<?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: 834.4010.X095.A1.xml,v 1.9 2004/12/12 20:57:34 johnholland Exp $
-->
<transaction>
  <id>834</id>
  <name>HIPAA Benefit Enrollment and Maintenance X095A1-834</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>
      </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>
      </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>BE</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>
      </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>
      </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>004010X095A1</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>Transaction Set Header</name>
          <usage>R</usage>
          <pos>005</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>834</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>010</pos>
          <repeat>1</repeat>
          <segment xid="BGN">
            <name>Beginning Segment</name>
            <usage>R</usage>
            <pos>020</pos>
            <max_use>1</max_use>
            <syntax>C0504</syntax>
            <element xid="BGN01">
              <data_ele>353</data_ele>
              <name>Transaction Set Purpose 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>00</code>
                <code>15</code>
                <code>22</code>
              </valid_codes>
            </element>
            <element xid="BGN02">
              <data_ele>127</data_ele>
              <name>Transaction Set Identifier Code</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="BGN03">
              <data_ele>373</data_ele>
              <name>Transaction Set Creation Date</name>
              <usage>R</usage>
              <seq>03</seq>
              <data_type>DT</data_type>
              <min_len>8</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="BGN04">
              <data_ele>337</data_ele>
              <name>Transaction Set Creation Time</name>
              <usage>R</usage>
              <seq>04</seq>
              <data_type>TM</data_type>
              <min_len>4</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="BGN05">
              <data_ele>623</data_ele>
              <name>Time Zone Code</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>01</code>
                <code>02</code>
                <code>03</code>
                <code>04</code>
                <code>05</code>
                <code>06</code>
                <code>07</code>
                <code>08</code>
                <code>09</code>
                <code>10</code>
                <code>11</code>
                <code>12</code>
                <code>13</code>
                <code>14</code>
                <code>15</code>
                <code>16</code>
                <code>17</code>
                <code>18</code>
                <code>19</code>
                <code>20</code>
                <code>21</code>
                <code>22</code>
                <code>23</code>
                <code>24</code>
                <code>AD</code>
                <code>AS</code>
                <code>AT</code>
                <code>CD</code>
                <code>CS</code>
                <code>CT</code>
                <code>ED</code>
                <code>ES</code>
                <code>ET</code>
                <code>GM</code>
                <code>HD</code>
                <code>HS</code>
                <code>HT</code>
                <code>LT</code>
                <code>MD</code>
                <code>MS</code>
                <code>MT</code>
                <code>ND</code>
                <code>NS</code>
                <code>NT</code>
                <code>PD</code>
                <code>PS</code>
                <code>PT</code>
                <code>TD</code>
                <code>TS</code>
                <code>TT</code>
                <code>UT</code>
              </valid_codes>
            </element>
            <element xid="BGN06">
              <data_ele>127</data_ele>
              <name>Transaction Set Identifier Code</name>
              <usage>S</usage>
              <seq>06</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>30</max_len>
            </element>
            <element xid="BGN07">
              <data_ele>640</data_ele>
              <name>Transaction Type 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="BGN08">
              <data_ele>306</data_ele>
              <name>Action Code</name>
              <usage>R</usage>
              <seq>08</seq>
              <data_type>ID</data_type>
              <min_len>1</min_len>
              <max_len>2</max_len>
              <valid_codes>
                <code>2</code>
                <code>4</code>
              </valid_codes>
            </element>
            <element xid="BGN09">
              <data_ele>786</data_ele>
              <name>Security Level Code</name>
              <usage>N</usage>
              <seq>09</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>2</max_len>
            </element>
          </segment>
<!--End of BGN segment-->
          <segment xid="REF">
            <name>Transaction Set Policy Number</name>
            <usage>S</usage>
            <pos>030</pos>
            <max_use>1</max_use>
            <syntax>R0203</syntax>
            <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>38</code>
              </valid_codes>
            </element>
            <element xid="REF02">
              <data_ele>127</data_ele>
              <name>Master 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="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="DTP">
            <name>File Effective Date</name>
            <usage>S</usage>
            <pos>040</pos>
            <max_use>&gt;1</max_use>
            <element xid="DTP01">
              <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>007</code>
                <code>303</code>
                <code>382</code>
                <code>388</code>
              </valid_codes>
            </element>
            <element xid="DTP02">
              <data_ele>1250</data_ele>
              <name>Date Time Period Format Qualifier</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>D8</code>
              </valid_codes>
            </element>
            <element xid="DTP03">
              <data_ele>1251</data_ele>
              <name>Date Time Period</name>
              <usage>R</usage>
              <seq>03</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>35</max_len>
            </element>
          </segment>
<!--End of DTP segment-->
          <loop xid="1000A">
            <name>Sponsor Name</name>
            <usage>R</usage>
            <pos>070</pos>
            <repeat>1</repeat>
            <segment xid="N1">
              <name>Sponsor Name</name>
              <usage>R</usage>
              <pos>070</pos>
              <max_use>1</max_use>
              <syntax>R0203</syntax>
              <syntax>P0304</syntax>
              <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>P5</code>
                </valid_codes>
              </element>
              <element xid="N102">
                <data_ele>93</data_ele>
                <name>Plan Sponsor 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>R</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>FI</code>
                  <code>ZZ</code>
                </valid_codes>
              </element>
              <element xid="N104">
                <data_ele>67</data_ele>
                <name>Sponsor 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="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-->
          </loop>
<!--End of 1000A loop-->
          <loop xid="1000B">
            <name>Payer</name>
            <usage>R</usage>
            <pos>070</pos>
            <repeat>1</repeat>
            <segment xid="N1">
              <name>Payer</name>
              <usage>R</usage>
              <pos>070</pos>
              <max_use>1</max_use>
              <syntax>R0203</syntax>
              <syntax>P0304</syntax>
              <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>IN</code>
                </valid_codes>
              </element>
              <element xid="N102">
                <data_ele>93</data_ele>
                <name>Insurer 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>R</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>FI</code>
                  <code>XV</code>
                </valid_codes>
              </element>
              <element xid="N104">
                <data_ele>67</data_ele>
                <name>Insurer Identification Code</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="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-->
          </loop>
<!--End of 1000B loop-->
          <loop xid="1000C">
            <name>TPA/Broker Name</name>
            <usage>S</usage>
            <pos>070</pos>
            <repeat>2</repeat>
            <segment xid="N1">
              <name>TPA/Broker Name</name>
              <usage>R</usage>
              <pos>070</pos>
              <max_use>1</max_use>
              <syntax>R0203</syntax>
              <syntax>P0304</syntax>
              <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>BO</code>
                  <code>TV</code>
                </valid_codes>
              </element>
              <element xid="N102">
                <data_ele>93</data_ele>
                <name>TPA or Broker 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="N103">
                <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>94</code>
                  <code>FI</code>
                  <code>XV</code>
                </valid_codes>
              </element>
              <element xid="N104">
                <data_ele>67</data_ele>
                <name>TPA or Broker Identification Code</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="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-->
            <loop xid="1100C">
              <name>TPA/Broker Account Information</name>
              <usage>S</usage>
              <pos>120</pos>
              <repeat>1</repeat>
              <segment xid="ACT">
                <name>TPA/Broker Account Information</name>
                <usage>R</usage>
