DTP Date - Date Last Seen S 1
135 DTP Date - Onset of Current Illness/Symptom S 1
135 DTP Date - Acute Manifestation S 5
135 DTP Date - Similar Illness/Symptom Onset S 10
135 DTP Date - Accident S 10
135 DTP Date - Last Menstrual Period S 1
135 DTP Date - Last X-Ray S 1
135 DTP Date - Estimated Date of Birth S 1
135 DTP Date - Hearing and Vision Prescription Date S 1
135 DTP Date - Disability Begin S 5
135 DTP Date - Disability End S 5
135 DTP Date - Last Worked S 1
135 DTP Date - Authorized Return to Work S 1
135 DTP Date - Admission S 1
135 DTP Date - Discharge S 1
135 DTP Date - Assumed and Relinquished Care Dates S 2
155 PWK Claim Supplemental Information S 10
160 CN1 Contract Information S 1
175 AMT Credit/Debit Card Maximum Amount S 1
175 AMT Patient Amount Paid S 1
175 AMT Total Purchased Service Amount S 1
180 REF Service Authorization Exception Code S 1
180 REF Mandatory Medicare (Section 4081) Crossover Indicator S 1
180 REF Mammography Certification Number S 1
180 REF Prior Authorization or Referral Number S 2
180 REF Original Reference Number (ICN/DCN) S 1
180 REF Clinical Laboratory Improvement Amendment (CLIA) Number S 3
180 REF Repriced Claim Number S 1
180 REF Adjusted Repriced Claim Number S 1
180 REF Investigational Device Exemption Number S 1
180 REF Claim Identification Number for Clearing Houses and Other Transmission Intermediaries S 1
180 REF Ambulatory Patient Group (APG) S 4
180 REF Medical Record Number S 1
180 REF Demonstration Project Identifier S 1
185 K3 File Information S 10
190 NTE Claim Note S 1
195 CR1 Ambulance Transport Information S 1
200 CR2 Spinal Manipulation Service Information S 1
220 CRC Ambulance Certification S 3
220 CRC Patient Condition Information: Vision S 3
220 CRC Homebound Indicator S 1
231 HI Health Care Diagnosis Code S 1
241 HCP Claim Pricing/Repricing Information S 1
242 2305 - Home Health Care Plan Information 6
242 CR7 Home Health Care Plan Information S 1
243 HSD Health Care Services Delivery S 3
250 2310A - Referring Provider Name 2
250 NM1 Referring Provider Name S 1
255 PRV Referring Provider Specialty Information S 1
260 N2 Additional Referring Provider Name Information S 1
271 REF Referring Provider Secondary Identification S 5
250 2310B - Rendering Provider Name 1
250 NM1 Rendering Provider Name S 1
255 PRV Rendering Provider Specialty Information R 1
260 N2 Additional Rendering Provider Name Information S 1
271 REF Rendering Provider Secondary Identification S 5
250 2310C - Purchased Service Provider Name 1
250 NM1 Purchased Service Provider Name S 1
271 REF Purchased Service Provider Secondary Identification S 5
250 2310D - Service Facility Location 1
250 NM1 Service Facility Location S 1
260 N2 Additional Service Facility Location Name Information S 1
265 N3 Service Facility Location Address R 1
270 N4 Service Facility Location City/State/ZIP R 1
271 REF Service Facility Location Secondary Identification S 5
250 2310E - Supervising Provider Name 1
250 NM1 Supervising Provider Name S 1
260 N2 Additional Supervising Provider Name Information S 1
271 REF Supervising Provider Secondary Identification S 5
290 2320 - Other Subscriber Information 10
290 SBR Other Subscriber Information S 1
295 CAS Claim Level Adjustments S 5
300 AMT Coordination of Benefits (COB) Payer Paid Amount S 1
300 AMT Coordination of Benefits (COB) Approved Amount S 1
300 AMT Coordination of Benefits (COB) Allowed Amount S 1
300 AMT Coordination of Benefits (COB) Patient Responsibility Amount S 1
300 AMT Coordination of Benefits (COB) Covered Amount S 1
300 AMT Coordination of Benefits (COB) Discount Amount S 1
300 AMT Coordination of Benefits (COB) Per Day Limit Amount S 1
300 AMT Coordination of Benefits (COB) Patient Paid Amount S 1
300 AMT Coordination of Benefits (COB) Tax Amount S 1
300 AMT Coordination of Benefits (COB) Total Claim Before Taxes Amount S 1
305 DMG Subscriber Demographic Information S 1
