<?xml version="1.0"?>
<!--
######################################################################
# Copyright (c) 2001-2005 Kalamazoo Community Mental Health Services,
#   John Holland <jholland@kazoocmh.org> <john@zoner.org>
# All rights reserved.
#
# This software is licensed as described in the file LICENSE.txt, which
# you should have received as part of this distribution.
#
######################################################################

#    $Id: 820.4010.X061.A1.xml,v 1.13 2005/05/16 17:13:52 johnholland Exp $
-->
<transaction>
  <id>820</id>
  <name>HIPAA Payment Deducted and Other Group Premium Payment for Insurance Products X061A1-820</name>
  <loop xid="ISA_LOOP" type="explicit">
    <name>Interchange Control Header</name>
    <usage>R</usage>
    <pos>001</pos>
    <repeat>&gt;1</repeat>
    <segment xid="ISA">
      <name>Interchange Control Header</name>
      <usage>R</usage>
      <pos>010</pos>
      <max_use>1</max_use>
      <element xid="ISA01">
        <data_ele>I01</data_ele>
        <name>Authorization Information Qualifier</name>
        <usage>R</usage>
        <seq>01</seq>
        <data_type>ID</data_type>
        <min_len>2</min_len>
        <max_len>2</max_len>
        <valid_codes>
          <code>00</code>
          <code>03</code>
        </valid_codes>
      </element>
      <element xid="ISA02">
        <data_ele>I02</data_ele>
        <name>Authorization Information</name>
        <usage>R</usage>
        <seq>02</seq>
        <data_type>AN</data_type>
        <min_len>10</min_len>
        <max_len>10</max_len>
      </element>
      <element xid="ISA03">
        <data_ele>I03</data_ele>
        <name>Security Information Qualifier</name>
        <usage>R</usage>
        <seq>03</seq>
        <data_type>ID</data_type>
        <min_len>2</min_len>
        <max_len>2</max_len>
        <valid_codes>
          <code>00</code>
          <code>01</code>
        </valid_codes>
      </element>
      <element xid="ISA04">
        <data_ele>I04</data_ele>
        <name>Security Information</name>
        <usage>R</usage>
        <seq>04</seq>
        <data_type>AN</data_type>
        <min_len>10</min_len>
        <max_len>10</max_len>
      </element>
      <element xid="ISA05">
        <data_ele>I05</data_ele>
        <name>Interchange ID Qualifier</name>
        <usage>R</usage>
        <seq>05</seq>
        <data_type>ID</data_type>
        <min_len>2</min_len>
        <max_len>2</max_len>
        <valid_codes>
          <code>01</code>
          <code>14</code>
          <code>20</code>
          <code>27</code>
          <code>28</code>
          <code>29</code>
          <code>30</code>
          <code>33</code>
          <code>ZZ</code>
        </valid_codes>
      </element>
      <element xid="ISA06">
        <data_ele>I06</data_ele>
        <name>Interchange Sender ID</name>
        <usage>R</usage>
        <seq>06</seq>
        <data_type>AN</data_type>
        <min_len>15</min_len>
        <max_len>15</max_len>
      </element>
      <element xid="ISA07">
        <data_ele>I05</data_ele>
        <name>Interchange ID Qualifier</name>
        <usage>R</usage>
        <seq>07</seq>
        <data_type>ID</data_type>
        <min_len>2</min_len>
        <max_len>2</max_len>
        <valid_codes>
          <code>01</code>
          <code>14</code>
          <code>20</code>
          <code>27</code>
          <code>28</code>
          <code>29</code>
          <code>30</code>
          <code>33</code>
          <code>ZZ</code>
        </valid_codes>
      </element>
      <element xid="ISA08">
        <data_ele>I07</data_ele>
        <name>Interchange Receiver ID</name>
        <usage>R</usage>
        <seq>08</seq>
        <data_type>AN</data_type>
        <min_len>15</min_len>
        <max_len>15</max_len>
      </element>
      <element xid="ISA09">
        <data_ele>I08</data_ele>
        <name>Interchange Date</name>
        <usage>R</usage>
        <seq>09</seq>
        <data_type>DT</data_type>
        <min_len>6</min_len>
        <max_len>6</max_len>
        <valid_codes/>
      </element>
      <element xid="ISA10">
        <data_ele>I09</data_ele>
        <name>Interchange Time</name>
        <usage>R</usage>
        <seq>10</seq>
        <data_type>TM</data_type>
        <min_len>4</min_len>
        <max_len>4</max_len>
        <valid_codes/>
      </element>
      <element xid="ISA11">
        <data_ele>I10</data_ele>
        <name>Interchange Control Standards Identifier</name>
        <usage>R</usage>
        <seq>11</seq>
        <data_type>ID</data_type>
        <min_len>1</min_len>
        <max_len>1</max_len>
        <valid_codes>
          <code>U</code>
        </valid_codes>
      </element>
      <element xid="ISA12">
        <data_ele>I11</data_ele>
        <name>Interchange Control Version Number</name>
        <usage>R</usage>
        <seq>12</seq>
        <data_type>ID</data_type>
        <min_len>5</min_len>
        <max_len>5</max_len>
        <valid_codes>
          <code>00401</code>
        </valid_codes>
      </element>
      <element xid="ISA13">
        <data_ele>I12</data_ele>
        <name>Interchange Control Number</name>
        <usage>R</usage>
        <seq>13</seq>
        <data_type>N0</data_type>
        <min_len>9</min_len>
        <max_len>9</max_len>
      </element>
      <element xid="ISA14">
        <data_ele>I13</data_ele>
        <name>Acknowledgment Requested</name>
        <usage>R</usage>
        <seq>14</seq>
        <data_type>ID</data_type>
        <min_len>1</min_len>
        <max_len>1</max_len>
        <valid_codes>
          <code>0</code>
          <code>1</code>
        </valid_codes>
      </element>
      <element xid="ISA15">
        <data_ele>I14</data_ele>
        <name>Usage Indicator</name>
        <usage>R</usage>
        <seq>15</seq>
        <data_type>ID</data_type>
        <min_len>1</min_len>
        <max_len>1</max_len>
        <valid_codes>
          <code>P</code>
          <code>T</code>
        </valid_codes>
      </element>
      <element xid="ISA16">
        <data_ele>I15</data_ele>
        <name>Component Element Separator</name>
        <usage>R</usage>
        <seq>16</seq>
        <data_type>AN</data_type>
        <min_len>1</min_len>
        <max_len>1</max_len>
      </element>
    </segment>
<!--End of ISA segment-->
    <loop xid="GS_LOOP" type="explicit">
      <name>Functional Group Header</name>
      <usage>R</usage>
      <pos>020</pos>
      <repeat>&gt;1</repeat>
      <segment xid="GS">
        <name>Functional Group Header</name>
        <usage>R</usage>
        <pos>010</pos>
        <max_use>1</max_use>
        <element xid="GS01">
          <data_ele>479</data_ele>
          <name>Functional Identifier Code</name>
          <usage>R</usage>
          <seq>01</seq>
          <data_type>ID</data_type>
          <min_len>2</min_len>
          <max_len>2</max_len>
          <valid_codes>
            <code>RA</code>
          </valid_codes>
        </element>
        <element xid="GS02">
          <data_ele>142</data_ele>
          <name>Application Sender's Code</name>
          <usage>R</usage>
          <seq>02</seq>
          <data_type>AN</data_type>
          <min_len>2</min_len>
          <max_len>15</max_len>
        </element>
        <element xid="GS03">
          <data_ele>124</data_ele>
          <name>Application Receiver's Code</name>
          <usage>R</usage>
          <seq>03</seq>
          <data_type>AN</data_type>
          <min_len>2</min_len>
          <max_len>15</max_len>
        </element>
        <element xid="GS04">
          <data_ele>373</data_ele>
          <name>Date</name>
          <usage>R</usage>
          <seq>04</seq>
          <data_type>DT</data_type>
          <min_len>8</min_len>
          <max_len>8</max_len>
          <valid_codes/>
        </element>
        <element xid="GS05">
          <data_ele>337</data_ele>
          <name>Time</name>
          <usage>R</usage>
          <seq>05</seq>
          <data_type>TM</data_type>
          <min_len>4</min_len>
          <max_len>8</max_len>
          <valid_codes/>
        </element>
        <element xid="GS06">
          <data_ele>28</data_ele>
          <name>Group Control Number</name>
          <usage>R</usage>
          <seq>06</seq>
          <data_type>N0</data_type>
          <min_len>1</min_len>
          <max_len>9</max_len>
        </element>
        <element xid="GS07">
          <data_ele>455</data_ele>
          <name>Responsible Agency Code</name>
          <usage>R</usage>
          <seq>07</seq>
          <data_type>ID</data_type>
          <min_len>1</min_len>
          <max_len>2</max_len>
          <valid_codes>
            <code>X</code>
          </valid_codes>
        </element>
        <element xid="GS08">
          <data_ele>480</data_ele>
          <name>Version / Release / Industry Identifier Code</name>
          <usage>R</usage>
          <seq>08</seq>
          <data_type>AN</data_type>
          <min_len>1</min_len>
          <max_len>12</max_len>
          <valid_codes>
            <code>004010X061A1</code>
          </valid_codes>
        </element>
      </segment>
<!--End of GS segment-->
      <loop xid="ST_LOOP" type="explicit">
        <name>Transaction Set Header</name>
        <usage>R</usage>
        <pos>020</pos>
        <repeat>&gt;1</repeat>
        <segment xid="ST">
          <name>820 Header</name>
          <usage>R</usage>
          <pos>010</pos>
          <max_use>1</max_use>
          <element xid="ST01">
            <data_ele>143</data_ele>
            <name>Transaction Set Identifier Code</name>
            <usage>R</usage>
            <seq>01</seq>
            <data_type>ID</data_type>
            <min_len>3</min_len>
            <max_len>3</max_len>
            <valid_codes>
              <code>820</code>
            </valid_codes>
          </element>
          <element xid="ST02">
            <data_ele>329</data_ele>
            <name>Transaction Set Control Number</name>
            <usage>R</usage>
            <seq>02</seq>
            <data_type>AN</data_type>
            <min_len>4</min_len>
            <max_len>9</max_len>
          </element>
        </segment>
<!--End of ST segment-->
        <loop xid="HEADER" type="wrapper">
          <name>Table 1 - Header</name>
          <usage>R</usage>
          <pos>015</pos>
          <repeat>1</repeat>
          <segment xid="BPR">
            <name>Financial Information</name>
            <usage>R</usage>