                <pos>120</pos>
                <max_use>1</max_use>
                <syntax>P0304</syntax>
                <syntax>C0506</syntax>
                <syntax>C0705</syntax>
                <element xid="ACT01">
                  <data_ele>508</data_ele>
                  <name>TPA or Broker Account Number</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="ACT02">
                  <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>
                <element xid="ACT03">
                  <data_ele>66</data_ele>
                  <name>Identification Code Qualifier</name>
                  <usage>N</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="ACT04">
                  <data_ele>67</data_ele>
                  <name>Identification Code</name>
                  <usage>N</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>2</min_len>
                  <max_len>80</max_len>
                </element>
                <element xid="ACT05">
                  <data_ele>569</data_ele>
                  <name>Account Number Qualifier</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>3</max_len>
                </element>
                <element xid="ACT06">
                  <data_ele>508</data_ele>
                  <name>TPA or Broker Account Number</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="ACT07">
                  <data_ele>352</data_ele>
                  <name>Description</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>80</max_len>
                </element>
                <element xid="ACT08">
                  <data_ele>107</data_ele>
                  <name>Payment Method Code</name>
                  <usage>N</usage>
                  <seq>08</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="ACT09">
                  <data_ele>1216</data_ele>
                  <name>Benefit Status Code</name>
                  <usage>N</usage>
                  <seq>09</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
              </segment>
<!--End of ACT segment-->
            </loop>
<!--End of 1100C loop-->
          </loop>
<!--End of 1000C 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="2000">
            <name>Member Level Detail</name>
            <usage>R</usage>
            <pos>010</pos>
            <repeat>&gt;1</repeat>
            <segment xid="INS">
              <name>Member Level Detail</name>
              <usage>R</usage>
              <pos>010</pos>
              <max_use>1</max_use>
              <syntax>P1112</syntax>
              <element xid="INS01">
                <data_ele>1073</data_ele>
                <name>Insured Indicator</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
                <valid_codes>
                  <code>N</code>
                  <code>Y</code>
                </valid_codes>
              </element>
              <element xid="INS02">
                <data_ele>1069</data_ele>
                <name>Individual Relationship 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>01</code>
                  <code>03</code>
                  <code>04</code>
                  <code>05</code>
                  <code>06</code>
                  <code>07</code>
                  <code>08</code>
                  <code>09</code>
                  <code>10</code>
                  <code>11</code>
                  <code>12</code>
                  <code>13</code>
                  <code>14</code>
                  <code>15</code>
                  <code>17</code>
                  <code>18</code>
                  <code>19</code>
                  <code>23</code>
                  <code>24</code>
                  <code>25</code>
                  <code>26</code>
                  <code>31</code>
                  <code>32</code>
                  <code>33</code>
                  <code>38</code>
                  <code>48</code>
                  <code>49</code>
                  <code>53</code>
                </valid_codes>
              </element>
              <element xid="INS03">
                <data_ele>875</data_ele>
                <name>Maintenance Type Code</name>
                <usage>R</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>3</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>001</code>
                  <code>021</code>
                  <code>024</code>
                  <code>025</code>
                  <code>030</code>
                </valid_codes>
              </element>
              <element xid="INS04">
                <data_ele>1203</data_ele>
                <name>Maintenance Reason 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>
                  <code>01</code>
                  <code>02</code>
                  <code>03</code>
                  <code>04</code>
                  <code>05</code>
                  <code>06</code>
                  <code>07</code>
                  <code>08</code>
                  <code>09</code>
                  <code>10</code>
                  <code>11</code>
                  <code>14</code>
                  <code>15</code>
                  <code>16</code>
                  <code>17</code>
                  <code>18</code>
                  <code>20</code>
                  <code>21</code>
                  <code>22</code>
                  <code>25</code>
                  <code>26</code>
                  <code>27</code>
                  <code>28</code>
                  <code>29</code>
                  <code>31</code>
                  <code>32</code>
                  <code>33</code>
                  <code>37</code>
                  <code>38</code>
                  <code>39</code>
                  <code>40</code>
                  <code>41</code>
                  <code>43</code>
                  <code>AI</code>
                  <code>XN</code>
                  <code>XT</code>
                </valid_codes>
              </element>
              <element xid="INS05">
                <data_ele>1216</data_ele>
                <name>Benefit Status Code</name>
                <usage>R</usage>
                <seq>05</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
                <valid_codes>
                  <code>A</code>
                  <code>C</code>
                  <code>S</code>
                  <code>T</code>
                </valid_codes>
              </element>
              <element xid="INS06">
                <data_ele>1218</data_ele>
                <name>Medicare Plan Code</name>
                <usage>S</usage>
                <seq>06</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
                <valid_codes>
                  <code>A</code>
                  <code>B</code>
                  <code>C</code>
                  <code>D</code>
                  <code>E</code>
                </valid_codes>
              </element>
              <element xid="INS07">
                <data_ele>1219</data_ele>
                <name>Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code</name>
                <usage>S</usage>
                <seq>07</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>1</code>
                  <code>2</code>
                  <code>3</code>
                  <code>4</code>
                  <code>5</code>
                  <code>6</code>
                  <code>7</code>
                  <code>8</code>
                </valid_codes>
              </element>
              <element xid="INS08">
                <data_ele>584</data_ele>
                <name>Employment Status Code</name>
                <usage>S</usage>
                <seq>08</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>AO</code>
                  <code>AU</code>
                  <code>FT</code>
                  <code>L1</code>
                  <code>PT</code>
                  <code>RT</code>
                  <code>TE</code>
                </valid_codes>
              </element>
              <element xid="INS09">
                <data_ele>1220</data_ele>
                <name>Student Status Code</name>
                <usage>S</usage>
                <seq>09</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
                <valid_codes>
                  <code>F</code>
                  <code>N</code>
                  <code>P</code>
                </valid_codes>
              </element>
              <element xid="INS10">
                <data_ele>1073</data_ele>
                <name>Handicap Indicator</name>
                <usage>S</usage>
                <seq>10</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
                <valid_codes>
                  <code>N</code>
                  <code>Y</code>
                </valid_codes>
              </element>
              <element xid="INS11">
                <data_ele>1250</data_ele>
                <name>Date Time Period Format Qualifier</name>
                <usage>S</usage>
                <seq>11</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>D8</code>
                </valid_codes>
              </element>
              <element xid="INS12">
                <data_ele>1251</data_ele>
                <name>Insured Individual Death Date</name>
                <usage>S</usage>
                <seq>12</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>35</max_len>
              </element>
              <element xid="INS13">
                <data_ele>1165</data_ele>
                <name>Confidentiality Code</name>
                <usage>N</usage>
                <seq>13</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
              </element>
              <element xid="INS14">
                <data_ele>19</data_ele>
                <name>City Name</name>
                <usage>N</usage>
                <seq>14</seq>
                <data_type>AN</data_type>
                <min_len>2</min_len>
                <max_len>30</max_len>
              </element>
              <element xid="INS15">
                <data_ele>156</data_ele>
                <name>State or Province Code</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="INS16">
                <data_ele>26</data_ele>
                <name>Country Code</name>
                <usage>N</usage>
