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sam bacha
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DEV/EDILib.js |
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freighttrust: | ||
info: | ||
version: "2.1.0" | ||
title: 'Protocol specifications' | ||
description: 'protocol values' | ||
license: | ||
name: Mozilla Public License 2.0 | ||
url: hhttps://www.mozilla.org/en-US/MPL/2.0/ | ||
contact: | ||
name: Freight Trust and Clearing Corporation | ||
url: https://freighttrust.com | ||
email: [email protected] |
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[ | ||
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"@id": "http://spdx.org/licenses/MPL-2.0", | ||
"@type": "spdx:License", | ||
"isFsfLibre": "true", | ||
"isOsiApproved": "true", | ||
"licenseId": "MPL-2.0", | ||
"#ref": "http://spdx.org/licenses/MPL-2.0", | ||
"#type": "spdx:License", | ||
"$id": "lei:254900C9UJMDGJ0ILK56", | ||
"copyright": "2020 FreightTrust and Clearing Corporation", | ||
"name": { | ||
"@id": "X12 Grammar" | ||
} | ||
}, | ||
{ | ||
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"TypeMaps": { | ||
"TS204": "LoadTender", | ||
"TS990": "LoadTenderResponse", | ||
"TS997": "Acknowledgment", | ||
"TS214": "LoadTenderStatus", | ||
"TS210": "LoadTenderInvoice", | ||
"S5": "Stop", | ||
"B1": "BeginningSegmentPickupDelivery", | ||
"B10": "BeginningSegment", | ||
"L11": "ReferenceNumber", | ||
"AT7": "ShipmentStatusDetails", | ||
"MS1": "ShipmentLocationInfo", | ||
"K1": "Remarks", | ||
"Loop_S5_204": "Stops", | ||
"N9": "Reference", | ||
"AT5": "HandlingRequirement", | ||
"Loop_N1_204": "Party", | ||
"Loop_N7_204": "Equipment", | ||
"LH6": "HazardousCertification", | ||
"NTE": "Note", | ||
"B3": "InvoiceInfo", | ||
"G62": "DateTimeInfo", | ||
"H3": "SpecialHandlingInstructions", | ||
"N7": "EquipmentDetails", | ||
"N1": "Name", | ||
"LX": "AssignedNumber", | ||
"L1": "RatesAndChargesInfo", | ||
"L3": "TotalWeightAndChargesInfo", | ||
"Loop_L1_210": "InvoiceRateChargeItem", | ||
"Loop_LX_210": "InvoiceAssignedNumber", | ||
"Loop_N1_210": "InvoiceName", | ||
"Loop_N7_210": "InvoiceEquipmentDetail", | ||
"Loop_S5_210": "InvoiceStop" | ||
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} | ||
} | ||
} | ||
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] |
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as2MessageId (String) - AS2 message ID | ||
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persistedTimestamp (Long) - timestamp in milliseconds | ||
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compressed (Boolean) - true or false depicting whether the AS2 message was compressed | ||
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encrypted (Boolean) - true or false depicting whether the AS2 message was encrypted | ||
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signed (Boolean) - true or false depicting whether the AS2 message was signed | ||
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subject (String) - Subject of AS2 message. If there is no subject, this field will not be included in the response. | ||
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receiverId (String) - AS2 ID of the AS2 partner who has sent/received this message | ||