            <pos>020</pos>
            <max_use>1</max_use>
            <element xid="BPR01">
              <data_ele>305</data_ele>
              <name>Transaction Handling Code</name>
              <usage>R</usage>
              <seq>01</seq>
              <data_type>ID</data_type>
              <min_len>1</min_len>
              <max_len>2</max_len>
              <valid_codes>
                <code>C</code>
                <code>D</code>
                <code>I</code>
                <code>P</code>
                <code>U</code>
                <code>X</code>
              </valid_codes>
            </element>
            <element xid="BPR02">
              <data_ele>782</data_ele>
              <name>Total Premium Payment Amount</name>
              <usage>R</usage>
              <seq>02</seq>
              <data_type>R</data_type>
              <min_len>1</min_len>
              <max_len>18</max_len>
            </element>
            <element xid="BPR03">
              <data_ele>478</data_ele>
              <name>Credit or Debit Flag Code</name>
              <usage>R</usage>
              <seq>03</seq>
              <data_type>ID</data_type>
              <min_len>1</min_len>
              <max_len>1</max_len>
              <valid_codes>
                <code>C</code>
                <code>D</code>
              </valid_codes>
            </element>
            <element xid="BPR04">
              <data_ele>591</data_ele>
              <name>Payment Method Code</name>
              <usage>R</usage>
              <seq>04</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
              <valid_codes>
                <code>ACH</code>
                <code>BOP</code>
                <code>CHK</code>
                <code>FWT</code>
                <code>SWT</code>
              </valid_codes>
            </element>
            <element xid="BPR05">
              <data_ele>812</data_ele>
              <name>Payment Format Code</name>
              <usage>S</usage>
              <seq>05</seq>
              <data_type>ID</data_type>
              <min_len>1</min_len>
              <max_len>10</max_len>
              <valid_codes>
                <code>CCP</code>
                <code>CTX</code>
              </valid_codes>
            </element>
            <element xid="BPR06">
              <data_ele>506</data_ele>
              <name>Depository Financial Institution (DFI) Identification Number Qualifier</name>
              <usage>S</usage>
              <seq>06</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>2</max_len>
              <valid_codes>
                <code>01</code>
                <code>04</code>
              </valid_codes>
            </element>
            <element xid="BPR07">
              <data_ele>507</data_ele>
              <name>Originating Depository Financial Institution (DFI) Identifier</name>
              <usage>S</usage>
              <seq>07</seq>
              <data_type>AN</data_type>
              <min_len>3</min_len>
              <max_len>12</max_len>
            </element>
            <element xid="BPR08">
              <data_ele>569</data_ele>
              <name>Account Number Qualifier</name>
              <usage>S</usage>
              <seq>08</seq>
              <data_type>ID</data_type>
              <min_len>1</min_len>
              <max_len>3</max_len>
              <valid_codes>
                <code>DA</code>
                <code>ALC</code>
              </valid_codes>
            </element>
            <element xid="BPR09">
              <data_ele>508</data_ele>
              <name>Sender Bank Account Number</name>
              <usage>S</usage>
              <seq>09</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>35</max_len>
            </element>
            <element xid="BPR10">
              <data_ele>509</data_ele>
              <name>Originating Company Identifier</name>
              <usage>S</usage>
              <seq>10</seq>
              <data_type>AN</data_type>
              <min_len>10</min_len>
              <max_len>10</max_len>
            </element>
            <element xid="BPR11">
              <data_ele>510</data_ele>
              <name>Originating Company Supplemental Code</name>
              <usage>S</usage>
              <seq>11</seq>
              <data_type>AN</data_type>
              <min_len>9</min_len>
              <max_len>9</max_len>
            </element>
            <element xid="BPR12">
              <data_ele>506</data_ele>
              <name>Depository Financial Institution (DFI) Identification Number Qualifier</name>
              <usage>S</usage>
              <seq>12</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>2</max_len>
              <valid_codes>
                <code>01</code>
                <code>04</code>
              </valid_codes>
            </element>
            <element xid="BPR13">
              <data_ele>507</data_ele>
              <name>Receiving Depository Financial Institution (DFI) Identifier</name>
              <usage>S</usage>
              <seq>13</seq>
              <data_type>AN</data_type>
              <min_len>3</min_len>
              <max_len>12</max_len>
            </element>
            <element xid="BPR14">
              <data_ele>569</data_ele>
              <name>Account Number Qualifier</name>
              <usage>S</usage>
              <seq>14</seq>
              <data_type>ID</data_type>
              <min_len>1</min_len>
              <max_len>3</max_len>
              <valid_codes>
                <code>DA</code>
                <code>SG</code>
              </valid_codes>
            </element>
            <element xid="BPR15">
              <data_ele>508</data_ele>
              <name>Receiver Bank Account Number</name>
              <usage>S</usage>
              <seq>15</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>35</max_len>
            </element>
            <element xid="BPR16">
              <data_ele>373</data_ele>
              <name>Check Issue or EFT Effective Date</name>
              <usage>R</usage>
              <seq>16</seq>
              <data_type>DT</data_type>
              <min_len>8</min_len>
              <max_len>8</max_len>
              <valid_codes/>
            </element>
            <element xid="BPR17">
              <data_ele>1048</data_ele>
              <name>Business Function Code</name>
              <usage>N</usage>
              <seq>17</seq>
              <data_type>ID</data_type>
              <min_len>1</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="BPR18">
              <data_ele>506</data_ele>
              <name>(DFI) ID Number Qualifier</name>
              <usage>N</usage>
              <seq>18</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>2</max_len>
            </element>
            <element xid="BPR19">
              <data_ele>507</data_ele>
              <name>(DFI) Identification Number</name>
              <usage>N</usage>
              <seq>19</seq>
              <data_type>AN</data_type>
              <min_len>3</min_len>
              <max_len>12</max_len>
            </element>
            <element xid="BPR20">
              <data_ele>569</data_ele>
              <name>Account Number Qualifier</name>
              <usage>N</usage>
              <seq>20</seq>
              <data_type>ID</data_type>
              <min_len>1</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="BPR21">
              <data_ele>508</data_ele>
              <name>Account Number</name>
              <usage>N</usage>
              <seq>21</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>35</max_len>
            </element>
          </segment>
<!--End of BPR segment-->
          <segment xid="TRN">
            <name>Reassociation Key</name>
            <usage>R</usage>
            <pos>035</pos>
            <max_use>1</max_use>
            <element xid="TRN01">
              <data_ele>481</data_ele>
              <name>Trace Type Code</name>
              <usage>R</usage>
              <seq>01</seq>
              <data_type>ID</data_type>
              <min_len>1</min_len>
              <max_len>2</max_len>
              <valid_codes>
                <code>1</code>
                <code>3</code>
              </valid_codes>
            </element>
            <element xid="TRN02">
              <data_ele>127</data_ele>
              <name>Check or EFT Trace Number</name>
              <usage>R</usage>
              <seq>02</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>30</max_len>
            </element>
            <element xid="TRN03">
              <data_ele>509</data_ele>
              <name>Originating Company Identifier</name>
              <usage>S</usage>
              <seq>03</seq>
              <data_type>AN</data_type>
              <min_len>10</min_len>
              <max_len>10</max_len>
            </element>
            <element xid="TRN04">
              <data_ele>127</data_ele>
              <name>Originating Company Supplemental Code</name>
              <usage>S</usage>
              <seq>04</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>30</max_len>
            </element>
          </segment>
<!--End of TRN segment-->
          <segment xid="CUR">
            <name>Non-US Dollars Currency</name>
            <usage>S</usage>
            <pos>040</pos>
            <max_use>1</max_use>
            <element xid="CUR01">
              <data_ele>98</data_ele>
              <name>Entity Identifier Code</name>
              <usage>R</usage>
              <seq>01</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>3</max_len>
              <valid_codes>
                <code>2B</code>
                <code>PR</code>
              </valid_codes>
            </element>
            <element xid="CUR02">
              <data_ele>100</data_ele>
              <name>Currency Code</name>
              <usage>R</usage>
              <seq>02</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
              <valid_codes>
                <code>MXP</code>
                <code>CAD</code>
                <code>USD</code>
              </valid_codes>
            </element>
            <element xid="CUR03">
              <data_ele>280</data_ele>
              <name>Exchange Rate</name>
              <usage>S</usage>
              <seq>03</seq>
              <data_type>R</data_type>
              <min_len>4</min_len>
              <max_len>10</max_len>
            </element>
            <element xid="CUR04">