                <seq>16</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="INS17">
                <data_ele>1470</data_ele>
                <name>Birth Sequence Number</name>
                <usage>S</usage>
                <seq>17</seq>
                <data_type>N0</data_type>
                <min_len>1</min_len>
                <max_len>9</max_len>
              </element>
            </segment>
<!--End of INS segment-->
            <segment xid="REF">
              <name>Subscriber Number</name>
              <usage>R</usage>
              <pos>020</pos>
              <max_use>1</max_use>
              <syntax>R0203</syntax>
              <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>0F</code>
                </valid_codes>
              </element>
              <element xid="REF02">
                <data_ele>127</data_ele>
                <name>Subscriber 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="REF">
              <name>Member Policy Number</name>
              <usage>S</usage>
              <pos>020</pos>
              <max_use>1</max_use>
              <syntax>R0203</syntax>
              <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>1L</code>
                </valid_codes>
              </element>
              <element xid="REF02">
                <data_ele>127</data_ele>
                <name>Insured 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="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="REF">
              <name>Member Identification Number</name>
              <usage>S</usage>
              <pos>020</pos>
              <max_use>5</max_use>
              <syntax>R0203</syntax>
              <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>17</code>
                  <code>23</code>
                  <code>3H</code>
                  <code>6O</code>
                  <code>DX</code>
                  <code>F6</code>
                  <code>Q4</code>
                  <code>ZZ</code>
                </valid_codes>
              </element>
              <element xid="REF02">
                <data_ele>127</data_ele>
                <name>Subscriber Supplemental 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="REF">
              <name>Prior Coverage Months</name>
              <usage>S</usage>
              <pos>020</pos>
              <max_use>1</max_use>
              <syntax>R0203</syntax>
              <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>QQ</code>
                </valid_codes>
              </element>
              <element xid="REF02">
                <data_ele>127</data_ele>
                <name>Prior Coverage Month Count</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="DTP">
              <name>Member Level Dates</name>
              <usage>S</usage>
              <pos>025</pos>
              <max_use>20</max_use>
              <element xid="DTP01">
                <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>286</code>
                  <code>296</code>
                  <code>297</code>
                  <code>300</code>
                  <code>301</code>
                  <code>303</code>
                  <code>336</code>
                  <code>337</code>
                  <code>338</code>
                  <code>339</code>
                  <code>340</code>
                  <code>341</code>
                  <code>350</code>
                  <code>351</code>
                  <code>356</code>
                  <code>357</code>
                  <code>383</code>
                  <code>393</code>
                  <code>394</code>
                  <code>473</code>
                  <code>474</code>
                </valid_codes>
              </element>
              <element xid="DTP02">
                <data_ele>1250</data_ele>
                <name>Date Time Period Format Qualifier</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>D8</code>
                </valid_codes>
              </element>
              <element xid="DTP03">
                <data_ele>1251</data_ele>
                <name>Status Information Effective Date</name>
                <usage>R</usage>
                <seq>03</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>35</max_len>
              </element>
            </segment>
<!--End of DTP segment-->
            <loop xid="2100A">
              <name>Member Name</name>
              <usage>R</usage>
              <pos>030</pos>
              <repeat>1</repeat>
              <segment xid="NM1">
                <name>Member Name</name>
                <usage>R</usage>
                <pos>030</pos>
                <max_use>1</max_use>
                <syntax>P0809</syntax>
                <syntax>C1110</syntax>
                <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>74</code>
                    <code>IL</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>Subscriber Last Name</name>
                  <usage>R</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>Subscriber First Name</name>
                  <usage>R</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>Subscriber 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>Subscriber 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>Subscriber 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>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Subscriber 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-->
              <segment xid="PER">
                <name>Member Communications Numbers</name>
                <usage>S</usage>
                <pos>040</pos>
                <max_use>1</max_use>
                <syntax>P0304</syntax>
                <syntax>P0506</syntax>
                <syntax>P0708</syntax>
                <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>IP</code>
                  </valid_codes>
                </element>
                <element xid="PER02">
                  <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>
                <element xid="PER03">
                  <data_ele>365</data_ele>
                  <name>Communication Number 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>EM</code>
                    <code>EX</code>
                    <code>FX</code>
                    <code>HP</code>
                    <code>TE</code>
                    <code>WP</code>
                  </valid_codes>
                </element>
                <element xid="PER04">
                  <data_ele>364</data_ele>
                  <name>Communication Number</name>
                  <usage>R</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>HP</code>
                    <code>TE</code>
                    <code>WP</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>HP</code>
                    <code>TE</code>
                    <code>WP</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-->
              <segment xid="N3">
                <name>Member Residence Street Address</name>
                <usage>S</usage>
                <pos>050</pos>
                <max_use>1</max_use>
                <element xid="N301">
                  <data_ele>166</data_ele>
                  <name>Subscriber 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>Subscriber 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>Member Residence City, State, Zip Code</name>
                <usage>S</usage>
                <pos>060</pos>
                <max_use>1</max_use>
                <syntax>C0605</syntax>
                <element xid="N401">
                  <data_ele>19</data_ele>
                  <name>Subscriber 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>Subscriber 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>Subscriber 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>
                </element>
                <element xid="N405">
                  <data_ele>309</data_ele>
                  <name>Location Qualifier</name>
                  <usage>S</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>60</code>
                    <code>CY</code>
                  </valid_codes>
                </element>
                <element xid="N406">
                  <data_ele>310</data_ele>
                  <name>Location Identification Code</name>
                  <usage>S</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="DMG">
                <name>Member Demographics</name>
                <usage>S</usage>
                <pos>080</pos>
                <max_use>1</max_use>
                <syntax>P0102</syntax>
                <element xid="DMG01">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format 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>D8</code>
                  </valid_codes>
                </element>
                <element xid="DMG02">
                  <data_ele>1251</data_ele>
                  <name>Member Birth Date</name>
                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="DMG03">
                  <data_ele>1068</data_ele>
                  <name>Gender 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>F</code>
                    <code>M</code>
                    <code>U</code>
                  </valid_codes>
                </element>
                <element xid="DMG04">
                  <data_ele>1067</data_ele>
                  <name>Marital Status Code</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                  <valid_codes>
                    <code>B</code>
                    <code>D</code>
                    <code>I</code>
                    <code>M</code>
                    <code>R</code>
                    <code>S</code>
                    <code>U</code>
                    <code>W</code>
                    <code>X</code>
                  </valid_codes>
                </element>
                <element xid="DMG05">
                  <data_ele>1109</data_ele>
                  <name>Race or Ethnicity Code</name>
                  <usage>S</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                  <valid_codes>
                    <code>7</code>
                    <code>8</code>
                    <code>A</code>
                    <code>B</code>