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senderId (String) - AS2 ID of the AS2 station which has received/sent this message | ||
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transportStatusReceived (Integer, optional) - HTTP response code received. Only available on sent messages. | ||
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deliveryStatus (String, optional) - AS2-level delivery status of the AS2 message. Only available on sent messages. Possible values are Delivered, Not Delivered and No Status. | ||
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mdnStatus (String) - Delivery status of MDN. Possible values are Pending, Received, Not Requested and No MDN. | ||
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partnerType (String) - AS2 Partner type. Possible values are Production and Test | ||
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mdnMessage (MDN Message, optional) - represents the MDN sent/received for this AS2 message | ||
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attachments (Array of Attachments) - the attachments sent/received in this AS2 message |
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MDN Message | ||
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Represents a receipt, i.e. disposition notification (MDN) message received/sent by AS2 Gateway, with the following attributes: | ||
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persistedTimestamp (Long) - timestamp in milliseconds when the message was saved in AS2 Gateway | ||
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mdnError (Boolean) - true or false depicting whether the received MDN is an error MDN or not | ||
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content (String) - String with human readable part of the MDN received | ||
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Attachment | ||
Represents details of a single attachment sent/received by AS2 Gateway (usually appearing within a list of attachments), with the following attributes: | ||
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name (String) - attachment file name | ||
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size (Integer) - size of the attachment in bytes | ||
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Pagination | ||
Represents a collection of entities (usually AS2 Messages) returned from a pagination-enabled endpoint (usually a list endpoint) | ||
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totalRecords (Integer) - the total number of results that match the query | ||
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records (Array) - a subset of those results based on the requested pageOffset and pageLength |
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let Rule5010270 = "FILE DATA\n" + | ||
"Version=005010X279A1\n" + | ||
"Description=270 Eligibility, Coverage or Benefit Inquiry\n" + | ||
"ELEMENT DEFINITIONS\n" + | ||
"19=AN,2,30,City Name\n" + | ||
"26=ID,2,3,Country Code\n" + | ||
"28=NO,1,9,Group Control Number\n" + | ||
"66=ID,1,2,Identification Code Qualifier\n" + | ||
"67=AN,2,80,Identification Code\n" + | ||