310 OI Other Insurance Coverage Information R 1
320 MOA Medicare Outpatient Adjudication Information S 1
325 2330A - Other Subscriber Name 1
325 NM1 Other Subscriber Name R 1
330 N2 Additional Other Subscriber Name Information S 1
332 N3 Other Subscriber Address S 1
340 N4 Other Subscriber City/State/ZIP Code S 1
355 REF Other Subscriber Secondary Identification S 3
325 2330B - Other Payer Name 1
325 NM1 Other Payer Name R 1
330 N2 Additional Other Payer Name Information S 1
345 PER Other Payer Contact Information S 2
345 DTP Claim Adjudication Date S 1
355 REF Other Payer Secondary Identifier S 2
355 REF Other Payer Prior Authorization or Referral Number S 2
355 REF Other Payer Claim Adjustment Indicator S 2
325 2330C - Other Payer Patient Information 1
325 NM1 Other Payer Patient Information S 1
355 REF Other Payer Patient Identification S 3
325 2330D - Other Payer Referring Provider 2
325 NM1 Other Payer Referring Provider S 1
355 REF Other Payer Referring Provider Identification R 3
325 2330E - Other Payer Rendering Provider 1
325 NM1 Other Payer Rendering Provider S 1
355 REF Other Payer Rendering Provider Secondary Identification R 3
325 2330F - Other Payer Purchased Service Provider 1
325 NM1 Other Payer Purchased Service Provider S 1
355 REF Other Payer Purchased Service Provider Identification R 3
325 2330G - Other Payer Service Facility Location 1
325 NM1 Other Payer Service Facility Location S 1
355 REF Other Payer Service Facility Location Identification R 3
325 2330H - Other Payer Supervising Provider 1
325 NM1 Other Payer Supervising Provider S 1
355 REF Other Payer Supervising Provider Identification R 3
365 2400 - Service Line 50
365 LX Service Line R 1
370 SV1 Professional Service R 1
385 SV4 Prescription Number S 1
420 PWK DMERC CMN Indicator S 1
425 CR1 Ambulance Transport Information S 1
430 CR2 Spinal Manipulation Service Information S 5
435 CR3 Durable Medical Equipment Certification S 1
445 CR5 Home Oxygen Therapy Information S 1
450 CRC Ambulance Certification S 3
450 CRC Hospice Employee Indicator S 1
450 CRC DMERC Condition Indicator S 2
455 DTP Date - Service Date R 1
455 DTP Date - Certification Revision Date S 1
455 DTP Date - Referral Date S 1
455 DTP Date - Begin Therapy Date S 1
455 DTP Date - Last Certification Date S 1
455 DTP Date - Order Date S 1
455 DTP Date - Date Last Seen S 1
455 DTP Date - Test S 2
455 DTP Date - Oxygen Saturation/Arterial Blood Gas Test S 3
455 DTP Date - Shipped S 1
455 DTP Date - Onset of Current Symptom/Illness S 1
455 DTP Date - Last X-ray S 1
455 DTP Date - Acute Manifestation S 1
455 DTP Date - Initial Treatment S 1
455 DTP Date - Similar Illness/Symptom Onset S 1
460 QTY Anesthesia Modifying Units S 5
462 MEA Test Result S 20
465 CN1 Contract Information S 1
470 REF Repriced Line Item Reference Number S 1
470 REF Adjusted Repriced Line Item Reference Number S 1
470 REF Prior Authorization or Referral Number S 2
470 REF Line Item Control Number S 1
470 REF Mammography Certification Number S 1
470 REF Clinical Laboratory Improvement Amendment (CLIA) Identification S 1
470 REF Referring Clinical Laboratory Improvement Amendment (CLIA) Facility Identification S 1
470 REF Immunization Batch Number S 1
470 REF Ambulatory Patient Group (APG) S 4
470 REF Oxygen Flow Rate S 1
470 REF Universal Product Number (UPN) S 1
475 AMT Sales Tax Amount S 1
475 AMT Approved Amount S 1
475 AMT Postage Claimed Amount S 1
480 K3 File Information S 10
485 NTE Line Note S 1
488 PS1 Purchased Service Information S 1
491 HSD Health Care Services Delivery S 1
492 HCP Line Pricing/Repricing Information S 1
500 2420A - Rendering Provider Name 1
500 NM1 Rendering Provider Name S 1
505 PRV Rendering Provider Specialty Information R 1
510 N2 Additional Rendering Provider Name Information S 1
525 REF Rendering Provider Secondary Identification S 5
500 2420B - Purchased Service Provider Name 1
500 NM1 Purchased Service Provider Name S 1