                    <code>C</code>
                    <code>D</code>
                    <code>E</code>
                    <code>F</code>
                    <code>G</code>
                    <code>H</code>
                    <code>I</code>
                    <code>J</code>
                    <code>N</code>
                    <code>O</code>
                    <code>P</code>
                    <code>Z</code>
                  </valid_codes>
                </element>
                <element xid="DMG06">
                  <data_ele>1066</data_ele>
                  <name>Citizenship Status Code</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>1</code>
                    <code>2</code>
                    <code>3</code>
                    <code>4</code>
                    <code>5</code>
                    <code>6</code>
                    <code>7</code>
                  </valid_codes>
                </element>
                <element xid="DMG07">
                  <data_ele>26</data_ele>
                  <name>Country Code</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                </element>
                <element xid="DMG08">
                  <data_ele>659</data_ele>
                  <name>Basis of Verification Code</name>
                  <usage>N</usage>
                  <seq>08</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="DMG09">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>09</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
              </segment>
<!--End of DMG segment-->
              <segment xid="ICM">
                <name>Member Income</name>
                <usage>S</usage>
                <pos>110</pos>
                <max_use>1</max_use>
                <element xid="ICM01">
                  <data_ele>594</data_ele>
                  <name>Frequency Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                  <valid_codes>
                    <code>1</code>
                    <code>2</code>
                    <code>3</code>
                    <code>4</code>
                    <code>6</code>
                    <code>7</code>
                    <code>8</code>
                    <code>9</code>
                    <code>B</code>
                    <code>C</code>
                    <code>H</code>
                    <code>Q</code>
                    <code>S</code>
                    <code>U</code>
                  </valid_codes>
                </element>
                <element xid="ICM02">
                  <data_ele>782</data_ele>
                  <name>Wage 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="ICM03">
                  <data_ele>380</data_ele>
                  <name>Work Hours Count</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="ICM04">
                  <data_ele>310</data_ele>
                  <name>Location Identification Code</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
                <element xid="ICM05">
                  <data_ele>1214</data_ele>
                  <name>Salary Grade Code</name>
                  <usage>S</usage>
                  <seq>05</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>5</max_len>
                </element>
                <element xid="ICM06">
                  <data_ele>100</data_ele>
                  <name>Currency Code</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>ID</data_type>
                  <min_len>3</min_len>
                  <max_len>3</max_len>
                </element>
              </segment>
<!--End of ICM segment-->
              <segment xid="AMT">
                <name>Member Policy Amounts</name>
                <usage>S</usage>
                <pos>120</pos>
                <max_use>4</max_use>
                <element xid="AMT01">
                  <data_ele>522</data_ele>
                  <name>Amount Qualifier Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>B9</code>
                    <code>C1</code>
                    <code>D2</code>
                    <code>P3</code>
                  </valid_codes>
                </element>
                <element xid="AMT02">
                  <data_ele>782</data_ele>
                  <name>Contract 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="AMT03">
                  <data_ele>478</data_ele>
                  <name>Credit/Debit Flag Code</name>
                  <usage>N</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
              </segment>
<!--End of AMT segment-->
              <segment xid="HLH">
                <name>Member Health Information</name>
                <usage>S</usage>
                <pos>130</pos>
                <max_use>1</max_use>
                <element xid="HLH01">
                  <data_ele>1212</data_ele>
                  <name>Health Related Code</name>
                  <usage>S</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                  <valid_codes>
                    <code>N</code>
                    <code>S</code>
                    <code>T</code>
                    <code>U</code>
                    <code>X</code>
                  </valid_codes>
                </element>
                <element xid="HLH02">
                  <data_ele>65</data_ele>
                  <name>Member Height</name>
                  <usage>S</usage>
                  <seq>02</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>8</max_len>
                </element>
                <element xid="HLH03">
                  <data_ele>81</data_ele>
                  <name>Member Weight</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>10</max_len>
                </element>
                <element xid="HLH04">
                  <data_ele>81</data_ele>
                  <name>Weight</name>
                  <usage>N</usage>
                  <seq>04</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>10</max_len>
                </element>
                <element xid="HLH05">
                  <data_ele>352</data_ele>
                  <name>Description</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>80</max_len>
                </element>
                <element xid="HLH06">
                  <data_ele>1213</data_ele>
                  <name>Current Health Condition Code</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
                <element xid="HLH07">
                  <data_ele>352</data_ele>
                  <name>Description</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>80</max_len>
                </element>
              </segment>
<!--End of HLH segment-->
              <segment xid="LUI">
                <name>Member Language</name>
                <usage>S</usage>
                <pos>150</pos>
                <max_use>5</max_use>
                <syntax>P0102</syntax>
                <syntax>L040203</syntax>
                <element xid="LUI01">
                  <data_ele>66</data_ele>
                  <name>Identification Code Qualifier</name>
                  <usage>S</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>LD</code>
                    <code>LE</code>
                  </valid_codes>
                </element>
                <element xid="LUI02">
                  <data_ele>67</data_ele>
                  <name>Language Code</name>
                  <usage>S</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>2</min_len>
                  <max_len>80</max_len>
                </element>
                <element xid="LUI03">
                  <data_ele>352</data_ele>
                  <name>Language Description</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>80</max_len>
                </element>
                <element xid="LUI04">
                  <data_ele>1303</data_ele>
                  <name>Language Use Indicator</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>5</code>
                    <code>7</code>
                    <code>8</code>
                  </valid_codes>
                </element>
                <element xid="LUI05">
                  <data_ele>1476</data_ele>
                  <name>Language Proficiency Indicator</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
              </segment>
<!--End of LUI segment-->
            </loop>
<!--End of 2100A loop-->
            <loop xid="2100B">
              <name>Incorrect Member Name</name>
              <usage>S</usage>
              <pos>030</pos>
              <repeat>1</repeat>
              <segment xid="NM1">
                <name>Incorrect Member Name</name>
                <usage>R</usage>
                <pos>030</pos>
                <max_use>1</max_use>
                <syntax>P0809</syntax>
                <syntax>C1110</syntax>
                <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>70</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>Prior Incorrect Insured Last Name</name>
                  <usage>R</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>Prior Incorrect Insured First Name</name>
                  <usage>R</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>Prior Incorrect Insured 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>Prior Incorrect Insured 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>Prior Incorrect Insured 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>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Prior Incorrect Insured 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-->
              <segment xid="DMG">
                <name>Incorrect Member Demographics</name>
                <usage>S</usage>
                <pos>080</pos>
                <max_use>1</max_use>
                <syntax>P0102</syntax>
                <element xid="DMG01">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format 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>D8</code>
                  </valid_codes>
                </element>
                <element xid="DMG02">
                  <data_ele>1251</data_ele>
                  <name>Prior Incorrect Insured Birth Date</name>
                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="DMG03">
                  <data_ele>1068</data_ele>