"93=AN,1,60,Name\n" + | ||
"96=NO,1,10,Number of Included Segments\n" + | ||
"97=NO,1,6,Number of Transaction Sets Included\n" + | ||
"98=ID,2,3,Entity Identifier Code\n" + | ||
"101=ID,2,2,Authorization Information Qualifier\n" + | ||
"102=AN,10,10,Authorization Information\n" + | ||
"103=ID,2,2,Security Information Qualifier\n" + | ||
"104=AN,10,10,Security Information\n" + | ||
"105=ID,2,2,Interchange ID Qualifier\n" + | ||
"106=AN,15,15,Interchange Sender ID\n" + | ||
"107=AN,15,15,Interchange Receiver ID\n" + | ||
"108=DT,6,6,Interchange Date\n" + | ||
"109=TM,4,4,Interchange Time\n" + | ||
"110=ID,1,1\n" + | ||
"111=ID,5,5,Interchange Control Version Number\n" + | ||
"112=NO,9,9,Interchange Control Number\n" + | ||
"113=ID,1,1,Acknowledgment Requested\n" + | ||
"114=ID,1,1,Interchange Usage Indicator\n" + | ||
"115=ID,1,1,Component Element Separator\n" + | ||
"116=ID,3,15,Postal Code\n" + | ||
"124=AN,2,15,Application Receiver Code\n" + | ||
"127=AN,1,50,Reference Identification\n" + | ||
"128=ID,2,3,Reference Identification Qualifier\n" + | ||
"142=AN,2,15,Application Sender Code\n" + | ||
"143=ID,3,3,Transaction Set Identifier Code\n" + | ||
"156=ID,2,2,State or Province Code\n" + | ||
"165=ID,1,1,Repetition Separator\n" + | ||
"166=AN,1,55,Address Information\n" + | ||
"234=AN,1,48,Product/Service ID\n" + | ||
"235=ID,2,2,Product/Service ID Qualifier\n" + | ||
"309=ID,1,2,Location Qualifier\n" + | ||
"310=AN,1,30,Location Identifier\n" + | ||
"329=AN,4,9,Transaction Set Control Number\n" + | ||
"337=TM,4,8,Time\n" + | ||
"352=AN,1,80,Description\n" + | ||
"353=ID,2,2,Transaction Set Purpose Code\n" + | ||
"364=AN,1,80,Communication Number\n" + | ||
"365=ID,2,2,Communication Number Qualifier\n" + | ||
"366=ID,2,2,Contact Function Code\n" + | ||
"373=DT,8,8,Date\n" + | ||
"374=ID,3,3,Date/Time Qualifier\n" + | ||
"380=R,1,15,Quantity\n" + | ||
"455=ID,1,2,Responsible Agency Code\n" + | ||
"478=ID,1,1,Credit/Debit Flag Code\n" + | ||
"479=ID,2,2,Functional Identifier Code\n" + | ||
"480=AN,1,12,Version / Release / Industry Identifier Code\n" + | ||
"481=ID,1,2,Trace Type Code\n" + | ||
"509=AN,10,10,Originating Company Identifier\n" + | ||
"522=ID,1,3,Amount Qualifier Code\n" + | ||
"584=ID,2,2,Employment Status Code\n" + | ||
"615=ID,1,2,Time Period Qualifier\n" + | ||
"628=AN,1,12,Hierarchical ID Number\n" + | ||
"640=ID,2,2,Transaction Type Code\n" + | ||
"659=ID,1,2,Basis of Verification Code\n" + | ||
"673=ID,2,2,Quantity Qualifier\n" + | ||
"734=AN,1,12,Hierarchical Parent ID Number\n" + | ||
"735=ID,1,12,Hierarchical Level Code\n" + | ||
"736=ID,1,1,Hierarchical Child Code\n" + | ||
"782=R,1,18,Monetary Amount\n" + | ||
"799=AN,1,30,Version Identifier\n" + | ||
"875=ID,3,3,Maintenance Type Code\n" + | ||
"933=AN,1,264,Free-form Message Text\n" + | ||
"934=ID,2,2,Printer Carriage Control Code\n" + | ||
"954=R,1,10,Percent\n" + | ||
"1005=ID,4,4,Hierarchical Structure Code\n" + | ||
"1035=AN,1,60,Name Last or Organization Name\n" + | ||
"1036=AN,1,25,Name First\n" + | ||
"1037=AN,1,25,Name Middle\n" + | ||
"1038=AN,1,10,Name Prefix\n" + | ||
"1039=AN,1,10,Name Suffix\n" + | ||
"1065=ID,1,1,Entity Type Qualifier\n" + | ||
"1066=ID,1,2,Citizenship Status Code\n" + | ||
