ISA- Interchange Control Header
01 I01 Authorization Information Qualifier R
00 03
02 I02 Authorization Information R
03 I03 Security Information Qualifier R
00 01
04 I04 Security Information R
05 I05 Interchange ID Qualifier R
01 14 20 27 28 29 30 33 ZZ
06 I06 Interchange Sender ID R
07 I05 Interchange ID Qualifier R
01 14 20 27 28 29 30 33 ZZ
08 I07 Interchange Receiver ID R
09 I08 Interchange Date R
10 I09 Interchange Time R
11 I10 Interchange Control Standards Identifier R
U
12 I11 Interchange Control Version Number R
00401
13 I12 Interchange Control Number R
14 I13 Acknowledgment Requested R
0 1
15 I14 Usage Indicator R
P T
16 I15 Component Element Separator R

GS- Functional Group Header
01 479 Functional Identifier Code R
HI HC BE HP HB HS RA HN HR FA
02 142 Application Sender's Code R
03 124 Application Receiver's Code R
04 373 Date R
05 337 Time R
06 28 Group Control Number R
07 455 Responsible Agency Code R
X
08 480 Version / Release / Industry Identifier Code R
004010 004010X061 004010X091 004010X092 004010X093 004010X094 004010X095 004010X096 004010X097 004010X098

ST- Transaction Set Header
01 143 Transaction Set Identifier Code R
997
02 329 Transaction Set Control Number R

AK1- Functional Group Response Header
01 479 Functional Identifier Code R
BE HB HC HI HN HP HR HS RA
02 28 Group Control Number R

AK2- Transaction Set Response Header
01 143 Transaction Set Identifier Code R
270 271 276 277 278 820 834 835 837
02 329 Transaction Set Control Number R

AK3- Data Segment Note
01 721 Segment ID Code R
02 719 Segment Position in Transaction Set R
03 447 Loop Identifier Code S
04 720 Segment Syntax Error Code S
1 2 3 4 5 6 7 8

AK4- Data Element Note
R C030 Position in Segment
01 722 Element Position in Segment R
02 1528 Component Data Element Position in Composite S
02 725 Data Element Reference Number S
03 723 Data Element Syntax Error Code R
1 2 3 4 5 6 7 8 9 10
04 724 Copy of Bad Data Element S

AK5- Transaction Set Response Trailer
01 717 Transaction Set Acknowledgment Code R
A E M R W X
02 718 Transaction Set Syntax Error Code S
1 2 3 4 5 6 7 8 9 10 11 12 13 15 16 17 23 24 25 26 27
03 718 Transaction Set Syntax Error Code S
1 2 3 4 5 6 7 8 9 10 11 12 13 15 16 17 23 24 25 26 27
04 718 Transaction Set Syntax Error Code S
1 2 3 4 5 6 7 8 9 10 11 12 13 15 16 17 23 24 25 26 27
05 718 Transaction Set Syntax Error Code S
1 2 3 4 5 6 7 8 9 10 11 12 13 15 16 17 23 24 25 26 27
06 718 Transaction Set Syntax Error Code S
1 2 3 4 5 6 7 8 9 10 11 12 13 15 16 17 23 24 25 26 27

AK9- Functional Group Response Trailer
01 715 Functional Group Acknowledge Code R
A E M P R W X
02 97 Number of Transaction Sets Included R
03 123 Number of Received Transaction Sets R
04 2 Number of Accepted Transaction Sets R
05 716 Functional Group Syntax Error Code S
1 2 3 4 5 6 10 11 12 13 14 15 16 17 18 23 24 25 26
06 716 Functional Group Syntax Error Code S
1 2 3 4 5 6 10 11 12 13 14 15 16 17 18 23 24 25 26
07 716 Functional Group Syntax Error Code S
1 2 3 4 5 6 10 11 12 13 14 15 16 17 18 23 24 25 26
08 716 Functional Group Syntax Error Code S
1 2 3 4 5 6 10 11 12 13 14 15 16 17 18 23 24 25 26
09 716 Functional Group Syntax Error Code S
1 2 3 4 5 6 10 11 12 13 14 15 16 17 18 23 24 25 26

SE- Transaction Set Trailer
01 96 Number of Included Segments R
02 329 Transaction Set Control Number R

GE- Functional Group Trailer
01 97 Number of Transaction Sets Included R
02 28 Group Control Number R

TA1- Interchange Acknowledgement
01 I12 Interchange Control Number R
02 I08 Interchange Date R
03 I09 Interchange Time R
04 I17 Interchange Acknowledgement Code R
A E R
05 I18 Interchange Note Code R
000 001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 018 019 020 021 022 023 024 025 026 027 028 029 030 031

IEA- Interchange Control Trailer
01 I16 Number of Included Functional Groups R
02 I12 Interchange Control Number R