                  <name>Prior Incorrect Insured Gender 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>F</code>
                    <code>M</code>
                    <code>U</code>
                  </valid_codes>
                </element>
                <element xid="DMG04">
                  <data_ele>1067</data_ele>
                  <name>Marital Status Code</name>
                  <usage>N</usage>
                  <seq>04</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
                <element xid="DMG05">
                  <data_ele>1109</data_ele>
                  <name>Race or Ethnicity Code</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
                <element xid="DMG06">
                  <data_ele>1066</data_ele>
                  <name>Citizenship Status Code</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="DMG07">
                  <data_ele>26</data_ele>
                  <name>Country Code</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                </element>
                <element xid="DMG08">
                  <data_ele>659</data_ele>
                  <name>Basis of Verification Code</name>
                  <usage>N</usage>
                  <seq>08</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="DMG09">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>09</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
              </segment>
<!--End of DMG segment-->
            </loop>
<!--End of 2100B loop-->
            <loop xid="2100C">
              <name>Member Mailing Address</name>
              <usage>S</usage>
              <pos>030</pos>
              <repeat>1</repeat>
              <segment xid="NM1">
                <name>Member Mailing Address</name>
                <usage>R</usage>
                <pos>030</pos>
                <max_use>1</max_use>
                <syntax>P0809</syntax>
                <syntax>C1110</syntax>
                <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>31</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>Name Last or Organization Name</name>
                  <usage>N</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>Name First</name>
                  <usage>N</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>Name Middle</name>
                  <usage>N</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>Name Prefix</name>
                  <usage>N</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>Name Suffix</name>
                  <usage>N</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>N</usage>
                  <seq>08</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Identification Code</name>
                  <usage>N</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-->
              <segment xid="N3">
                <name>Member Mail Street Address</name>
                <usage>S</usage>
                <pos>050</pos>
                <max_use>1</max_use>
                <element xid="N301">
                  <data_ele>166</data_ele>
                  <name>Subscriber 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>Subscriber 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>Member Mail City, State, Zip</name>
                <usage>S</usage>
                <pos>060</pos>
                <max_use>1</max_use>
                <syntax>C0605</syntax>
                <element xid="N401">
                  <data_ele>19</data_ele>
                  <name>Subscriber 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>Subscriber 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>Subscriber 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 2100C loop-->
            <loop xid="2100D">
              <name>Member Employer</name>
              <usage>S</usage>
              <pos>030</pos>
              <repeat>3</repeat>
              <segment xid="NM1">
                <name>Member Employer</name>
                <usage>R</usage>
                <pos>030</pos>
                <max_use>1</max_use>
                <syntax>P0809</syntax>
                <syntax>C1110</syntax>
                <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>ES</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>
                    <code>2</code>
                  </valid_codes>
                </element>
                <element xid="NM103">
                  <data_ele>1035</data_ele>
                  <name>Insured Employer 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>Insured Employer 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>Insured Employer 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>Name Prefix</name>
                  <usage>N</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>Insured Employer 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>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Insured Employer 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-->
              <segment xid="PER">
                <name>Member Employer Communications Numbers</name>
                <usage>S</usage>
                <pos>040</pos>
                <max_use>1</max_use>
                <syntax>P0304</syntax>
                <syntax>P0506</syntax>
                <syntax>P0708</syntax>
                <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>EP</code>
                  </valid_codes>
                </element>
                <element xid="PER02">
                  <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>
                <element xid="PER03">
                  <data_ele>365</data_ele>
                  <name>Communication Number 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>EM</code>
                    <code>EX</code>
                    <code>FX</code>
                    <code>TE</code>
                  </valid_codes>
                </element>
                <element xid="PER04">
                  <data_ele>364</data_ele>
                  <name>Communication Number</name>
                  <usage>R</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-->
              <segment xid="N3">
                <name>Member Employer Street Address</name>
                <usage>S</usage>
                <pos>050</pos>
                <max_use>1</max_use>
                <element xid="N301">
                  <data_ele>166</data_ele>
                  <name>Insured Employer 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>Insured Employer 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>Member Employer City, State, Zip</name>
                <usage>S</usage>
                <pos>060</pos>
                <max_use>1</max_use>
                <syntax>C0605</syntax>
                <element xid="N401">
                  <data_ele>19</data_ele>
                  <name>Insured Employer 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>Insured Employer 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>Insured Employer 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 2100D loop-->
            <loop xid="2100E">
              <name>Member School</name>
              <usage>S</usage>
              <pos>030</pos>
              <repeat>3</repeat>
              <segment xid="NM1">
                <name>Member School</name>
                <usage>R</usage>
                <pos>030</pos>
                <max_use>1</max_use>
                <syntax>P0809</syntax>
                <syntax>C1110</syntax>
                <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>M8</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>2</code>
                  </valid_codes>
                </element>
                <element xid="NM103">
                  <data_ele>1035</data_ele>
                  <name>School Name</name>
                  <usage>R</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>Name First</name>
                  <usage>N</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>Name Middle</name>
                  <usage>N</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>Name Prefix</name>
                  <usage>N</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>Name Suffix</name>
                  <usage>N</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>N</usage>
                  <seq>08</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Identification Code</name>
                  <usage>N</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-->
              <segment xid="PER">
                <name>Member School Communications Numbers</name>
                <usage>S</usage>
                <pos>040</pos>
                <max_use>1</max_use>
                <syntax>P0304</syntax>
                <syntax>P0506</syntax>
                <syntax>P0708</syntax>
                <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>SK</code>
                  </valid_codes>
                </element>
                <element xid="PER02">
                  <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>
                <element xid="PER03">
                  <data_ele>365</data_ele>
                  <name>Communication Number 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>EM</code>
                    <code>EX</code>
                    <code>FX</code>
                    <code>TE</code>
                  </valid_codes>
                </element>
                <element xid="PER04">
                  <data_ele>364</data_ele>
                  <name>Communication Number</name>
                  <usage>R</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-->
              <segment xid="N3">
                <name>Member School Street Address</name>
                <usage>S</usage>
                <pos>050</pos>
                <max_use>1</max_use>
                <element xid="N301">
                  <data_ele>166</data_ele>
                  <name>School 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>School 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>Member School City, State, Zip</name>
                <usage>S</usage>
                <pos>060</pos>
                <max_use>1</max_use>
                <syntax>C0605</syntax>
                <element xid="N401">
                  <data_ele>19</data_ele>
