<?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: 278.4010.X094.27.xml,v 1.12 2004/12/12 20:57:30 johnholland Exp $
-->
<transaction>
  <id>278</id>
  <name>HIPAA Health Care Services Review: Response X094-278</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>
          <code/>
        </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>
          <code/>
        </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>HI</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>
            <code/>
          </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>
        </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>004010X094</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>010</pos>
          <max_use>1</max_use>
          <element xid="ST01">
            <data_ele>143</data_ele>
            <name>Transaction Set Identifier Code</name>
            <usage>R</usage>
            <seq>01</seq>
            <data_type>ID</data_type>
            <min_len>3</min_len>
            <max_len>3</max_len>
            <valid_codes>
              <code>278</code>
            </valid_codes>
          </element>
          <element xid="ST02">
            <data_ele>329</data_ele>
            <name>Transaction Set Control Number</name>
            <usage>R</usage>
            <seq>02</seq>
            <data_type>AN</data_type>
            <min_len>4</min_len>
            <max_len>9</max_len>
          </element>
        </segment>
<!--End of ST segment-->
        <loop xid="HEADER" type="wrapper">
          <name>Table 1 - Header</name>
          <usage>R</usage>
          <pos>015</pos>
          <repeat>1</repeat>
          <segment xid="BHT">
            <name>Beginning of Hierarchical Transaction</name>
            <usage>R</usage>
            <pos>020</pos>
            <max_use>1</max_use>
            <element xid="BHT01">
              <data_ele>1005</data_ele>
              <name>Hierarchical Structure Code</name>
              <usage>R</usage>
              <seq>01</seq>
              <data_type>ID</data_type>
              <min_len>4</min_len>
              <max_len>4</max_len>
              <valid_codes>
                <code>0078</code>
              </valid_codes>
            </element>
            <element xid="BHT02">
              <data_ele>353</data_ele>
              <name>Transaction Set Purpose 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>11</code>
              </valid_codes>
            </element>
            <element xid="BHT03">
              <data_ele>127</data_ele>
              <name>Submitter Transaction Identifier</name>
              <usage>R</usage>
              <seq>03</seq>
              <data_type>AN</data_type>
              <min_len>1</min_len>
              <max_len>30</max_len>
            </element>
            <element xid="BHT04">
              <data_ele>373</data_ele>
              <name>Transaction Set Creation 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>
                <code/>
              </valid_codes>
            </element>
            <element xid="BHT05">
              <data_ele>337</data_ele>
              <name>Transaction Set Creation Time</name>
              <usage>R</usage>
              <seq>05</seq>
              <data_type>TM</data_type>
              <min_len>4</min_len>
              <max_len>8</max_len>
            </element>
            <element xid="BHT06">
              <data_ele>640</data_ele>
              <name>Transaction Type Code</name>
              <usage>S</usage>
              <seq>06</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>2</max_len>
              <valid_codes>
                <code>18</code>
                <code>19</code>
              </valid_codes>
            </element>
          </segment>
<!--End of BHT segment-->
        </loop>
<!--End of HEADER loop-->
        <loop xid="DETAIL" type="wrapper">
          <name>Table 2 - Detail</name>
          <usage>S</usage>
          <pos>020</pos>
          <repeat>&gt;1</repeat>
          <loop xid="2000A">
            <name>Utilization Management Organization (UMO) Level</name>
            <usage>R</usage>
            <pos>010</pos>
            <count>1</count>
            <segment xid="HL">
              <name>Utilization Management Organization (UMO) Level</name>
              <usage>R</usage>
              <pos>010</pos>
              <max_use>1</max_use>
              <element xid="HL01">
                <data_ele>628</data_ele>
                <name>Hierarchical ID Number</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL02">
                <data_ele>734</data_ele>
                <name>Hierarchical Parent ID Number</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL03">
                <data_ele>735</data_ele>
                <name>Hierarchical Level Code</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>20</code>
                </valid_codes>
              </element>
              <element xid="HL04">
                <data_ele>736</data_ele>
                <name>Hierarchical Child 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>1</code>
                </valid_codes>
              </element>
            </segment>
<!--End of HL segment-->
            <segment xid="AAA">
              <name>Request Validation</name>
              <usage>S</usage>
              <pos>030</pos>
              <max_use>9</max_use>
              <element xid="AAA01">
                <data_ele>1073</data_ele>
                <name>Valid Request 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="AAA02">
                <data_ele>559</data_ele>
                <name>Agency Qualifier Code</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="AAA03">
                <data_ele>901</data_ele>
                <name>Reject Reason Code</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>04</code>
                  <code>41</code>
                  <code>42</code>
                  <code>79</code>
                </valid_codes>
              </element>
              <element xid="AAA04">
                <data_ele>889</data_ele>
                <name>Follow-up Action 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>C</code>
                  <code>N</code>
                  <code>P</code>
                  <code>Y</code>
                </valid_codes>
              </element>
            </segment>
<!--End of AAA segment-->
            <loop xid="2010A">
              <name>Utilization Management Organization (UMO) Name</name>
              <usage>R</usage>
              <pos>170</pos>
              <count>1</count>
              <segment xid="NM1">
                <name>Utilization Management Organization (UMO) Name</name>
                <usage>R</usage>
                <pos>170</pos>
                <max_use>1</max_use>
                <element xid="NM101">
                  <data_ele>98</data_ele>