525 REF Purchased Service Provider Secondary Identification S 5
500 2420C - Service Facility Location 1
500 NM1 Service Facility Location S 1
510 N2 Additional Service Facility Location Name Information S 1
514 N3 Service Facility Location Address R 1
520 N4 Service Facility Location City/State/ZIP R 1
525 REF Service Facility Location Secondary Identification S 5
500 2420D - Supervising Provider Name 1
500 NM1 Supervising Provider Name S 1
510 N2 Additional Supervising Provider Name Information S 1
525 REF Supervising Provider Secondary Identification S 5
500 2420E - Ordering Provider Name 1
500 NM1 Ordering Provider Name S 1
510 N2 Additional Ordering Provider Name Information S 1
514 N3 Ordering Provider Address S 1
520 N4 Ordering Provider City/State/ZIP Code S 1
525 REF Ordering Provider Secondary Identification S 5
530 PER Ordering Provider Contact Information S 1
500 2420F - Referring Provider Name 2
500 NM1 Referring Provider Name S 1
505 PRV Referring Provider Specialty Information S 1
510 N2 Additional Referring Provider Name Information S 1
525 REF Referring Provider Secondary Identification S 5
500 2420G - Other Payer Prior Authorization or Referral Number 4
500 NM1 Other Payer Prior Authorization or Referral Number S 1
525 REF Other Payer Prior Authorization or Referral Number R 2
540 2430 - Line Adjudication Information 25
540 SVD Line Adjudication Information S 1
545 CAS Line Adjustment S 99
550 DTP Line Adjudication Date R 1
551 2440 - Form Identification Code 5
551 LQ Form Identification Code S 1
552 FRM Supporting Documentation R 99
140 2000C - Patient Hierarchical Level >1
001 HL Patient Hierarchical Level R 1
007 PAT Patient Information R 1
015 2010CA - Patient Name 1
015 NM1 Patient Name S 1
020 N2 Additional Patient Name Information S 1
025 N3 Patient Address R 1
030 N4 Patient City/State/ZIP Code R 1
032 DMG Patient Demographic Information R 1
035 REF Patient Secondary Identification S 5
035 REF Property and Casualty Claim Number S 1
130 2300 - Claim Information 100
130 CLM Claim Information R 1
135 DTP Date - Order Date S 1
135 DTP Date - Initial Treatment S 1
135 DTP Date - Referral Date S 1
135 DTP Date - Date Last Seen S 1
135 DTP Date - Onset of Current Illness/Symptom S 1
135 DTP Date - Acute Manifestation S 5
135 DTP Date - Similar Illness/Symptom Onset S 10
135 DTP Date - Accident S 10
135 DTP Date - Last Menstrual Period S 1
135 DTP Date - Last X-Ray S 1
135 DTP Date - Estimated Date of Birth S 1
135 DTP Date - Hearing and Vision Prescription Date S 1
135 DTP Date - Disability Begin S 5
135 DTP Date - Disability End S 5
135 DTP Date - Last Worked S 1
135 DTP Date - Authorized Return to Work S 1
135 DTP Date - Admission S 1
135 DTP Date - Discharge S 1
135 DTP Date - Assumed and Relinquished Care Dates S 2
155 PWK Claim Supplemental Information S 10
160 CN1 Contract Information S 1
175 AMT Credit/Debit Card Maximum Amount S 1
175 AMT Patient Amount Paid S 1
175 AMT Total Purchased Service Amount S 1
180 REF Service Authorization Exception Code S 1
180 REF Mandatory Medicare (Section 4081) Crossover Indicator S 1
180 REF Mammography Certification Number S 1
180 REF Prior Authorization or Referral Number S 2
180 REF Original Reference Number (ICN/DCN) S 1
180 REF Clinical Laboratory Improvement Amendment (CLIA) Number S 3
180 REF Repriced Claim Number S 1
180 REF Adjusted Repriced Claim Number S 1
180 REF Investigational Device Exemption Number S 1
180 REF Claim Identification Number for Clearing Houses and Other Transmission Intermediaries S 1
180 REF Ambulatory Patient Group (APG) S 4
180 REF Medical Record Number S 1
180 REF Demonstration Project Identifier S 1
185 K3 File Information S 10
190 NTE Claim Note S 1
195 CR1 Ambulance Transport Information S 1
200 CR2 Spinal Manipulation Service Information S 1
220 CRC Ambulance Certification S 3
220 CRC Patient Condition Information: Vision S 3
220 CRC Homebound Indicator S 1