                  <name>School 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>School 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>School 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 2100E loop-->
            <loop xid="2100F">
              <name>Custodial Parent</name>
              <usage>S</usage>
              <pos>030</pos>
              <repeat>1</repeat>
              <segment xid="NM1">
                <name>Custodial Parent</name>
                <usage>R</usage>
                <pos>030</pos>
                <max_use>1</max_use>
                <syntax>P0809</syntax>
                <syntax>C1110</syntax>
                <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>S3</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>Custodial Parent Last Name</name>
                  <usage>R</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>Custodial Parent First Name</name>
                  <usage>R</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>Custodial Parent 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>Custodial Parent 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>Custodial Parent 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>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Custodial Parent 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-->
              <segment xid="PER">
                <name>Custodial Parent Communications Numbers</name>
                <usage>S</usage>
                <pos>040</pos>
                <max_use>1</max_use>
                <syntax>P0304</syntax>
                <syntax>P0506</syntax>
                <syntax>P0708</syntax>
                <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>PQ</code>
                  </valid_codes>
                </element>
                <element xid="PER02">
                  <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>
                <element xid="PER03">
                  <data_ele>365</data_ele>
                  <name>Communication Number 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>EM</code>
                    <code>EX</code>
                    <code>FX</code>
                    <code>HP</code>
                    <code>TE</code>
                    <code>WP</code>
                  </valid_codes>
                </element>
                <element xid="PER04">
                  <data_ele>364</data_ele>
                  <name>Communication Number</name>
                  <usage>R</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>HP</code>
                    <code>TE</code>
                    <code>WP</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>HP</code>
                    <code>TE</code>
                    <code>WP</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-->
              <segment xid="N3">
                <name>Custodial Parent Street Address</name>
                <usage>S</usage>
                <pos>050</pos>
                <max_use>1</max_use>
                <element xid="N301">
                  <data_ele>166</data_ele>
                  <name>Custodial Parent 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>Custodial Parent 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>Custodial Parent City, State, Zip</name>
                <usage>S</usage>
                <pos>060</pos>
                <max_use>1</max_use>
                <syntax>C0605</syntax>
                <element xid="N401">
                  <data_ele>19</data_ele>
                  <name>Custodial Parent 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>Custodial Parent 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>Custodial Parent 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 2100F loop-->
            <loop xid="2100G">
              <name>Responsible Person</name>
              <usage>S</usage>
              <pos>030</pos>
              <repeat>1</repeat>
              <segment xid="NM1">
                <name>Responsible Person</name>
                <usage>R</usage>
                <pos>030</pos>
                <max_use>1</max_use>
                <syntax>P0809</syntax>
                <syntax>C1110</syntax>
                <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>E1</code>
                    <code>EI</code>
                    <code>EXS</code>
                    <code>GD</code>
                    <code>J6</code>
                    <code>QD</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>Responsible Party Last or Organization Name</name>
                  <usage>R</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>Responsible Party First Name</name>
                  <usage>R</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>Responsible Party 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>Responsible Party 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>Responsible Party Suffix Name</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>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Responsible Party 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-->
              <segment xid="PER">
                <name>Responsible Person Communications Numbers</name>
                <usage>S</usage>
                <pos>040</pos>
                <max_use>1</max_use>
                <syntax>P0304</syntax>
                <syntax>P0506</syntax>
                <syntax>P0708</syntax>
                <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>RP</code>
                  </valid_codes>
                </element>
                <element xid="PER02">
                  <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>
                <element xid="PER03">
                  <data_ele>365</data_ele>
                  <name>Communication Number 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>EM</code>
                    <code>EX</code>
                    <code>FX</code>
                    <code>HP</code>
                    <code>TE</code>
                    <code>WP</code>
                  </valid_codes>
                </element>
                <element xid="PER04">
                  <data_ele>364</data_ele>
                  <name>Communication Number</name>
                  <usage>R</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>HP</code>
                    <code>TE</code>
                    <code>WP</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>HP</code>
                    <code>TE</code>
                    <code>WP</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-->
              <segment xid="N3">
                <name>Responsible Person Street Address</name>
                <usage>S</usage>
                <pos>050</pos>
                <max_use>1</max_use>
                <element xid="N301">
                  <data_ele>166</data_ele>
                  <name>Responsible Party 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>Responsible Party 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>Responsible Person City, State, Zip</name>
                <usage>S</usage>
                <pos>060</pos>
                <max_use>1</max_use>
                <syntax>C0605</syntax>
                <element xid="N401">
                  <data_ele>19</data_ele>
                  <name>Responsible Party 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>Responsible Party 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>Responsible Party 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 2100G loop-->
            <loop xid="2200">
              <name>Disability Information</name>
              <usage>S</usage>
              <pos>200</pos>
              <repeat>1</repeat>
              <segment xid="DSB">
                <name>Disability Information</name>
                <usage>R</usage>
                <pos>200</pos>
                <max_use>1</max_use>
                <syntax>P0708</syntax>
                <element xid="DSB01">
                  <data_ele>1146</data_ele>
                  <name>Disability Type Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                  <valid_codes>
                    <code>1</code>
                    <code>2</code>
                    <code>3</code>
                    <code>4</code>
                  </valid_codes>
                </element>
                <element xid="DSB02">
                  <data_ele>380</data_ele>
                  <name>Quantity</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="DSB03">
                  <data_ele>1149</data_ele>
                  <name>Occupation Code</name>
                  <usage>N</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>4</min_len>
                  <max_len>6</max_len>
                </element>
                <element xid="DSB04">
                  <data_ele>1154</data_ele>
                  <name>Work Intensity Code</name>
                  <usage>N</usage>
                  <seq>04</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
                <element xid="DSB05">
                  <data_ele>1161</data_ele>
                  <name>Product Option Code</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="DSB06">
                  <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="DSB07">
                  <data_ele>235</data_ele>
                  <name>Product or Service ID 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>DX</code>
                  </valid_codes>
                </element>
                <element xid="DSB08">
                  <data_ele>1137</data_ele>
                  <name>Diagnosis Code</name>
                  <usage>S</usage>
                  <seq>08</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
              </segment>
<!--End of DSB segment-->
              <segment xid="DTP">
                <name>Disability Eligibility Dates</name>
                <usage>S</usage>
                <pos>210</pos>
                <max_use>2</max_use>
                <element xid="DTP01">
                  <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>360</code>
                    <code>361</code>
                  </valid_codes>
                </element>