                  <name>Entity Identifier Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>X3</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>Utilization Management Organization (UMO) 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>Utilization Management Organization (UMO) 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>Utilization Management Organization (UMO) 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>Utilization Management Organization (UMO) 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>R</usage>
                  <seq>08</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>24</code>
                    <code>34</code>
                    <code>46</code>
                    <code>PI</code>
                    <code>XV</code>
                    <code>XX</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Utilization Management Organization (UMO) Identifier</name>
                  <usage>R</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>Utilization Management Organization (UMO) Contact Information</name>
                <usage>S</usage>
                <pos>220</pos>
                <max_use>1</max_use>
                <element xid="PER01">
                  <data_ele>366</data_ele>
                  <name>Contact Function Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>IC</code>
                  </valid_codes>
                </element>
                <element xid="PER02">
                  <data_ele>93</data_ele>
                  <name>Utilization Management Organization (UMO) Contact 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="PER03">
                  <data_ele>365</data_ele>
                  <name>Communication Number Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>EM</code>
                    <code>FX</code>
                    <code>TE</code>
                  </valid_codes>
                </element>
                <element xid="PER04">
                  <data_ele>364</data_ele>
                  <name>Utilization Management Organization (UMO) Contact Communication Number</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>80</max_len>
                </element>
                <element xid="PER05">
                  <data_ele>365</data_ele>
                  <name>Communication Number Qualifier</name>
                  <usage>S</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>EM</code>
                    <code>EX</code>
                    <code>FX</code>
                    <code>TE</code>
                  </valid_codes>
                </element>
                <element xid="PER06">
                  <data_ele>364</data_ele>
                  <name>Utilization Management Organization (UMO) Contact 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>Utilization Management Organization (UMO) Contact 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="AAA">
                <name>Utilization Management Organization (UMO) Request Validation</name>
                <usage>S</usage>
                <pos>230</pos>
                <max_use>9</max_use>
                <element xid="AAA01">
                  <data_ele>1073</data_ele>
                  <name>Valid Request 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="AAA02">
                  <data_ele>559</data_ele>
                  <name>Agency Qualifier Code</name>
                  <usage>N</usage>
                  <seq>02</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="AAA03">
                  <data_ele>901</data_ele>
                  <name>Reject Reason Code</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>04</code>
                    <code>41</code>
                    <code>42</code>
                    <code>79</code>
                    <code>80</code>
                    <code>T4</code>
                  </valid_codes>
                </element>
                <element xid="AAA04">
                  <data_ele>889</data_ele>
                  <name>Follow-up Action 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>N</code>
                    <code>P</code>
                    <code>Y</code>
                  </valid_codes>
                </element>
              </segment>
<!--End of AAA segment-->
            </loop>
<!--End of 2010A loop-->
          </loop>
<!--End of 2000A loop-->
          <loop xid="2000B">
            <name>Requester Level</name>
            <usage>R</usage>
            <pos>180</pos>
            <count>1</count>
            <segment xid="HL">
              <name>Requester Level</name>
              <usage>R</usage>
              <pos>010</pos>
              <max_use>1</max_use>
              <element xid="HL01">
                <data_ele>628</data_ele>
                <name>Hierarchical ID Number</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL02">
                <data_ele>734</data_ele>
                <name>Hierarchical Parent ID Number</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL03">
                <data_ele>735</data_ele>
                <name>Hierarchical Level Code</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>21</code>
                </valid_codes>
              </element>
              <element xid="HL04">
                <data_ele>736</data_ele>
                <name>Hierarchical Child 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>1</code>
                </valid_codes>
              </element>
            </segment>
<!--End of HL segment-->
            <loop xid="2010B">
              <name>Requester Name</name>
              <usage>R</usage>
              <pos>170</pos>
              <count>1</count>
              <segment xid="NM1">
                <name>Requester Name</name>
                <usage>R</usage>
                <pos>170</pos>
                <max_use>1</max_use>
                <element xid="NM101">
                  <data_ele>98</data_ele>
                  <name>Entity Identifier Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>1P</code>
                    <code>FA</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>Requester 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>Requester 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>Requester 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>Requester 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>R</usage>
                  <seq>08</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>24</code>
                    <code>34</code>
                    <code>46</code>
                    <code>XX</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Requester Identifier</name>
                  <usage>R</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="REF">
                <name>Requester Supplemental Identification</name>
                <usage>S</usage>
                <pos>180</pos>
                <max_use>8</max_use>
                <element xid="REF01">
                  <data_ele>128</data_ele>
                  <name>Reference Identification Qualifier</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>1G</code>
                    <code>1J</code>