"1067=ID,1,1,Marital Status Code\n" + | ||
"1068=ID,1,1,Gender Code\n" + | ||
"1069=ID,2,2,Individual Relationship Code\n" + | ||
"1073=ID,1,1,Yes/No Condition or Response Code\n" + | ||
"1109=ID,1,1\n" + | ||
"1136=ID,2,2,Code Category\n" + | ||
"1165=ID,1,1,Confidentiality Code\n" + | ||
"1203=ID,2,3,Maintenance Reason Code\n" + | ||
"1204=AN,1,50,Plan Coverage Description\n" + | ||
"1207=ID,3,3,Coverage Level Code\n" + | ||
"1216=ID,1,1,Benefit Status Code\n" + | ||
"1218=ID,1,1\n" + | ||
"1219=AN,1,2,COBRA\n" + | ||
"1220=ID,1,1,Student Status Code\n" + | ||
"1221=AN,1,3,Provider Code\n" + | ||
"1250=ID,2,3,DateTime Period Format Qualifier\n" + | ||
"1251=AN,1,35,Date Time Period\n" + | ||
"1270=ID,2,3,Code List Qual Code\n" + | ||
"1271=AN,1,30,Industry Code\n" + | ||
"1328=NO,1,2,Diagnosis Code Pointer\n" + | ||
"1336=ID,1,3,Insurance Type Code\n" + | ||
"1339=AN,2,2,Procedure Modifier\n" + | ||
"1365=ID,1,2,Service Type Code\n" + | ||
"1470=NO,1,9,Number\n" + | ||
"1705=AN,1,35,Implementation Convention Reference\n" + | ||
"1715=ID,1,3,Country Subdivision Code\n" + | ||
"11111112=NO,1,9,Interchange Control Number\n" + | ||
"11111116=NO,1,5,Number of Included Functional Groups\n" + | ||
"COMPOSITE ELEMENT DEFINITIONS\n" + | ||
"C003=[235,O][234,O][1339,O][1339,O][1339,O][1339,O][352,O],@@....#\n" + | ||
"C004=[1328,O][1328,O][1328,O][1328,O],@...\n" + | ||
"C022=[1270,O][1271,O][1250,O][1251,O][782,O][380,O][799,O][1271,O][1073,O],@@#######\n" + | ||
"SEGMENT DEFINITIONS\n" + | ||
"AMT=[522][782][478],@@#\n" + | ||
"BHT=[1005,M][353,M][127][373,M][337,M][640]\n" + | ||
"DMG=[1250][1251][1068][1067][1109][1066][26][659][380]+P0102,...######\n" + | ||
"DTP=[374,M][1250,M][1251,M]\n" + | ||
"EQ=[1365][C003][1207][1336][C004]+R0102,..*1.#.*1,..*1##.*1\n" + | ||
"GE=[97,M][28,M]\n" + | ||
"GS=[479,M][142,M][124,M][373,M][337,M][28,M][455,M][480,M]\n" + | ||
"HI=[C022][C022][C022][C022][C022][C022][C022][C022][C022][C022][C022][C022],@*1.*1.*1.*1.*1.*1.*1.*1#*1#*1#*1#*1\n" + | ||
"HL=[628][734][735][736],@#@@,@@@@\n" + | ||
"IEA=[11111116,M][11111112,M]\n" + | ||
"III=[1270,M][1271,M]\n" + | ||
"INS=[1073][1069][875][1203][1216][1218][1219][584][1220][1073][1250][1251][1165][19][156][26][1470],@@##############@,@@##############.\n" + | ||
"ISA=[101,M][102,M][103,M][104,M][105,M][106,M][105,M][107,M][108,M][109,M][165,M][111,M][112,M][113,M][114,M][115,M]\n" + | ||
"MSG=[933][934][1470],@##\n" + | ||
"N3=[166,M][166]\n" + | ||
"N4=[19][156][116][26][309][310][1715],@...##.,....##.,@...##.\n" + | ||
"NM1=[98,M][1065,M][1035][1036][1037][1038][1039][66][67]+P0809,@@...#.@@,@@...#...,@@...#.##,@@@..#.@@\n" + | ||
"PER=[366][93][365][364][365][364][365][364]+P0304P0506P0708,@.......\n" + | ||
"PRV=[1221][128][127],@..\n" + | ||
"REF=[128,M][127,M][352],@@#\n" + | ||
"SE=[96,M][329,M]\n" + | ||
"ST=[143,M][329,M][1705,M]\n" + | ||
"TRN=[481,M][127,M][509,M][127]\n" + | ||
"SEGMENT SELF RULES\n" + | ||
"NM1~2~[EQ]1~4~0\n" + | ||
"NM1~2~[EQ]2~2~4,5\n" + | ||
"COMPOSITE ELEMENT SELF RULES\n" + | ||
"CODELISTS\n" + | ||
"FORMATS\n" + | ||
"Date CCYYMMDD=^(((\\d{4}((0[13578]|1[02])(0[1-9]|[12]\\d|3[01])|(0[13456789]|1[012])(0[1-9]|[12]\\d|30)|02(0[1-9]|1\\d|2[0-8])))|((\\d{2}[02468][048]|\\d{2}[13579][26]))0229)){0,8}$\n" + | ||