                <element xid="DTP02">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</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>D8</code>
                  </valid_codes>
                </element>
                <element xid="DTP03">
                  <data_ele>1251</data_ele>
                  <name>Disability Eligibility Date</name>
                  <usage>R</usage>
                  <seq>03</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
              </segment>
<!--End of DTP segment-->
            </loop>
<!--End of 2200 loop-->
            <loop xid="2300">
              <name>Health Coverage</name>
              <usage>S</usage>
              <pos>260</pos>
              <repeat>99</repeat>
              <segment xid="HD">
                <name>Health Coverage</name>
                <usage>R</usage>
                <pos>260</pos>
                <max_use>1</max_use>
                <element xid="HD01">
                  <data_ele>875</data_ele>
                  <name>Maintenance Type 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>001</code>
                    <code>002</code>
                    <code>021</code>
                    <code>024</code>
                    <code>025</code>
                    <code>026</code>
                    <code>030</code>
                    <code>032</code>
                  </valid_codes>
                </element>
                <element xid="HD02">
                  <data_ele>1203</data_ele>
                  <name>Maintenance Reason Code</name>
                  <usage>N</usage>
                  <seq>02</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                </element>
                <element xid="HD03">
                  <data_ele>1205</data_ele>
                  <name>Insurance Line Code</name>
                  <usage>R</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>AG</code>
                    <code>AH</code>
                    <code>AJ</code>
                    <code>AK</code>
                    <code>HE</code>
                    <code>MM</code>
                    <code>UR</code>
                    <code>DCP</code>
                    <code>DEN</code>
                    <code>EPO</code>
                    <code>FAC</code>
                    <code>HE</code>
                    <code>HLT</code>
                    <code>HMO</code>
                    <code>LTC</code>
                    <code>LTD</code>
                    <code>MM</code>
                    <code>MOD</code>
                    <code>PDG</code>
                    <code>POS</code>
                    <code>PPO</code>
                    <code>PRA</code>
                    <code>STD</code>
                    <code>UR</code>
                    <code>VIS</code>
                  </valid_codes>
                </element>
                <element xid="HD04">
                  <data_ele>1204</data_ele>
                  <name>Plan Coverage Description</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>50</max_len>
                </element>
                <element xid="HD05">
                  <data_ele>1207</data_ele>
                  <name>Coverage Level Code</name>
                  <usage>S</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>3</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>CHD</code>
                    <code>DEP</code>
                    <code>E1D</code>
                    <code>E2D</code>
                    <code>E3D</code>
                    <code>E5D</code>
                    <code>E6D</code>
                    <code>E7D</code>
                    <code>E8D</code>
                    <code>E9D</code>
                    <code>ECH</code>
                    <code>EMP</code>
                    <code>ESP</code>
                    <code>FAM</code>
                    <code>IND</code>
                    <code>SPC</code>
                    <code>SPO</code>
                    <code>TWO</code>
                  </valid_codes>
                </element>
                <element xid="HD06">
                  <data_ele>609</data_ele>
                  <name>Count</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>N0</data_type>
                  <min_len>1</min_len>
                  <max_len>9</max_len>
                </element>
                <element xid="HD07">
                  <data_ele>609</data_ele>
                  <name>Count</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>N0</data_type>
                  <min_len>1</min_len>
                  <max_len>9</max_len>
                </element>
                <element xid="HD08">
                  <data_ele>1209</data_ele>
                  <name>Underwriting Decision 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="HD09">
                  <data_ele>1073</data_ele>
                  <name>Yes/No Condition or Response Code</name>
                  <usage>N</usage>
                  <seq>09</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
                <element xid="HD10">
                  <data_ele>1211</data_ele>
                  <name>Drug House Code</name>
                  <usage>N</usage>
                  <seq>10</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                </element>
                <element xid="HD11">
                  <data_ele>1073</data_ele>
                  <name>Yes/No Condition or Response Code</name>
                  <usage>N</usage>
                  <seq>11</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
              </segment>
<!--End of HD segment-->
              <segment xid="DTP">
                <name>Health Coverage Dates</name>
                <usage>R</usage>
                <pos>270</pos>
                <max_use>4</max_use>
                <element xid="DTP01">
                  <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>303</code>
                    <code>348</code>
                    <code>349</code>
                    <code>543</code>
                  </valid_codes>
                </element>
                <element xid="DTP02">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</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>D8</code>
                  </valid_codes>
                </element>
                <element xid="DTP03">
                  <data_ele>1251</data_ele>
                  <name>Coverage Period</name>
                  <usage>R</usage>
                  <seq>03</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
              </segment>
<!--End of DTP segment-->
              <segment xid="AMT">
                <name>Health Coverage Policy</name>
                <usage>S</usage>
                <pos>280</pos>
                <max_use>4</max_use>
                <element xid="AMT01">
                  <data_ele>522</data_ele>
                  <name>Amount Qualifier Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>B9</code>
                    <code>C1</code>
                    <code>D2</code>
                    <code>P3</code>
                  </valid_codes>
                </element>
                <element xid="AMT02">
                  <data_ele>782</data_ele>
                  <name>Contract 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="AMT03">
                  <data_ele>478</data_ele>
                  <name>Credit/Debit Flag Code</name>
                  <usage>N</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
              </segment>
<!--End of AMT segment-->
              <segment xid="REF">
                <name>Health Coverage Policy Number</name>
                <usage>S</usage>
                <pos>290</pos>
                <max_use>2</max_use>
                <syntax>R0203</syntax>
                <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>17</code>
                    <code>1L</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="REF02">
                  <data_ele>127</data_ele>
                  <name>Insured 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="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="IDC">
                <name>Identification Card</name>
                <usage>S</usage>
                <pos>300</pos>
                <max_use>10</max_use>
                <element xid="IDC01">
                  <data_ele>1204</data_ele>
                  <name>Plan Coverage Description</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>50</max_len>
                </element>
                <element xid="IDC02">
                  <data_ele>1215</data_ele>
                  <name>Identification Card Type Code</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>D</code>
                    <code>H</code>
                    <code>P</code>
                  </valid_codes>
                </element>
                <element xid="IDC03">
                  <data_ele>380</data_ele>
                  <name>Identification Card Count</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="IDC04">
                  <data_ele>306</data_ele>
                  <name>Action Code</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>1</code>
                    <code>2</code>
                    <code>RX</code>
                  </valid_codes>
                </element>
              </segment>
<!--End of IDC segment-->
              <loop xid="2310">
                <name>Provider Information</name>
                <usage>S</usage>
                <pos>310</pos>
                <repeat>30</repeat>
                <segment xid="LX">
                  <name>Provider Information</name>
                  <usage>R</usage>
                  <pos>310</pos>
                  <max_use>1</max_use>
                  <element xid="LX01">
                    <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>
                </segment>
<!--End of LX segment-->
                <segment xid="NM1">
                  <name>Provider Name</name>
                  <usage>R</usage>
                  <pos>320</pos>
                  <max_use>1</max_use>
                  <syntax>P0809</syntax>
                  <syntax>C1110</syntax>
                  <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>3D</code>
                      <code>OD</code>