                    <code>CT</code>
                    <code>EI</code>
                    <code>N5</code>
                    <code>N7</code>
                    <code>SY</code>
                    <code>ZH</code>
                  </valid_codes>
                </element>
                <element xid="REF02">
                  <data_ele>127</data_ele>
                  <name>Requester 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="AAA">
                <name>Requester Request Validation</name>
                <usage>S</usage>
                <pos>230</pos>
                <max_use>9</max_use>
                <element xid="AAA01">
                  <data_ele>1073</data_ele>
                  <name>Valid Request 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="AAA02">
                  <data_ele>559</data_ele>
                  <name>Agency Qualifier Code</name>
                  <usage>N</usage>
                  <seq>02</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="AAA03">
                  <data_ele>901</data_ele>
                  <name>Reject Reason Code</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>35</code>
                    <code>41</code>
                    <code>43</code>
                    <code>44</code>
                    <code>45</code>
                    <code>46</code>
                    <code>47</code>
                    <code>49</code>
                    <code>50</code>
                    <code>51</code>
                    <code>79</code>
                    <code>97</code>
                  </valid_codes>
                </element>
                <element xid="AAA04">
                  <data_ele>889</data_ele>
                  <name>Follow-up Action 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>C</code>
                    <code>N</code>
                    <code>R</code>
                  </valid_codes>
                </element>
              </segment>
<!--End of AAA segment-->
              <segment xid="PRV">
                <name>Requester Provider Information</name>
                <usage>S</usage>
                <pos>240</pos>
                <max_use>1</max_use>
                <element xid="PRV01">
                  <data_ele>1221</data_ele>
                  <name>Provider 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>AD</code>
                    <code>AS</code>
                    <code>AT</code>
                    <code>CO</code>
                    <code>CV</code>
                    <code>OP</code>
                    <code>OR</code>
                    <code>OT</code>
                    <code>PC</code>
                    <code>PE</code>
                    <code>RF</code>
                  </valid_codes>
                </element>
                <element xid="PRV02">
                  <data_ele>128</data_ele>
                  <name>Reference Identification 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>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="PRV03">
                  <data_ele>127</data_ele>
                  <name>Provider Taxonomy Code</name>
                  <usage>R</usage>
                  <seq>03</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
<!--<valid_codes external="prov_taxonomy"/>-->
                </element>
                <element xid="PRV04">
                  <data_ele>156</data_ele>
                  <name>State or Province Code</name>
                  <usage>N</usage>
                  <seq>04</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <composite>
                  <data_ele>C035</data_ele>
                  <name>Provider Specialty Information</name>
                  <usage>N</usage>
                  <seq>05</seq>
                </composite>
                <element xid="PRV06">
                  <data_ele>1223</data_ele>
                  <name>Provider Organization 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 PRV segment-->
            </loop>
<!--End of 2010B loop-->
          </loop>
<!--End of 2000B loop-->
          <loop xid="2000C">
            <name>Subscriber Level</name>
            <usage>R</usage>
            <pos>180</pos>
            <count>1</count>
            <segment xid="HL">
              <name>Subscriber Level</name>
              <usage>R</usage>
              <pos>010</pos>
              <max_use>1</max_use>
              <element xid="HL01">
                <data_ele>628</data_ele>
                <name>Hierarchical ID Number</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL02">
                <data_ele>734</data_ele>
                <name>Hierarchical Parent ID Number</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL03">
                <data_ele>735</data_ele>
                <name>Hierarchical Level Code</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>22</code>
                </valid_codes>
              </element>
              <element xid="HL04">
                <data_ele>736</data_ele>
                <name>Hierarchical Child 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>1</code>
                </valid_codes>
              </element>
            </segment>
<!--End of HL segment-->
            <segment xid="AAA">
              <name>Subscriber Request Validation</name>
              <usage>S</usage>
              <pos>030</pos>
              <max_use>9</max_use>
              <element xid="AAA01">
                <data_ele>1073</data_ele>
                <name>Valid Request 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="AAA02">
                <data_ele>559</data_ele>
                <name>Agency Qualifier Code</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="AAA03">
                <data_ele>901</data_ele>
                <name>Reject Reason Code</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>15</code>
                  <code>33</code>
                  <code>56</code>
                </valid_codes>
              </element>
              <element xid="AAA04">
                <data_ele>889</data_ele>
                <name>Follow-up Action 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>C</code>
                  <code>N</code>
                </valid_codes>
              </element>
            </segment>
<!--End of AAA segment-->
            <segment xid="DTP">
              <name>Accident Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>439</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>Accident 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-->
            <segment xid="DTP">
              <name>Last Menstrual Period Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>484</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>Last Menstrual Period 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-->
            <segment xid="DTP">
              <name>Estimated Date of Birth</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>ABC</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>Estimated Birth 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-->