231 HI Health Care Diagnosis Code S 1
241 HCP Claim Pricing/Repricing Information S 1
242 2305 - Home Health Care Plan Information 6
242 CR7 Home Health Care Plan Information S 1
243 HSD Health Care Services Delivery S 3
250 2310A - Referring Provider Name 2
250 NM1 Referring Provider Name S 1
255 PRV Referring Provider Specialty Information S 1
260 N2 Additional Referring Provider Name Information S 1
271 REF Referring Provider Secondary Identification S 5
250 2310B - Rendering Provider Name 1
250 NM1 Rendering Provider Name S 1
255 PRV Rendering Provider Specialty Information R 1
260 N2 Additional Rendering Provider Name Information S 1
271 REF Rendering Provider Secondary Identification S 5
250 2310C - Purchased Service Provider Name 1
250 NM1 Purchased Service Provider Name S 1
271 REF Purchased Service Provider Secondary Identification S 5
250 2310D - Service Facility Location 1
250 NM1 Service Facility Location S 1
260 N2 Additional Service Facility Location Name Information S 1
265 N3 Service Facility Location Address R 1
270 N4 Service Facility Location City/State/ZIP R 1
271 REF Service Facility Location Secondary Identification S 5
250 2310E - Supervising Provider Name 1
250 NM1 Supervising Provider Name S 1
260 N2 Additional Supervising Provider Name Information S 1
271 REF Supervising Provider Secondary Identification S 5
290 2320 - Other Subscriber Information 10
290 SBR Other Subscriber Information S 1
295 CAS Claim Level Adjustments S 5
300 AMT Coordination of Benefits (COB) Payer Paid Amount S 1
300 AMT Coordination of Benefits (COB) Approved Amount S 1
300 AMT Coordination of Benefits (COB) Allowed Amount S 1
300 AMT Coordination of Benefits (COB) Patient Responsibility Amount S 1
300 AMT Coordination of Benefits (COB) Covered Amount S 1
300 AMT Coordination of Benefits (COB) Discount Amount S 1
300 AMT Coordination of Benefits (COB) Per Day Limit Amount S 1
300 AMT Coordination of Benefits (COB) Patient Paid Amount S 1
300 AMT Coordination of Benefits (COB) Tax Amount S 1
300 AMT Coordination of Benefits (COB) Total Claim Before Taxes Amount S 1
305 DMG Subscriber Demographic Information S 1
310 OI Other Insurance Coverage Information R 1
320 MOA Medicare Outpatient Adjudication Information S 1
325 2330A - Other Subscriber Name 1
325 NM1 Other Subscriber Name R 1
330 N2 Additional Other Subscriber Name Information S 1
332 N3 Other Subscriber Address S 1
340 N4 Other Subscriber City/State/ZIP Code S 1
355 REF Other Subscriber Secondary Identification S 3
325 2330B - Other Payer Name 1
325 NM1 Other Payer Name R 1
330 N2 Additional Other Payer Name Information S 1
345 PER Other Payer Contact Information S 2
345 DTP Claim Adjudication Date S 1
355 REF Other Payer Secondary Identifier S 2
355 REF Other Payer Prior Authorization or Referral Number S 2
355 REF Other Payer Claim Adjustment Indicator S 2
325 2330C - Other Payer Patient Information 1
325 NM1 Other Payer Patient Information S 1
355 REF Other Payer Patient Identification S 3
325 2330D - Other Payer Referring Provider 2
325 NM1 Other Payer Referring Provider S 1
355 REF Other Payer Referring Provider Identification R 3
325 2330E - Other Payer Rendering Provider 1
325 NM1 Other Payer Rendering Provider S 1
355 REF Other Payer Rendering Provider Secondary Identification R 3
325 2330F - Other Payer Purchased Service Provider 1
325 NM1 Other Payer Purchased Service Provider S 1
355 REF Other Payer Purchased Service Provider Identification R 3
325 2330G - Other Payer Service Facility Location 1
325 NM1 Other Payer Service Facility Location S 1
355 REF Other Payer Service Facility Location Identification R 3
325 2330H - Other Payer Supervising Provider 1
325 NM1 Other Payer Supervising Provider S 1
355 REF Other Payer Supervising Provider Identification R 3
365 2400 - Service Line 50
365 LX Service Line R 1
370 SV1 Professional Service R 1
385 SV4 Prescription Number S 1