"EDI FILE STRUCTURE\n" + | ||
"{INTERCHANGE HEADER:1[ISA,M]{FUNCTIONAL GROUP:1[GS,M]{ST HEADER:>1[ST,M][BHT,M]{2000A:>1[HL*1,M]{2100A:1[NM1*4,M]}{2000B:>1[HL*2,M]{2100B:1[NM1*4,M][REF,O,9][N3][N4*1][PRV*1]}{2000C:>1[HL*2,M][TRN,O,2]{2100C:1[NM1*2,M][REF*1,O,9][N3][N4*1][PRV*1][DMG*1][INS*1][HI*1][DTP,O,2]{2110C:99[EQ*1][AMT*1][AMT*1][III][REF*1][DTP]}{2000D:>1[HL*2,X][TRN,O,2]{2100D:1[NM1*3,M][REF*1,O,9][N3][N4*3][PRV*1][DMG*1][INS*2][HI*1][DTP,O,2]{2110D:99[EQ*2,M][III][REF*1][DTP]}}}}}}}{END ST HEADER LOOP:1[SE,M]}}{END GS LOOP:1[GE,M]}}{END ISA LOOP:1[IEA,M]}}\n" + | ||
"ELEMENT CODES\n" + | ||
"101=1:1,00,03\n" + | ||
"103=1:3,00,01\n" + | ||
"105=1:5,01,14,20,27,28,29,30,33,ZZ*1:7,01,14,20,27,28,29,30,33,ZZ\n" + | ||
"111=1:12,00501\n" + | ||
"113=1:14,0,1\n" + | ||
"114=1:15,P,T\n" + | ||
"479=2:1,HS\n" + | ||
"455=2:7,X\n" + | ||
"480=2:8,005010X279A1\n" + | ||
"143=3:1,270\n" + | ||
"1705=3:3,005010X279A1\n" + | ||
"1005=4:1,0022\n" + | ||
"353=4:2,01,13\n" + | ||
"640=4:6,RT\n" + | ||
"735=5:3,20*7:3,21*13:3,22*30:3,23\n" + | ||
"736=5:4,1*7:4,1*13:4,0,1*30:4,0\n" + | ||
"98=6:1,2B,36,GP,P5,PR*8:1,1P,2B,36,80,FA,GP,P5,PR*15:1,IL*32:1,03\n" + | ||
"1065=6:2,1,2*8:2,1,2*15:2,1,2*32:2,1\n" + | ||
"66=6:8,24,46,FI,NI,PI,XV,XX*8:8,24,34,FI,PI,PP,SV,XV,XX*15:8,II,MI\n" + | ||
"128=9:1,0B,1C,1D,1J,4A,CT,EL,EO,HPI,JD,N5,N7,Q4,SY,TJ*12:2,PXC*16:1,18,1L,1W,3H,6P,CT,EA,EJ,F6,GH,HJ,IG,N6,NQ,SY,Y4*19:2,9K,D3,EI,HPI,PXC,SY,TJ*28:1,9F,G1*33:1,18,1L,1W,6P,CT,EA,EJ,F6,GH,HJ,IF,IG,MRC,N6,SY,Y4*36:2,9K,D3,EI,HPI,PXC,SY,TJ*43:1,9F,G1\n" + | ||
"1221=12:1,AD,AT,BI,CO,CV,H,HH,LA,OT,P1,P2,PC,PE,R,RF,SB,SK,SU*19:1,AD,AT,BI,CO,CV,H,HH,LA,OT,P1,P2,PC,PE,R,RF,SK,SU*36:1,AD,AT,BI,CO,CV,H,HH,LA,OT,P1,P2,PC,PE,R,RF,SK,SU\n" + | ||
"481=14:1,1*31:1,1\n" + | ||
"1250=20:1,D8*23:2,D8,RD8*29:2,D8,RD8*37:1,D8*40:2,D8,RD8*44:2,D8,RD8\n" + | ||
"1068=20:3,F,M*37:3,F,M\n" + | ||
"1073=21:1,Y*38:1,N\n" + | ||
"1069=21:2,18*38:2,01,19,34\n" + | ||
"1270=22:1:1,ABK,BK*22:2:1,ABF,BF*22:3:1,ABF,BF*22:4:1,ABF,BF*22:5:1,ABF,BF*22:6:1,ABF,BF*22:7:1,ABF,BF*22:8:1,ABF,BF*27:1,ZZ*39:1:1,ABK,BK*39:2:1,ABF,BF*39:3:1,ABF,BF*39:4:1,ABF,BF*39:5:1,ABF,BF*39:6:1,ABF,BF*39:7:1,ABF,BF*39:8:1,ABF,BF*42:1,BF,BK,ZZ\n" + | ||
"374=23:1,102,291*29:1,291*40:1,102,291*44:1,291\n" + | ||
"1365=24:1,1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,30,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,A0,A1,A2,A3,A4,A5,A6,A7,A8,A9,AA,AB,AC,AD,AE,AF,AG,AH,AI,AJ,AK,AL,AM,AN,AO,AQ,AR,B1,B2,B3,BA,BB,BC,BD,BE,BF,BG,BH,BI,BJ,BK,BL,BM,BN,BP,BQ,BR,BS,BT,BU,BV,BW,BX,BY,BZ,C1,CA,CB,CC,CD,CE,CF,CG,CH,CI,CJ,CK,CL,CM,CN,CO,CP,CQ,DG,DM,DS,GF,GN,GY,IC,MH,NI,ON,PT,PU,RN,RT,TC,TN,UC*41:1,1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,30,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,A0,A1,A2,A3,A4,A5,A6,A7,A8,A9,AA,AB,AC,AD,AE,AF,AG,AH,AI,AJ,AK,AL,AM,AN,AO,AQ,AR,BA,BB,BC,BD,BE,BF,BG,BH,BI,BJ,BK,BL,BM,BN,BP,BQ,BR,BS\n" + | ||
"235=24:2:1,AD,CJ,HC,ID,IV,N4,ZZ*41:2:1,AD,CJ,HC,ID,IV,N4,ZZ\n" + | ||
"1207=24:3,FAM*41:3,CHD,DEP,ECH,EMP,ESP,FAM,IND,SPC,SPO\n" + | ||
"522=25:1,R*26:1,PB\n" + | ||
"1336=41:4,AP,C1,CO,HM,IP,OT,PR,PS,SP,WC\n" + | ||