            <segment xid="DTP">
              <name>Onset of Current Symptoms or Illness Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>431</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>
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              </element>
              <element xid="DTP03">
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                <seq>03</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>35</max_len>
              </element>
            </segment>
<!--End of DTP segment-->
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              <name>Subscriber Diagnosis</name>
              <usage>S</usage>
              <pos>080</pos>
              <max_use>1</max_use>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 1</name>
                <usage>R</usage>
                <seq>01</seq>
                <element xid="HI01-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                    <code>BJ</code>
                    <code>BK</code>
                  </valid_codes>
                </element>
                <element xid="HI01-02">
                  <data_ele>1271</data_ele>
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                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
                <element xid="HI01-03">
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                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI01-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI01-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI01-06">
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                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI01-07">
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                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 2</name>
                <usage>S</usage>
                <seq>02</seq>
                <element xid="HI02-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
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                  <max_len>3</max_len>
                  <valid_codes>
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                    <code>BJ</code>
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                </element>
                <element xid="HI02-02">
                  <data_ele>1271</data_ele>
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                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
                <element xid="HI02-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
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                </element>
                <element xid="HI02-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI02-05">
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                  <usage>N</usage>
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                <element xid="HI02-06">
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                  <name>Quantity</name>
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                  <data_type>R</data_type>
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                <element xid="HI02-07">
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                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
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              <composite>
                <data_ele>C022</data_ele>
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                <usage>S</usage>
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                <element xid="HI03-01">
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                  <data_type>ID</data_type>
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                  <max_len>3</max_len>
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                <element xid="HI03-02">
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                </element>
                <element xid="HI03-03">
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                  <name>Date Time Period Format Qualifier</name>
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                  <data_type>ID</data_type>
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                </element>
                <element xid="HI03-05">
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                <element xid="HI03-06">
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                <element xid="HI03-07">
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              <composite>
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                <usage>S</usage>
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                <element xid="HI04-01">
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                  <seq>01</seq>
                  <data_type>ID</data_type>
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                  <max_len>3</max_len>
                  <valid_codes>
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                </element>
                <element xid="HI04-02">
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                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
                <element xid="HI04-03">
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                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
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                  <data_type>ID</data_type>
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                  <max_len>3</max_len>
                  <valid_codes>
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                </element>
                <element xid="HI04-04">
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                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI04-05">
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                  <seq>05</seq>
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                </element>
                <element xid="HI04-06">
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                  <name>Quantity</name>
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                  <data_type>R</data_type>
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                </element>
                <element xid="HI04-07">
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                  <data_type>AN</data_type>
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              <composite>
                <data_ele>C022</data_ele>
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                <usage>S</usage>
                <seq>05</seq>
                <element xid="HI05-01">
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                  <name>Diagnosis Type Code</name>
                  <usage>R</usage>