              <data_ele>98</data_ele>
              <name>Entity Identifier Code</name>
              <usage>N</usage>
              <seq>04</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="CUR05">
              <data_ele>100</data_ele>
              <name>Currency Code</name>
              <usage>N</usage>
              <seq>05</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="CUR06">
              <data_ele>669</data_ele>
              <name>Currency Market/Exchange Code</name>
              <usage>N</usage>
              <seq>06</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="CUR07">
              <data_ele>374</data_ele>
              <name>Date/Time Qualifier</name>
              <usage>N</usage>
              <seq>07</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="CUR08">
              <data_ele>373</data_ele>
              <name>Date</name>
              <usage>N</usage>
              <seq>08</seq>
              <data_type>DT</data_type>
              <min_len>8</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="CUR09">
              <data_ele>337</data_ele>
              <name>Time</name>
              <usage>N</usage>
              <seq>09</seq>
              <data_type>TM</data_type>
              <min_len>4</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="CUR10">
              <data_ele>374</data_ele>
              <name>Date/Time Qualifier</name>
              <usage>N</usage>
              <seq>10</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="CUR11">
              <data_ele>373</data_ele>
              <name>Date</name>
              <usage>N</usage>
              <seq>11</seq>
              <data_type>DT</data_type>
              <min_len>8</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="CUR12">
              <data_ele>337</data_ele>
              <name>Time</name>
              <usage>N</usage>
              <seq>12</seq>
              <data_type>TM</data_type>
              <min_len>4</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="CUR13">
              <data_ele>374</data_ele>
              <name>Date/Time Qualifier</name>
              <usage>N</usage>
              <seq>13</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="CUR14">
              <data_ele>373</data_ele>
              <name>Date</name>
              <usage>N</usage>
              <seq>14</seq>
              <data_type>DT</data_type>
              <min_len>8</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="CUR15">
              <data_ele>337</data_ele>
              <name>Time</name>
              <usage>N</usage>
              <seq>15</seq>
              <data_type>TM</data_type>
              <min_len>4</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="CUR16">
              <data_ele>374</data_ele>
              <name>Date/Time Qualifier</name>
              <usage>N</usage>
              <seq>16</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="CUR17">
              <data_ele>373</data_ele>
              <name>Date</name>
              <usage>N</usage>
              <seq>17</seq>
              <data_type>DT</data_type>
              <min_len>8</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="CUR18">
              <data_ele>337</data_ele>
              <name>Time</name>
              <usage>N</usage>
              <seq>18</seq>
              <data_type>TM</data_type>
              <min_len>4</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="CUR19">
              <data_ele>374</data_ele>
              <name>Date/Time Qualifier</name>
              <usage>N</usage>
              <seq>19</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="CUR20">
              <data_ele>373</data_ele>
              <name>Date</name>
              <usage>N</usage>
              <seq>20</seq>
              <data_type>DT</data_type>
              <min_len>8</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="CUR21">
              <data_ele>337</data_ele>
              <name>Time</name>
              <usage>N</usage>
              <seq>21</seq>
              <data_type>TM</data_type>
              <min_len>4</min_len>
              <max_len>8</max_len>
            </element>
          </segment>
<!--End of CUR segment-->
          <segment xid="REF">
            <name>Premium Receivers Identification Key</name>
            <usage>S</usage>
            <pos>050</pos>
            <max_use>&gt;1</max_use>
            <element xid="REF01">
              <data_ele>128</data_ele>
              <name>Reference Identification Qualifier</name>
              <usage>R</usage>
              <seq>01</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>3</max_len>
              <valid_codes>
                <code>14</code>
                <code>18</code>
                <code>2F</code>
                <code>38</code>
                <code>72</code>
              </valid_codes>
            </element>
            <element xid="REF02">
              <data_ele>127</data_ele>
              <name>Premium Receiver Reference Identifier</name>
              <usage>R</usage>
              <seq>02</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>30</max_len>
            </element>
            <element xid="REF03">
              <data_ele>352</data_ele>
              <name>Description</name>
              <usage>N</usage>
              <seq>03</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>80</max_len>
            </element>
            <composite>
              <data_ele>C040</data_ele>
              <name>Reference Identifier</name>
              <usage>N</usage>
              <seq>04</seq>
            </composite>
          </segment>
<!--End of REF segment-->
          <segment xid="DTM">
            <name>Process Date</name>
            <usage>S</usage>
            <pos>060</pos>
            <max_use>1</max_use>
            <element xid="DTM01">
              <data_ele>374</data_ele>
              <name>Date Time Qualifier</name>
              <usage>R</usage>
              <seq>01</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
              <valid_codes>
                <code>009</code>
              </valid_codes>
            </element>
            <element xid="DTM02">
              <data_ele>373</data_ele>
              <name>Payer Process Date</name>
              <usage>R</usage>
              <seq>02</seq>
              <data_type>DT</data_type>
              <min_len>8</min_len>
              <max_len>8</max_len>
              <valid_codes/>
            </element>
            <element xid="DTM03">
              <data_ele>337</data_ele>
              <name>Time</name>
              <usage>N</usage>
              <seq>03</seq>
              <data_type>TM</data_type>
              <min_len>4</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="DTM04">
              <data_ele>623</data_ele>
              <name>Time Code</name>
              <usage>N</usage>
              <seq>04</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>2</max_len>
            </element>
            <element xid="DTM05">
              <data_ele>1250</data_ele>
              <name>Date Time Period Format Qualifier</name>
              <usage>N</usage>
              <seq>05</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="DTM06">
              <data_ele>1251</data_ele>
              <name>Date Time Period</name>
              <usage>N</usage>
              <seq>06</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>35</max_len>
            </element>
          </segment>
<!--End of DTM segment-->
          <segment xid="DTM">
            <name>Delivery Date</name>
            <usage>S</usage>
            <pos>060</pos>
            <max_use>1</max_use>
            <element xid="DTM01">
              <data_ele>374</data_ele>
              <name>Date Time Qualifier</name>
              <usage>R</usage>
              <seq>01</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
              <valid_codes>
                <code>035</code>
              </valid_codes>
            </element>
            <element xid="DTM02">
              <data_ele>373</data_ele>
              <name>Premium Delivery Date</name>
              <usage>R</usage>
              <seq>02</seq>
              <data_type>DT</data_type>
              <min_len>8</min_len>
              <max_len>8</max_len>
              <valid_codes/>
            </element>
            <element xid="DTM03">
              <data_ele>337</data_ele>
              <name>Time</name>
              <usage>N</usage>
              <seq>03</seq>
              <data_type>TM</data_type>
              <min_len>4</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="DTM04">
              <data_ele>623</data_ele>
              <name>Time Code</name>
              <usage>N</usage>
              <seq>04</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>2</max_len>
            </element>
            <element xid="DTM05">
              <data_ele>1250</data_ele>
              <name>Date Time Period Format Qualifier</name>
              <usage>N</usage>
              <seq>05</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>3</max_len>
            </element>
            <element xid="DTM06">
              <data_ele>1251</data_ele>
              <name>Date Time Period</name>
              <usage>N</usage>
              <seq>06</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>35</max_len>
            </element>
          </segment>
<!--End of DTM segment-->
          <segment xid="DTM">
            <name>Coverage Period</name>
            <usage>S</usage>
            <pos>060</pos>
            <max_use>1</max_use>
            <element xid="DTM01">
              <data_ele>374</data_ele>
              <name>Date Time Qualifier</name>
              <usage>R</usage>
              <seq>01</seq>
              <data_type>ID</data_type>
              <min_len>3</min_len>
              <max_len>3</max_len>
              <valid_codes>
                <code>582</code>
              </valid_codes>
            </element>
            <element xid="DTM02">
              <data_ele>373</data_ele>
              <name>Date</name>
              <usage>N</usage>
              <seq>02</seq>
              <data_type>DT</data_type>
              <min_len>8</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="DTM03">
              <data_ele>337</data_ele>
              <name>Time</name>
              <usage>N</usage>
              <seq>03</seq>