420 PWK DMERC CMN Indicator S 1
425 CR1 Ambulance Transport Information S 1
430 CR2 Spinal Manipulation Service Information S 5
435 CR3 Durable Medical Equipment Certification S 1
445 CR5 Home Oxygen Therapy Information S 1
450 CRC Ambulance Certification S 3
450 CRC Hospice Employee Indicator S 1
450 CRC DMERC Condition Indicator S 2
455 DTP Date - Service Date R 1
455 DTP Date - Certification Revision Date S 1
455 DTP Date - Referral Date S 1
455 DTP Date - Begin Therapy Date S 1
455 DTP Date - Last Certification Date S 1
455 DTP Date - Order Date S 1
455 DTP Date - Date Last Seen S 1
455 DTP Date - Test S 2
455 DTP Date - Oxygen Saturation/Arterial Blood Gas Test S 3
455 DTP Date - Shipped S 1
455 DTP Date - Onset of Current Symptom/Illness S 1
455 DTP Date - Last X-ray S 1
455 DTP Date - Acute Manifestation S 1
455 DTP Date - Initial Treatment S 1
455 DTP Date - Similar Illness/Symptom Onset S 1
460 QTY Anesthesia Modifying Units S 5
462 MEA Test Result S 20
465 CN1 Contract Information S 1
470 REF Repriced Line Item Reference Number S 1
470 REF Adjusted Repriced Line Item Reference Number S 1
470 REF Prior Authorization or Referral Number S 2
470 REF Line Item Control Number S 1
470 REF Mammography Certification Number S 1
470 REF Clinical Laboratory Improvement Amendment (CLIA) Identification S 1
470 REF Referring Clinical Laboratory Improvement Amendment (CLIA) Facility Identification S 1
470 REF Immunization Batch Number S 1
470 REF Ambulatory Patient Group (APG) S 4
470 REF Oxygen Flow Rate S 1
470 REF Universal Product Number (UPN) S 1
475 AMT Sales Tax Amount S 1
475 AMT Approved Amount S 1
475 AMT Postage Claimed Amount S 1
480 K3 File Information S 10
485 NTE Line Note S 1
488 PS1 Purchased Service Information S 1
491 HSD Health Care Services Delivery S 1
492 HCP Line Pricing/Repricing Information S 1
500 2420A - Rendering Provider Name 1
500 NM1 Rendering Provider Name S 1
505 PRV Rendering Provider Specialty Information R 1
510 N2 Additional Rendering Provider Name Information S 1
525 REF Rendering Provider Secondary Identification S 5
500 2420B - Purchased Service Provider Name 1
500 NM1 Purchased Service Provider Name S 1
525 REF Purchased Service Provider Secondary Identification S 5
500 2420C - Service Facility Location 1
500 NM1 Service Facility Location S 1
510 N2 Additional Service Facility Location Name Information S 1
514 N3 Service Facility Location Address R 1
520 N4 Service Facility Location City/State/ZIP R 1
525 REF Service Facility Location Secondary Identification S 5
500 2420D - Supervising Provider Name 1
500 NM1 Supervising Provider Name S 1
510 N2 Additional Supervising Provider Name Information S 1
525 REF Supervising Provider Secondary Identification S 5
500 2420E - Ordering Provider Name 1
500 NM1 Ordering Provider Name S 1
510 N2 Additional Ordering Provider Name Information S 1
514 N3 Ordering Provider Address S 1
520 N4 Ordering Provider City/State/ZIP Code S 1
525 REF Ordering Provider Secondary Identification S 5
530 PER Ordering Provider Contact Information S 1
500 2420F - Referring Provider Name 2
500 NM1 Referring Provider Name S 1
505 PRV Referring Provider Specialty Information S 1
510 N2 Additional Referring Provider Name Information S 1
525 REF Referring Provider Secondary Identification S 5
500 2420G - Other Payer Prior Authorization or Referral Number 4
500 NM1 Other Payer Prior Authorization or Referral Number S 1
525 REF Other Payer Prior Authorization or Referral Number R 2
540 2430 - Line Adjudication Information 25
540 SVD Line Adjudication Information S 1
545 CAS Line Adjustment S 99
550 DTP Line Adjudication Date R 1
551 2440 - Form Identification Code 5
551 LQ Form Identification Code S 1
552 FRM Supporting Documentation R 99
030 FOOTER - Table 3 - Footer
555 SE Transaction Set Trailer R 1
030 GE Functional Group Trailer R 1
020 TA1 Interchange Acknowledgement S
030 IEA Interchange Control Trailer R 1