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                  <data_type>ID</data_type>
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                  <max_len>3</max_len>
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                <element xid="HI05-03">
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                  <data_type>ID</data_type>
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                </element>
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                <element xid="HI05-06">
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              <composite>
                <data_ele>C022</data_ele>
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                <usage>S</usage>
                <seq>06</seq>
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                  <data_type>ID</data_type>
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                  <data_type>AN</data_type>
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                <element xid="HI06-03">
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                  <data_type>ID</data_type>
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                <element xid="HI06-05">
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              <composite>
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                  <data_type>ID</data_type>
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                  <max_len>30</max_len>
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                <element xid="HI08-03">
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                  <data_type>ID</data_type>
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                <element xid="HI08-05">
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                <element xid="HI08-06">
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              <composite>
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                <usage>S</usage>
                <seq>09</seq>
                <element xid="HI09-01">
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                  <data_type>ID</data_type>
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                  <max_len>30</max_len>
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                <element xid="HI09-03">
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                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
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                  <max_len>3</max_len>
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                <element xid="HI09-04">
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                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
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                  <max_len>35</max_len>
                </element>
                <element xid="HI09-05">
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                  <seq>05</seq>
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                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI09-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI09-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 10</name>
                <usage>S</usage>
                <seq>10</seq>
                <element xid="HI10-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI10-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI10-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI10-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI10-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI10-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI10-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 11</name>
                <usage>S</usage>
                <seq>11</seq>
                <element xid="HI11-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI11-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI11-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI11-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI11-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI11-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI11-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 12</name>
                <usage>S</usage>
                <seq>12</seq>
                <element xid="HI12-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI12-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI12-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI12-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI12-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI12-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI12-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
            </segment>
<!--End of HI segment-->
            <loop xid="2010C">
              <name>Subscriber Name</name>
              <usage>R</usage>
              <pos>170</pos>
              <count>1</count>
              <segment xid="NM1">
                <name>Subscriber Name</name>
                <usage>R</usage>
                <pos>170</pos>
                <max_use>1</max_use>
                <element xid="NM101">
                  <data_ele>98</data_ele>
                  <name>Entity Identifier Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>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>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>Subscriber 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>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>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>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>R</usage>
                  <seq>08</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>MI</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Subscriber Primary Identifier</name>
                  <usage>R</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="REF">
                <name>Subscriber Supplemental Identification</name>
                <usage>S</usage>
                <pos>180</pos>
                <max_use>9</max_use>
                <element xid="REF01">
                  <data_ele>128</data_ele>
                  <name>Reference Identification Qualifier</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>1L</code>
                    <code>1W</code>
                    <code>6P</code>
                    <code>A6</code>
                    <code>EJ</code>
                    <code>F6</code>
                    <code>HJ</code>
                    <code>IG</code>
                    <code>N6</code>
                    <code>NQ</code>
                    <code>SY</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="AAA">
                <name>Subscriber Request Validation</name>
                <usage>S</usage>
                <pos>230</pos>
                <max_use>9</max_use>
                <element xid="AAA01">
                  <data_ele>1073</data_ele>