"ELEMENT FORMATS\n" + | ||
"1251=20:2,0,,Date CCYYMMDD\n" + | ||
"SUMMARY\n" + | ||
"ELEMENT EQUALITY\n" + | ||
"1:13=47:2\n" + | ||
"3:2=45:2\n" + | ||
"RULES\n" + | ||
"24=13:4'EQ'0!USAGE!2!1\n" + | ||
"30=13:4'EQ'1!USAGE!2!1\n" + | ||
"ELEMENT COUNTERS\n" + | ||
"ELEMENT CODE DESCRIPTION\n" + | ||
"LOOP DESCRIPTIONS\n" + | ||
"INTERCHANGE HEADER=START OF INTERCHANGE HEADER\n" + | ||
"FUNCTIONAL GROUP=START OF FUNCTIONAL GROUP\n" + | ||
"ST HEADER=START OF ST HEADER\n" + | ||
"2000A=INFORMATION SOURCE LEVEL\n" + | ||
"2100A=INFORMATION SOURCE NAME\n" + | ||
"2000B=INFORMATION RECEIVER LEVEL\n" + | ||
"2100B=INFORMATION RECEIVER NAME\n" + | ||
"2000C=SUBSCRIBER LEVEL\n" + | ||
"2100C=SUBSCRIBER NAME\n" + | ||
"2110C=SUBSCRIBER ELIGIBILITY OR BENEFIT INQUIRY\n" + | ||
"2000D=DEPENDENT LEVEL\n" + | ||
"2100D=DEPENDENT NAME\n" + | ||
"2110D=DEPENDENT ELIGIBILITY OR BENEFIT INQUIRY\n" + | ||
"END ST HEADER LOOP=END ST HEADER LOOP\n" + | ||
"END GS LOOP=END OF FUNCTIONAL HEADER\n" + | ||
"END ISA LOOP=END OF INTERCHANGE HEADER\n" + | ||
"SEGMENT DESCRIPTIONS\n" + | ||
"ISA=1,Interchange Header\n" + | ||
"GS=2,Functional Group\n" + | ||
"ST=3,Transaction Set Header\n" + | ||
"BHT=4,Beginning of Hierarchical Transaction\n" + | ||
"HL=5,Information Source Level\n" + | ||
"NM1=6,Information Source Name\n" + | ||
"HL=7,Information Receiver Level\n" + | ||
"NM1=8,Information Receiver Name\n" + | ||
"REF=9,Information Receiver Additional Identification\n" + | ||
"N3=10,Information Receiver Address\n" + | ||
"N4=11,Information Receiver City\n" + | ||
"PRV=12,Information Receiver Provider Information\n" + | ||
"HL=13,Subscriber Level\n" + | ||
"TRN=14,Subscriber Trace Number\n" + | ||
"NM1=15,Subscriber Name\n" + | ||
"REF=16,Subscriber Additional Identification\n" + | ||
"N3=17,Subscriber Address\n" + | ||
"N4=18,Subscriber City\n" + | ||
"PRV=19,Provider Information\n" + | ||
"DMG=20,Subscriber Demographic Information\n" + | ||
"INS=21,Multiple Birth Sequence Number\n" + | ||
"HI=22,Subscriber Health Care Diagnosis Code\n" + | ||
"DTP=23,Subscriber Date\n" + | ||
"EQ=24,Subscriber Eligibility or Benefit Inquiry\n" + | ||
"AMT=25,Subscriber Spend Down Amount\n" + | ||
"AMT=26,Subscriber Spend Down Total Billed Amount\n" + | ||
"III=27,Subscriber Eligibility or Benefit Additional Inquiry Information\n" + | ||
"REF=28,Subscriber Additional Information\n" + | ||
"DTP=29,Subscriber Eligibility/Benefit Date\n" + | ||
"HL=30,Dependent Level\n" + | ||
"TRN=31,Dependent Trace Number\n" + | ||
"NM1=32,Dependent Name\n" + | ||
"REF=33,Dependent Additional Identification\n" + | ||
"N3=34,Dependent Address\n" + | ||
"N4=35,Dependent City\n" + | ||
"PRV=36,Provider Information\n" + | ||
"DMG=37,Dependent Demographic Information\n" + | ||
"INS=38,Dependent Relationship\n" + | ||
"HI=39,Dependent Health Care Diagnosis Code\n" + | ||
"DTP=40,Dependent Date\n" + | ||
"EQ=41,Dependent Eligibility or Benefit Inquiry\n" + | ||
"III=42,Dependent Eligibility or Benefit Additional Inquiry Information\n" + | ||
"REF=43,Dependent Additional Information\n" + | ||
"DTP=44,Dependent Eligibility/Benefit Date\n" + | ||
"SAMPLE DATA"; |
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