              <data_type>TM</data_type>
              <min_len>4</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="DTM04">
              <data_ele>623</data_ele>
              <name>Time Code</name>
              <usage>N</usage>
              <seq>04</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>2</max_len>
            </element>
            <element xid="DTM05">
              <data_ele>1250</data_ele>
              <name>Date Time Period Format Qualifier</name>
              <usage>R</usage>
              <seq>05</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>3</max_len>
              <valid_codes>
                <code>RD8</code>
              </valid_codes>
            </element>
            <element xid="DTM06">
              <data_ele>1251</data_ele>
              <name>Coverage Period</name>
              <usage>R</usage>
              <seq>06</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>35</max_len>
            </element>
          </segment>
<!--End of DTM segment-->
          <loop xid="1000A">
            <name>Premium Receiver's Name</name>
            <usage>R</usage>
            <pos>070</pos>
            <repeat>1</repeat>
            <segment xid="N1">
              <name>Premium Receiver's Name</name>
              <usage>R</usage>
              <pos>070</pos>
              <max_use>1</max_use>
              <element xid="N101">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>PE</code>
                </valid_codes>
              </element>
              <element xid="N102">
                <data_ele>93</data_ele>
                <name>Information Receiver Last or Organization Name</name>
                <usage>S</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
              <element xid="N103">
                <data_ele>66</data_ele>
                <name>Identification Code Qualifier</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>1</code>
                  <code>9</code>
                  <code>EQ</code>
                  <code>FI</code>
                  <code>XV</code>
                </valid_codes>
              </element>
              <element xid="N104">
                <data_ele>67</data_ele>
                <name>Receiver Identifier</name>
                <usage>S</usage>
                <seq>04</seq>
                <data_type>AN</data_type>
                <min_len>2</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="N105">
                <data_ele>706</data_ele>
                <name>Entity Relationship Code</name>
                <usage>N</usage>
                <seq>05</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="N106">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>N</usage>
                <seq>06</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
              </element>
            </segment>
<!--End of N1 segment-->
            <segment xid="N2">
              <name>Premium Receiver Additional Name</name>
              <usage>S</usage>
              <pos>080</pos>
              <max_use>1</max_use>
              <element xid="N201">
                <data_ele>93</data_ele>
                <name>Receiver Additional Name</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
              <element xid="N202">
                <data_ele>93</data_ele>
                <name>Name</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
            </segment>
<!--End of N2 segment-->
            <segment xid="N3">
              <name>Premium Receiver's Address</name>
              <usage>S</usage>
              <pos>090</pos>
              <max_use>1</max_use>
              <element xid="N301">
                <data_ele>166</data_ele>
                <name>Receiver Address Line</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>55</max_len>
              </element>
              <element xid="N302">
                <data_ele>166</data_ele>
                <name>Receiver Address Line</name>
                <usage>S</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>55</max_len>
              </element>
            </segment>
<!--End of N3 segment-->
            <segment xid="N4">
              <name>Premium Receiver's City, State, ZIP</name>
              <usage>S</usage>
              <pos>100</pos>
              <max_use>1</max_use>
              <element xid="N401">
                <data_ele>19</data_ele>
                <name>Information Receiver City Name</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>2</min_len>
                <max_len>30</max_len>
              </element>
              <element xid="N402">
                <data_ele>156</data_ele>
                <name>Information Receiver State Code</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes external="states"/>
              </element>
              <element xid="N403">
                <data_ele>116</data_ele>
                <name>Information Receiver Postal Zone or ZIP Code</name>
                <usage>R</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>3</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="N404">
                <data_ele>26</data_ele>
                <name>Country Code</name>
                <usage>S</usage>
                <seq>04</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes external="country"/>
              </element>
              <element xid="N405">
                <data_ele>309</data_ele>
                <name>Location Qualifier</name>
                <usage>N</usage>
                <seq>05</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="N406">
                <data_ele>310</data_ele>
                <name>Location Identifier</name>
                <usage>N</usage>
                <seq>06</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>30</max_len>
              </element>
            </segment>
<!--End of N4 segment-->
          </loop>
<!--End of 1000A loop-->
          <loop xid="1000B">
            <name>Premium Payer's Name</name>
            <usage>R</usage>
            <pos>070</pos>
            <repeat>1</repeat>
            <segment xid="N1">
              <name>Premium Payer's Name</name>
              <usage>R</usage>
              <pos>070</pos>
              <max_use>1</max_use>
              <element xid="N101">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>PR</code>
                </valid_codes>
              </element>
              <element xid="N102">
                <data_ele>93</data_ele>
                <name>Premium Payer Name</name>
                <usage>S</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
              <element xid="N103">
                <data_ele>66</data_ele>
                <name>Identification Code Qualifier</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>1</code>
                  <code>9</code>
                  <code>24</code>
                  <code>75</code>
                  <code>EQ</code>
                  <code>FI</code>
                  <code>PI</code>
                </valid_codes>
              </element>
              <element xid="N104">
                <data_ele>67</data_ele>
                <name>Premium Payer Identifier</name>
                <usage>S</usage>
                <seq>04</seq>
                <data_type>AN</data_type>
                <min_len>2</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="N105">
                <data_ele>706</data_ele>
                <name>Entity Relationship Code</name>
                <usage>N</usage>
                <seq>05</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="N106">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>N</usage>
                <seq>06</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
              </element>
            </segment>
<!--End of N1 segment-->
            <segment xid="N2">
              <name>Premium Payer Additional Name</name>
              <usage>S</usage>
              <pos>080</pos>
              <max_use>1</max_use>
              <element xid="N201">
                <data_ele>93</data_ele>
                <name>Premium Payer Additional Name</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
              <element xid="N202">
                <data_ele>93</data_ele>
                <name>Name</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
            </segment>
<!--End of N2 segment-->
            <segment xid="N3">
              <name>Premium Payer's Address</name>
              <usage>S</usage>
              <pos>090</pos>
              <max_use>1</max_use>
              <element xid="N301">
                <data_ele>166</data_ele>
                <name>Premium Payer Address Line</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>55</max_len>
              </element>
              <element xid="N302">
                <data_ele>166</data_ele>
                <name>Premium Payer Address Line</name>
                <usage>S</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>55</max_len>
              </element>
            </segment>
<!--End of N3 segment-->
            <segment xid="N4">
              <name>Premium Payer's City, State, ZIP</name>
              <usage>S</usage>
              <pos>100</pos>
              <max_use>1</max_use>
              <element xid="N401">
                <data_ele>19</data_ele>
                <name>Premium Payer City Name</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>2</min_len>
                <max_len>30</max_len>
              </element>
              <element xid="N402">
                <data_ele>156</data_ele>
                <name>Premium Payer State Code</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes external="states"/>
              </element>
              <element xid="N403">
                <data_ele>116</data_ele>
                <name>Premium Payer Postal Zone or ZIP Code</name>
                <usage>R</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>3</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="N404">
                <data_ele>26</data_ele>
                <name>Country Code</name>
                <usage>S</usage>
                <seq>04</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes external="country"/>
              </element>
              <element xid="N405">
                <data_ele>309</data_ele>
                <name>Location Qualifier</name>
                <usage>N</usage>
                <seq>05</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="N406">
                <data_ele>310</data_ele>