                  <name>Valid Request 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="AAA02">
                  <data_ele>559</data_ele>
                  <name>Agency Qualifier Code</name>
                  <usage>N</usage>
                  <seq>02</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="AAA03">
                  <data_ele>901</data_ele>
                  <name>Reject Reason Code</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>15</code>
                    <code>58</code>
                    <code>64</code>
                    <code>65</code>
                    <code>66</code>
                    <code>67</code>
                    <code>68</code>
                    <code>71</code>
                    <code>72</code>
                    <code>73</code>
                    <code>74</code>
                    <code>75</code>
                    <code>76</code>
                    <code>77</code>
                    <code>78</code>
                    <code>79</code>
                    <code>95</code>
                  </valid_codes>
                </element>
                <element xid="AAA04">
                  <data_ele>889</data_ele>
                  <name>Follow-up Action 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>C</code>
                    <code>N</code>
                  </valid_codes>
                </element>
              </segment>
<!--End of AAA segment-->
              <segment xid="DMG">
                <name>Subscriber Demographic Information</name>
                <usage>S</usage>
                <pos>250</pos>
                <max_use>1</max_use>
                <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>Subscriber 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>Subscriber Gender Code</name>
                  <usage>S</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 2010C loop-->
          </loop>
<!--End of 2000C loop-->
          <loop xid="2000D">
            <name>Dependent Level</name>
            <usage>S</usage>
            <pos>180</pos>
            <count>1</count>
            <segment xid="HL">
              <name>Dependent Level</name>
              <usage>R</usage>
              <pos>010</pos>
              <max_use>1</max_use>
              <element xid="HL01">
                <data_ele>628</data_ele>
                <name>Hierarchical ID Number</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL02">
                <data_ele>734</data_ele>
                <name>Hierarchical Parent ID Number</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL03">
                <data_ele>735</data_ele>
                <name>Hierarchical Level Code</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>23</code>
                </valid_codes>
              </element>
              <element xid="HL04">
                <data_ele>736</data_ele>
                <name>Hierarchical Child 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>1</code>
                </valid_codes>
              </element>
            </segment>
<!--End of HL segment-->
            <segment xid="AAA">
              <name>Dependent Request Validation</name>
              <usage>S</usage>
              <pos>030</pos>
              <max_use>9</max_use>
              <element xid="AAA01">
                <data_ele>1073</data_ele>
                <name>Valid Request 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="AAA02">
                <data_ele>559</data_ele>
                <name>Agency Qualifier Code</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="AAA03">
                <data_ele>901</data_ele>
                <name>Reject Reason Code</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>15</code>
                  <code>33</code>
                  <code>56</code>
                </valid_codes>
              </element>
              <element xid="AAA04">
                <data_ele>889</data_ele>
                <name>Follow-up Action 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>C</code>
                  <code>N</code>
                </valid_codes>
              </element>
            </segment>
<!--End of AAA segment-->
            <segment xid="DTP">
              <name>Accident Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>439</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>Accident 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-->
            <segment xid="DTP">
              <name>Last Menstrual Period Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>484</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>Last Menstrual Period 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-->
            <segment xid="DTP">
              <name>Estimated Date of Birth</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>ABC</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>Estimated Birth 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-->
            <segment xid="DTP">
              <name>Onset of Current Symptoms or Illness Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>431</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>Onset of Current Symptoms or Illness 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-->
            <segment xid="HI">
              <name>Dependent Diagnosis</name>
              <usage>S</usage>
              <pos>080</pos>
              <max_use>1</max_use>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 1</name>
                <usage>R</usage>
                <seq>01</seq>
                <element xid="HI01-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                    <code>BJ</code>
                    <code>BK</code>
                  </valid_codes>
                </element>
                <element xid="HI01-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI01-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI01-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI01-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI01-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI01-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 2</name>
                <usage>S</usage>
                <seq>02</seq>
                <element xid="HI02-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                    <code>BJ</code>
                  </valid_codes>
                </element>
                <element xid="HI02-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI02-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI02-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI02-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI02-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI02-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 3</name>
                <usage>S</usage>
                <seq>03</seq>