                      <code>P3</code>
                      <code>QA</code>
                      <code>QN</code>
                      <code>Y2</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>
                      <code>2</code>
                    </valid_codes>
                  </element>
                  <element xid="NM103">
                    <data_ele>1035</data_ele>
                    <name>Provider Last or Organization 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>Provider 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>Provider 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>Provider 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>Provider 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>FI</code>
                      <code>SV</code>
                      <code>XX</code>
                    </valid_codes>
                  </element>
                  <element xid="NM109">
                    <data_ele>67</data_ele>
                    <name>Provider 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>R</usage>
                    <seq>10</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                    <valid_codes>
                      <code>25</code>
                      <code>26</code>
                      <code>72</code>
                    </valid_codes>
                  </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-->
                <segment xid="N4">
                  <name>Provider City, State, Zip Code</name>
                  <usage>S</usage>
                  <pos>360</pos>
                  <max_use>1</max_use>
                  <syntax>C0605</syntax>
                  <element xid="N401">
                    <data_ele>19</data_ele>
                    <name>Member 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>Member 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>Member 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>S</usage>
                    <seq>05</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                    <valid_codes>
                      <code>60</code>
                      <code>CY</code>
                      <code>RJ</code>
                    </valid_codes>
                  </element>
                  <element xid="N406">
                    <data_ele>310</data_ele>
                    <name>Location Identification Code</name>
                    <usage>S</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>Provider Communications Numbers</name>
                  <usage>S</usage>
                  <pos>370</pos>
                  <max_use>2</max_use>
                  <syntax>P0304</syntax>
                  <syntax>P0506</syntax>
                  <syntax>P0708</syntax>
                  <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>Name</name>
                    <usage>N</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>R</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>EX</code>
                      <code>FX</code>
                      <code>HP</code>
                      <code>TE</code>
                      <code>WP</code>
                    </valid_codes>
                  </element>
                  <element xid="PER04">
                    <data_ele>364</data_ele>
                    <name>Communication Number</name>
                    <usage>R</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>HP</code>
                      <code>TE</code>
                      <code>WP</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>HP</code>
                      <code>TE</code>
                      <code>WP</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-->
                <segment xid="PLA">
                  <name>PCP Change Reason</name>
                  <usage>S</usage>
                  <pos>395</pos>
                  <max_use>1</max_use>
                  <element xid="PLA01">
                    <data_ele>306</data_ele>
                    <name>Action 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>2</code>
                    </valid_codes>
                  </element>
                  <element xid="PLA02">
                    <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>1P</code>
                    </valid_codes>
                  </element>
                  <element xid="PLA03">
                    <data_ele>373</data_ele>
                    <name>Provider Effective Date</name>
                    <usage>R</usage>
                    <seq>03</seq>
                    <data_type>DT</data_type>
                    <min_len>8</min_len>
                    <max_len>8</max_len>
                    <valid_codes>
            </valid_codes>
                  </element>
                  <element xid="PLA04">
                    <data_ele>337</data_ele>
                    <name>Time</name>
                    <usage>N</usage>
                    <seq>04</seq>
                    <data_type>TM</data_type>
                    <min_len>4</min_len>
                    <max_len>8</max_len>
                  </element>
                  <element xid="PLA05">
                    <data_ele>1203</data_ele>
                    <name>Maintenance Reason Code</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>14</code>
                      <code>22</code>
                      <code>46</code>
                      <code>AA</code>
                      <code>AB</code>
                      <code>AC</code>
                      <code>AD</code>
                      <code>AE</code>
                      <code>AF</code>
                      <code>AG</code>
                      <code>AH</code>
                      <code>AI</code>
                      <code>AJ</code>
                    </valid_codes>
                  </element>
                </segment>
<!--End of PLA segment-->
              </loop>
<!--End of 2310 loop-->
              <loop xid="2320">
                <name>Coordination of Benefits</name>
                <usage>S</usage>
                <pos>400</pos>
                <repeat>5</repeat>
                <segment xid="COB">
                  <name>Coordination of Benefits</name>
                  <usage>R</usage>
                  <pos>400</pos>
                  <max_use>1</max_use>
                  <element xid="COB01">
                    <data_ele>1138</data_ele>
                    <name>Payer Responsibility Sequence Number Code</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                    <valid_codes>
                      <code>P</code>
                      <code>S</code>
                      <code>T</code>
                      <code>U</code>
                    </valid_codes>
                  </element>
                  <element xid="COB02">
                    <data_ele>127</data_ele>
                    <name>Insured Group or Policy Number</name>
                    <usage>S</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="COB03">
                    <data_ele>1143</data_ele>
                    <name>Coordination of Benefits 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>1</code>
                      <code>5</code>
                      <code>6</code>
                    </valid_codes>
                  </element>
                </segment>
<!--End of COB segment-->
                <segment xid="REF">
                  <name>Additional Coordination of Benefits Identifiers</name>
                  <usage>S</usage>
                  <pos>405</pos>
                  <max_use>5</max_use>
                  <syntax>R0203</syntax>
                  <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>60</code>
                      <code>6P</code>
                      <code>A6</code>
                      <code>SY</code>
                      <code>ZZ</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Insured 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="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="N1">
                  <name>Other Insurance Company Name</name>
                  <usage>S</usage>
                  <pos>410</pos>
                  <max_use>1</max_use>
                  <syntax>R0203</syntax>
                  <syntax>P0304</syntax>
                  <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>IN</code>
                    </valid_codes>
                  </element>
                  <element xid="N102">
                    <data_ele>93</data_ele>
                    <name>Insurer 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>FI</code>
                      <code>NI</code>
                      <code>XV</code>
                    </valid_codes>
                  </element>
                  <element xid="N104">
                    <data_ele>67</data_ele>
                    <name>Insured Group or Policy Number</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="DTP">
                  <name>Coordination of Benefits Eligibility Dates</name>
                  <usage>S</usage>
                  <pos>450</pos>
                  <max_use>2</max_use>
                  <element xid="DTP01">
                    <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>344</code>
                      <code>345</code>
                    </valid_codes>
                  </element>
                  <element xid="DTP02">
                    <data_ele>1250</data_ele>
                    <name>Date Time Period Format Qualifier</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>D8</code>
                    </valid_codes>
                  </element>
                  <element xid="DTP03">
                    <data_ele>1251</data_ele>
                    <name>Coordination of Benefits Date</name>
                    <usage>R</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>35</max_len>
                  </element>
                </segment>
<!--End of DTP segment-->
              </loop>
<!--End of 2320 loop-->
            </loop>
<!--End of 2300 loop-->
          </loop>
<!--End of 2000 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>Transaction Set Trailer</name>
          <usage>R</usage>
          <pos>690</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>