                <name>Location Identifier</name>
                <usage>N</usage>
                <seq>06</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>30</max_len>
              </element>
            </segment>
<!--End of N4 segment-->
            <segment xid="PER">
              <name>Premium Payer's Administrative Contact</name>
              <usage>S</usage>
              <pos>120</pos>
              <max_use>&gt;1</max_use>
              <element xid="PER01">
                <data_ele>366</data_ele>
                <name>Contact Function Code</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>IC</code>
                </valid_codes>
              </element>
              <element xid="PER02">
                <data_ele>93</data_ele>
                <name>Premium Payer Contact Name</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
              <element xid="PER03">
                <data_ele>365</data_ele>
                <name>Communication Number Qualifier</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>EM</code>
                  <code>FX</code>
                  <code>TE</code>
                </valid_codes>
              </element>
              <element xid="PER04">
                <data_ele>364</data_ele>
                <name>Communication Number</name>
                <usage>S</usage>
                <seq>04</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="PER05">
                <data_ele>365</data_ele>
                <name>Communication Number Qualifier</name>
                <usage>S</usage>
                <seq>05</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>EM</code>
                  <code>EX</code>
                  <code>FX</code>
                  <code>TE</code>
                </valid_codes>
              </element>
              <element xid="PER06">
                <data_ele>364</data_ele>
                <name>Communication Number</name>
                <usage>S</usage>
                <seq>06</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="PER07">
                <data_ele>365</data_ele>
                <name>Communication Number Qualifier</name>
                <usage>S</usage>
                <seq>07</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>EM</code>
                  <code>EX</code>
                  <code>FX</code>
                  <code>TE</code>
                </valid_codes>
              </element>
              <element xid="PER08">
                <data_ele>364</data_ele>
                <name>Communication Number</name>
                <usage>S</usage>
                <seq>08</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="PER09">
                <data_ele>443</data_ele>
                <name>Contact Inquiry Reference</name>
                <usage>N</usage>
                <seq>09</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>20</max_len>
              </element>
            </segment>
<!--End of PER segment-->
          </loop>
<!--End of 1000B loop-->
        </loop>
<!--End of HEADER loop-->
        <loop xid="DETAIL" type="wrapper">
          <name>Table 2 - Detail</name>
          <usage>S</usage>
          <pos>020</pos>
          <repeat>&gt;1</repeat>
          <loop xid="2000A">
            <name>Organization Summary Remittance</name>
            <usage>S</usage>
            <pos>010</pos>
            <repeat>1</repeat>
            <segment xid="ENT">
              <name>Organization Summary Remittance</name>
              <usage>R</usage>
              <pos>010</pos>
              <max_use>1</max_use>
              <element xid="ENT01">
                <data_ele>554</data_ele>
                <name>Assigned Number</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>N0</data_type>
                <min_len>1</min_len>
                <max_len>6</max_len>
              </element>
              <element xid="ENT02">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>2L</code>
                </valid_codes>
              </element>
              <element xid="ENT03">
                <data_ele>66</data_ele>
                <name>Identification Code Qualifier</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>1</code>
                  <code>9</code>
                  <code>FI</code>
                </valid_codes>
              </element>
              <element xid="ENT04">
                <data_ele>67</data_ele>
                <name>Organization Identification Code</name>
                <usage>S</usage>
                <seq>04</seq>
                <data_type>AN</data_type>
                <min_len>2</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="ENT05">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>N</usage>
                <seq>05</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="ENT06">
                <data_ele>66</data_ele>
                <name>Identification Code Qualifier</name>
                <usage>N</usage>
                <seq>06</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="ENT07">
                <data_ele>67</data_ele>
                <name>Identification Code</name>
                <usage>N</usage>
                <seq>07</seq>
                <data_type>AN</data_type>
                <min_len>2</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="ENT08">
                <data_ele>128</data_ele>
                <name>Reference Identification Qualifier</name>
                <usage>N</usage>
                <seq>08</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="ENT09">
                <data_ele>127</data_ele>
                <name>Reference Identification</name>
                <usage>N</usage>
                <seq>09</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>30</max_len>
              </element>
            </segment>
<!--End of ENT segment-->
            <loop xid="2300A">
              <name>Organization Summary Remittance Detail</name>
              <usage>R</usage>
              <pos>150</pos>
              <repeat>&gt;1</repeat>
              <segment xid="RMR">
                <name>Organization Summary Remittance Detail</name>
                <usage>R</usage>
                <pos>150</pos>
                <max_use>1</max_use>
                <element xid="RMR01">
                  <data_ele>128</data_ele>
                  <name>Reference Identification Qualifier</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>11</code>
                    <code>1L</code>
                    <code>CT</code>
                    <code>IK</code>
                  </valid_codes>
                </element>
                <element xid="RMR02">
                  <data_ele>127</data_ele>
                  <name>Contract, Invoice, Account, Group, or Policy Number</name>
                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
                <element xid="RMR03">
                  <data_ele>482</data_ele>
                  <name>Payment Action Code</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>PA</code>
                    <code>PI</code>
                    <code>PO</code>
                    <code>PP</code>
                  </valid_codes>
                </element>
                <element xid="RMR04">
                  <data_ele>782</data_ele>
                  <name>Detail Premium Payment Amount</name>
                  <usage>R</usage>
                  <seq>04</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="RMR05">
                  <data_ele>782</data_ele>
                  <name>Billed Premium Amount</name>
                  <usage>S</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="RMR06">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="RMR07">
                  <data_ele>426</data_ele>
                  <name>Adjustment Reason Code</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="RMR08">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>08</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
              </segment>
<!--End of RMR segment-->
              <loop xid="2310A">
                <name>Summary Line Item</name>
                <usage>S</usage>
                <pos>190</pos>
                <repeat>1</repeat>
                <segment xid="IT1">
                  <name>Summary Line Item</name>
                  <usage>R</usage>
                  <pos>190</pos>
                  <max_use>1</max_use>
                  <element xid="IT101">
                    <data_ele>350</data_ele>
                    <name>Line Item Control Number</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>20</max_len>
                  </element>
                  <element xid="IT102">
                    <data_ele>358</data_ele>
                    <name>Quantity Invoiced</name>
                    <usage>N</usage>
                    <seq>02</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>10</max_len>
                  </element>
                  <element xid="IT103">
                    <data_ele>355</data_ele>
                    <name>Unit or Basis for Measurement Code</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT104">
                    <data_ele>212</data_ele>
                    <name>Unit Price</name>
                    <usage>N</usage>
                    <seq>04</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>17</max_len>
                  </element>
                  <element xid="IT105">
                    <data_ele>639</data_ele>
                    <name>Basis of Unit Price Code</name>
                    <usage>N</usage>
                    <seq>05</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT106">
                    <data_ele>235</data_ele>
                    <name>Product/Service ID Qualifier</name>
                    <usage>N</usage>
                    <seq>06</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT107">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>07</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                  <element xid="IT108">
                    <data_ele>235</data_ele>
                    <name>Product/Service ID Qualifier</name>
                    <usage>N</usage>
                    <seq>08</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT109">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>09</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                  <element xid="IT110">
                    <data_ele>235</data_ele>
                    <name>Product/Service ID Qualifier</name>
                    <usage>N</usage>
                    <seq>10</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT111">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>11</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                  <element xid="IT112">
                    <data_ele>235</data_ele>
                    <name>Product/Service ID Qualifier</name>
                    <usage>N</usage>
                    <seq>12</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT113">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>13</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                  <element xid="IT114">
                    <data_ele>235</data_ele>
                    <name>Product/Service ID Qualifier</name>
                    <usage>N</usage>
                    <seq>14</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT115">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>15</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                  <element xid="IT116">
                    <data_ele>235</data_ele>
                    <name>Product/Service ID Qualifier</name>
                    <usage>N</usage>
                    <seq>16</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT117">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>17</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                  <element xid="IT118">
                    <data_ele>235</data_ele>
                    <name>Product/Service ID Qualifier</name>
                    <usage>N</usage>
                    <seq>18</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT119">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>19</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                  <element xid="IT120">
                    <data_ele>235</data_ele>
                    <name>Product/Service ID Qualifier</name>
                    <usage>N</usage>
                    <seq>20</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT121">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>21</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                  <element xid="IT122">
                    <data_ele>235</data_ele>
                    <name>Product/Service ID Qualifier</name>
                    <usage>N</usage>
                    <seq>22</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT123">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>23</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                  <element xid="IT124">
                    <data_ele>235</data_ele>
                    <name>Product/Service ID Qualifier</name>
                    <usage>N</usage>
                    <seq>24</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="IT125">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>25</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                </segment>
<!--End of IT1 segment-->
                <loop xid="2315A">
                  <name>Member Count</name>
                  <usage>S</usage>
                  <pos>204</pos>
                  <repeat>&gt;1</repeat>
                  <segment xid="SLN">
                    <name>Member Count</name>
                    <usage>R</usage>
                    <pos>204</pos>
                    <max_use>1</max_use>
                    <element xid="SLN01">
                      <data_ele>350</data_ele>
                      <name>Line Item Control Number</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>20</max_len>
                    </element>
                    <element xid="SLN02">
                      <data_ele>350</data_ele>
                      <name>Assigned Identification</name>
                      <usage>N</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>20</max_len>
                    </element>
                    <element xid="SLN03">
                      <data_ele>662</data_ele>
                      <name>Information Only Indicator</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>O</code>
                      </valid_codes>
                    </element>
                    <element xid="SLN04">
                      <data_ele>380</data_ele>
                      <name>Head Count</name>
                      <usage>R</usage>
                      <seq>04</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                    <composite>
                      <data_ele>C001</data_ele>
                      <name>Composite Unit of Measure</name>
                      <usage>R</usage>
                      <seq>05</seq>
                      <element xid="SLN05-01">
                        <data_ele>355</data_ele>
                        <name>Unit or Basis for Measurement Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>10</code>
                          <code>IE</code>
                          <code>PR</code>
                        </valid_codes>
                      </element>
                      <element xid="SLN05-02">
                        <data_ele>1018</data_ele>
                        <name>Exponent</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="SLN05-03">
                        <data_ele>649</data_ele>
                        <name>Multiplier</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="SLN05-04">
                        <data_ele>355</data_ele>
                        <name>Unit or Basis for Measurement Code</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SLN05-05">
                        <data_ele>1018</data_ele>
                        <name>Exponent</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="SLN05-06">
                        <data_ele>649</data_ele>
                        <name>Multiplier</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="SLN05-07">
                        <data_ele>355</data_ele>
                        <name>Unit or Basis for Measurement Code</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SLN05-08">
                        <data_ele>1018</data_ele>
                        <name>Exponent</name>
                        <usage>N</usage>
                        <seq>08</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="SLN05-09">
                        <data_ele>649</data_ele>
                        <name>Multiplier</name>
                        <usage>N</usage>
                        <seq>09</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="SLN05-10">
                        <data_ele>355</data_ele>
                        <name>Unit or Basis for Measurement Code</name>
                        <usage>N</usage>
                        <seq>10</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SLN05-11">
                        <data_ele>1018</data_ele>
                        <name>Exponent</name>
                        <usage>N</usage>
                        <seq>11</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="SLN05-12">
                        <data_ele>649</data_ele>
                        <name>Multiplier</name>
                        <usage>N</usage>
                        <seq>12</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="SLN05-13">
                        <data_ele>355</data_ele>
                        <name>Unit or Basis for Measurement Code</name>
                        <usage>N</usage>
                        <seq>13</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SLN05-14">
                        <data_ele>1018</data_ele>
                        <name>Exponent</name>
                        <usage>N</usage>
                        <seq>14</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="SLN05-15">
                        <data_ele>649</data_ele>
                        <name>Multiplier</name>
                        <usage>N</usage>
                        <seq>15</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                    </composite>
                    <element xid="SLN06">
                      <data_ele>212</data_ele>
                      <name>Unit Price</name>
                      <usage>N</usage>
                      <seq>06</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>17</max_len>
                    </element>
                    <element xid="SLN07">
                      <data_ele>639</data_ele>
                      <name>Basis of Unit Price Code</name>
                      <usage>N</usage>
                      <seq>07</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SLN08">
                      <data_ele>662</data_ele>
                      <name>Relationship Code</name>
                      <usage>N</usage>
                      <seq>08</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="SLN09">
                      <data_ele>235</data_ele>
                      <name>Product/Service ID Qualifier</name>
                      <usage>N</usage>
                      <seq>09</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SLN10">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>10</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="SLN11">
                      <data_ele>235</data_ele>
                      <name>Product/Service ID Qualifier</name>
                      <usage>N</usage>
                      <seq>11</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SLN12">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>12</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="SLN13">
                      <data_ele>235</data_ele>
                      <name>Product/Service ID Qualifier</name>
                      <usage>N</usage>
                      <seq>13</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SLN14">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>14</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="SLN15">
                      <data_ele>235</data_ele>
                      <name>Product/Service ID Qualifier</name>
                      <usage>N</usage>
                      <seq>15</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SLN16">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>16</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="SLN17">
                      <data_ele>235</data_ele>
                      <name>Product/Service ID Qualifier</name>
                      <usage>N</usage>
                      <seq>17</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SLN18">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>18</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="SLN19">
                      <data_ele>235</data_ele>
                      <name>Product/Service ID Qualifier</name>
                      <usage>N</usage>
                      <seq>19</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SLN20">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>20</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="SLN21">
                      <data_ele>235</data_ele>
                      <name>Product/Service ID Qualifier</name>
                      <usage>N</usage>
                      <seq>21</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SLN22">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>22</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="SLN23">
                      <data_ele>235</data_ele>
                      <name>Product/Service ID Qualifier</name>
                      <usage>N</usage>
                      <seq>23</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SLN24">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>24</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="SLN25">
                      <data_ele>235</data_ele>
                      <name>Product/Service ID Qualifier</name>
                      <usage>N</usage>
                      <seq>25</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SLN26">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>26</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="SLN27">
                      <data_ele>235</data_ele>
                      <name>Product/Service ID Qualifier</name>
                      <usage>N</usage>
                      <seq>27</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SLN28">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>28</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                  </segment>
<!--End of SLN segment-->
                </loop>
<!--End of 2315A loop-->
              </loop>
<!--End of 2310A loop-->
              <loop xid="2320A">
                <name>Organization Summary Remittance Level Adjustment</name>
                <usage>S</usage>
                <pos>210</pos>
                <repeat>&gt;1</repeat>
                <segment xid="ADX">
                  <name>Organization Summary Remittance Level Adjustment</name>
                  <usage>R</usage>
                  <pos>210</pos>
                  <max_use>1</max_use>
                  <element xid="ADX01">
                    <data_ele>782</data_ele>
                    <name>Adjustment Amount</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>18</max_len>
                  </element>
                  <element xid="ADX02">
                    <data_ele>426</data_ele>
                    <name>Adjustment Reason Code</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                    <valid_codes>
                        <code>20</code>
                        <code>52</code>
                        <code>53</code>
                        <code>AA</code>
                        <code>H1</code>
                        <code>H6</code>
                        <code>IA</code>
                        <code>J3</code>
                    </valid_codes>
                  </element>
                  <element xid="ADX03">
                    <data_ele>128</data_ele>
                    <name>Reference Identification Qualifier</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>3</max_len>
                  </element>
                  <element xid="ADX04">
                    <data_ele>127</data_ele>
                    <name>Reference Identification</name>
                    <usage>N</usage>
                    <seq>04</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                </segment>
<!--End of ADX segment-->
              </loop>
<!--End of 2320A loop-->
            </loop>
<!--End of 2300A loop-->
          </loop>
<!--End of 2000A loop-->
          <loop xid="2000B">
            <name>Individual Remittance</name>
            <usage>S</usage>
            <pos>160</pos>
            <repeat>&gt;1</repeat>
            <segment xid="ENT">
              <name>Individual Remittance</name>
              <usage>R</usage>
              <pos>010</pos>
              <max_use>1</max_use>
              <element xid="ENT01">
                <data_ele>554</data_ele>
                <name>Assigned Number</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>N0</data_type>
                <min_len>1</min_len>
                <max_len>6</max_len>
              </element>
              <element xid="ENT02">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>2J</code>
                </valid_codes>
              </element>
              <element xid="ENT03">
                <data_ele>66</data_ele>
                <name>Identification Code Qualifier</name>
                <usage>R</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>34</code>
                  <code>EI</code>
                  <code>ZZ</code>
                </valid_codes>
              </element>
              <element xid="ENT04">
                <data_ele>67</data_ele>
                <name>Receiver's Individual Identifier</name>
                <usage>R</usage>
                <seq>04</seq>
                <data_type>AN</data_type>
                <min_len>2</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="ENT05">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>N</usage>
                <seq>05</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="ENT06">
                <data_ele>66</data_ele>
                <name>Identification Code Qualifier</name>
                <usage>N</usage>
                <seq>06</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="ENT07">
                <data_ele>67</data_ele>
                <name>Identification Code</name>
                <usage>N</usage>
                <seq>07</seq>
                <data_type>AN</data_type>
                <min_len>2</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="ENT08">
                <data_ele>128</data_ele>
                <name>Reference Identification Qualifier</name>
                <usage>N</usage>
                <seq>08</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="ENT09">
                <data_ele>127</data_ele>
                <name>Reference Identification</name>
                <usage>N</usage>
                <seq>09</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>30</max_len>
              </element>
            </segment>
<!--End of ENT segment-->
            <loop xid="2100B">
              <name>Individual Name</name>
              <usage>S</usage>
              <pos>020</pos>
              <repeat>&gt;1</repeat>
              <segment xid="NM1">
                <name>Individual Name</name>
                <usage>R</usage>
                <pos>020</pos>
                <max_use>1</max_use>
                <element xid="NM101">
                  <data_ele>98</data_ele>
                  <name>Entity Identifier Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>EY</code>
                    <code>QE</code>
                  </valid_codes>
                </element>
                <element xid="NM102">
                  <data_ele>1065</data_ele>
                  <name>Entity Type Qualifier</name>
                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                  <valid_codes>
                    <code>1</code>
                  </valid_codes>
                </element>
                <element xid="NM103">
                  <data_ele>1035</data_ele>
                  <name>Individual Last Name</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="NM104">
                  <data_ele>1036</data_ele>
                  <name>Individual First Name</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>25</max_len>
                </element>
                <element xid="NM105">
                  <data_ele>1037</data_ele>
                  <name>Individual Middle Name</name>
                  <usage>S</usage>
                  <seq>05</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>25</max_len>
                </element>
                <element xid="NM106">
                  <data_ele>1038</data_ele>
                  <name>Individual Name Prefix</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>10</max_len>
                </element>
                <element xid="NM107">
                  <data_ele>1039</data_ele>
                  <name>Individual Name Suffix</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>10</max_len>
                </element>
                <element xid="NM108">
                  <data_ele>66</data_ele>
                  <name>Identification Code Qualifier</name>
                  <usage>S</usage>
                  <seq>08</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>34</code>
                    <code>EI</code>
                    <code>N</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Individual Identifier</name>
                  <usage>S</usage>
                  <seq>09</seq>
                  <data_type>AN</data_type>
                  <min_len>2</min_len>
                  <max_len>80</max_len>
                </element>
                <element xid="NM110">
                  <data_ele>706</data_ele>
                  <name>Entity Relationship Code</name>
                  <usage>N</usage>
                  <seq>10</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="NM111">
                  <data_ele>98</data_ele>
                  <name>Entity Identifier Code</name>
                  <usage>N</usage>
                  <seq>11</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                </element>
              </segment>
<!--End of NM1 segment-->
            </loop>
<!--End of 2100B loop-->
            <loop xid="2300B">
              <name>Individual Premium Remittance Detail</name>
              <usage>S</usage>
              <pos>150</pos>
              <repeat>&gt;1</repeat>
              <segment xid="RMR">
                <name>Individual Premium Remittance Detail</name>
                <usage>R</usage>
                <pos>150</pos>
                <max_use>1</max_use>
                <element xid="RMR01">
                  <data_ele>128</data_ele>
                  <name>Reference Identification Qualifier</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>11</code>
                    <code>9J</code>
                    <code>AZ</code>
                    <code>B7</code>
                    <code>CT</code>
                    <code>ID</code>
                    <code>IG</code>
                    <code>IK</code>
                    <code>KW</code>
                  </valid_codes>
                </element>
                <element xid="RMR02">
                  <data_ele>127</data_ele>
                  <name>Insurance Remittance Reference Number</name>
                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
                <element xid="RMR03">
                  <data_ele>482</data_ele>
                  <name>Payment Action Code</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>PI</code>
                    <code>PP</code>
                  </valid_codes>
                </element>
                <element xid="RMR04">
                  <data_ele>782</data_ele>
                  <name>Detail Premium Payment Amount</name>
                  <usage>R</usage>
                  <seq>04</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="RMR05">
                  <data_ele>782</data_ele>
                  <name>Billed Premium Amount</name>
                  <usage>S</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="RMR06">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="RMR07">
                  <data_ele>426</data_ele>
                  <name>Adjustment Reason Code</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="RMR08">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>08</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
              </segment>
<!--End of RMR segment-->
              <segment xid="DTM">
                <name>Individual Coverage Period</name>
                <usage>S</usage>
                <pos>180</pos>
                <max_use>1</max_use>
                <element xid="DTM01">
                  <data_ele>374</data_ele>
                  <name>Date Time Qualifier</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>3</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>582</code>
                  </valid_codes>
                </element>
                <element xid="DTM02">
                  <data_ele>373</data_ele>
                  <name>Date</name>
                  <usage>N</usage>
                  <seq>02</seq>
                  <data_type>DT</data_type>
                  <min_len>8</min_len>
                  <max_len>8</max_len>
                </element>
                <element xid="DTM03">
                  <data_ele>337</data_ele>
                  <name>Time</name>
                  <usage>N</usage>
                  <seq>03</seq>
                  <data_type>TM</data_type>
                  <min_len>4</min_len>
                  <max_len>8</max_len>
                </element>
                <element xid="DTM04">
                  <data_ele>623</data_ele>
                  <name>Time Code</name>
                  <usage>N</usage>
                  <seq>04</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="DTM05">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>R</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="DTM06">
                  <data_ele>1251</data_ele>
                  <name>Coverage Period</name>
                  <usage>R</usage>
                  <seq>06</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
              </segment>
<!--End of DTM segment-->
              <loop xid="2320B">
                <name>Individual Premium Adjustment</name>
                <usage>S</usage>
                <pos>210</pos>
                <repeat>&gt;1</repeat>
                <segment xid="ADX">
                  <name>Individual Premium Adjustment</name>
                  <usage>R</usage>
                  <pos>210</pos>
                  <max_use>1</max_use>
                  <element xid="ADX01">
                    <data_ele>782</data_ele>
                    <name>Adjustment Amount</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>18</max_len>
                  </element>
                  <element xid="ADX02">
                    <data_ele>426</data_ele>
                    <name>Adjustment Reason Code</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                    <valid_codes>
                        <code>20</code>
                        <code>52</code>
                        <code>53</code>
                        <code>AA</code>
                        <code>AX</code>
                        <code>H1</code>
                        <code>H6</code>
                        <code>IA</code>
                        <code>J3</code>
                    </valid_codes>
                  </element>
                  <element xid="ADX03">
                    <data_ele>128</data_ele>
                    <name>Reference Identification Qualifier</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>3</max_len>
                  </element>
                  <element xid="ADX04">
                    <data_ele>127</data_ele>
                    <name>Reference Identification</name>
                    <usage>N</usage>
                    <seq>04</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                </segment>
<!--End of ADX segment-->
              </loop>
<!--End of 2320B loop-->
            </loop>
<!--End of 2300B loop-->
          </loop>
<!--End of 2000B loop-->
        </loop>
<!--End of DETAIL loop-->
        <loop xid="FOOTER" type="wrapper">
          <name>Table 3 - Footer</name>
          <usage>N</usage>
          <pos>030</pos>
          <repeat>1</repeat>
        </loop>
<!--End of FOOTER loop-->
        <segment xid="SE">
          <name>820 Trailer</name>
          <usage>R</usage>
          <pos>050</pos>
          <max_use>1</max_use>
          <element xid="SE01">
            <data_ele>96</data_ele>
            <name>Transaction Segment Count</name>
            <usage>R</usage>
            <seq>01</seq>
            <data_type>N0</data_type>
            <min_len>1</min_len>
            <max_len>10</max_len>
          </element>
          <element xid="SE02">
            <data_ele>329</data_ele>
            <name>Transaction Set Control Number</name>
            <usage>R</usage>
            <seq>02</seq>
            <data_type>AN</data_type>
            <min_len>4</min_len>
            <max_len>9</max_len>
          </element>
        </segment>
<!--End of SE segment-->
      </loop>
<!--End of ST loop-->
      <segment xid="GE">
        <name>Functional Group Trailer</name>
        <usage>R</usage>
        <pos>030</pos>
        <max_use>1</max_use>
        <element xid="GE01">
          <data_ele>97</data_ele>
          <name>Number of Transaction Sets Included</name>
          <usage>R</usage>
          <seq>01</seq>
          <data_type>N0</data_type>
          <min_len>1</min_len>
          <max_len>6</max_len>
        </element>
        <element xid="GE02">
          <data_ele>28</data_ele>
          <name>Group Control Number</name>
          <usage>R</usage>
          <seq>02</seq>
          <data_type>N0</data_type>
          <min_len>1</min_len>
          <max_len>9</max_len>
        </element>
      </segment>
<!--End of GE segment-->
    </loop>
<!--End of GS loop-->
    <segment xid="TA1">
      <name>Interchange Achnowledgement</name>
      <usage>S</usage>
      <pos>020</pos>
      <element xid="TA101">
        <data_ele>I12</data_ele>
        <name>Interchange Control Number</name>
        <usage>R</usage>
        <seq>01</seq>
        <data_type>N0</data_type>
        <min_len>9</min_len>
        <max_len>9</max_len>
      </element>
      <element xid="TA102">
        <data_ele>I08</data_ele>
        <name>Interchange Date</name>
        <usage>R</usage>
        <seq>02</seq>
        <data_type>DT</data_type>
        <min_len>6</min_len>
        <max_len>6</max_len>
      </element>
      <element xid="TA103">
        <data_ele>I09</data_ele>
        <name>Interchange Time</name>
        <usage>R</usage>
        <seq>03</seq>
        <data_type>TM</data_type>
        <min_len>4</min_len>
        <max_len>4</max_len>
      </element>
      <element xid="TA104">
        <data_ele>I17</data_ele>
        <name>Interchange Achnowledgement Code</name>
        <usage>R</usage>
        <seq>04</seq>
        <data_type>ID</data_type>
        <min_len>1</min_len>
        <max_len>1</max_len>
        <valid_codes>
          <code>A</code>
          <code>E</code>
          <code>R</code>
        </valid_codes>
      </element>
      <element xid="TA105">
        <data_ele>I18</data_ele>
        <name>Interchange Note Code</name>
        <usage>R</usage>
        <seq>05</seq>
        <data_type>ID</data_type>
        <min_len>3</min_len>
        <max_len>3</max_len>
        <valid_codes>
          <code>000</code>
          <code>001</code>
          <code>002</code>
          <code>003</code>
          <code>004</code>
          <code>005</code>
          <code>006</code>
          <code>007</code>
          <code>008</code>
          <code>009</code>
          <code>010</code>
          <code>011</code>
          <code>012</code>
          <code>013</code>
          <code>014</code>
          <code>015</code>
          <code>016</code>
          <code>017</code>
          <code>018</code>
          <code>019</code>
          <code>020</code>
          <code>021</code>
          <code>022</code>
          <code>023</code>
          <code>024</code>
          <code>025</code>
          <code>026</code>
          <code>027</code>
          <code>028</code>
          <code>029</code>
          <code>030</code>
          <code>031</code>
        </valid_codes>
      </element>
    </segment>
<!--End of TA1 segment-->
    <segment xid="IEA">
      <name>Interchange Control Trailer</name>
      <usage>R</usage>
      <pos>030</pos>
      <max_use>1</max_use>
      <element xid="IEA01">
        <data_ele>I16</data_ele>
        <name>Number of Included Functional Groups</name>
        <usage>R</usage>
        <seq>01</seq>
        <data_type>N0</data_type>
        <min_len>1</min_len>
        <max_len>5</max_len>
      </element>
      <element xid="IEA02">
        <data_ele>I12</data_ele>
        <name>Interchange Control Number</name>
        <usage>R</usage>
        <seq>02</seq>
        <data_type>N0</data_type>
        <min_len>9</min_len>
        <max_len>9</max_len>
      </element>
    </segment>
<!--End of IEA segment-->
  </loop>
<!--End of ISA loop-->
</transaction>