                <element xid="HI03-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI03-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI03-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI03-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI03-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI03-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI03-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 4</name>
                <usage>S</usage>
                <seq>04</seq>
                <element xid="HI04-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI04-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI04-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI04-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI04-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI04-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI04-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 5</name>
                <usage>S</usage>
                <seq>05</seq>
                <element xid="HI05-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI05-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI05-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI05-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI05-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI05-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI05-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 6</name>
                <usage>S</usage>
                <seq>06</seq>
                <element xid="HI06-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI06-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI06-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI06-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI06-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI06-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI06-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 7</name>
                <usage>S</usage>
                <seq>07</seq>
                <element xid="HI07-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI07-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI07-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI07-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI07-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI07-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI07-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 8</name>
                <usage>S</usage>
                <seq>08</seq>
                <element xid="HI08-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI08-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI08-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI08-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI08-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI08-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI08-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 9</name>
                <usage>S</usage>
                <seq>09</seq>
                <element xid="HI09-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI09-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI09-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI09-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI09-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI09-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI09-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 10</name>
                <usage>S</usage>
                <seq>10</seq>
                <element xid="HI10-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI10-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI10-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI10-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI10-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI10-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI10-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 11</name>
                <usage>S</usage>
                <seq>11</seq>
                <element xid="HI11-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI11-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI11-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI11-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI11-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI11-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI11-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Diagnosis 12</name>
                <usage>S</usage>
                <seq>12</seq>
                <element xid="HI12-01">
                  <data_ele>1270</data_ele>
                  <name>Diagnosis Type 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>BF</code>
                  </valid_codes>
                </element>
                <element xid="HI12-02">
                  <data_ele>1271</data_ele>
                  <name>Diagnosis 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="HI12-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</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="HI12-04">
                  <data_ele>1251</data_ele>
                  <name>Diagnosis Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI12-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI12-06">
                  <data_ele>380</data_ele>
                  <name>Quantity</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI12-07">
                  <data_ele>799</data_ele>
                  <name>Version Identifier</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
            </segment>
<!--End of HI segment-->
            <loop xid="2010D">
              <name>Dependent Name</name>
              <usage>R</usage>
              <pos>170</pos>
              <count>1</count>
              <segment xid="NM1">
                <name>Dependent Name</name>
                <usage>R</usage>
                <pos>170</pos>
                <max_use>1</max_use>
                <element xid="NM101">
                  <data_ele>98</data_ele>
                  <name>Entity Identifier Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>QC</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>Dependent Last Name</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="NM104">
                  <data_ele>1036</data_ele>
                  <name>Dependent 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>Dependent 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>Dependent 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>MI</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Dependent Primary 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="REF">
                <name>Dependent Supplemental Identification</name>
                <usage>S</usage>
                <pos>180</pos>
                <max_use>3</max_use>
                <element xid="REF01">
                  <data_ele>128</data_ele>
                  <name>Reference Identification Qualifier</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>A6</code>
                    <code>EJ</code>
                    <code>SY</code>
                  </valid_codes>
                </element>
                <element xid="REF02">
                  <data_ele>127</data_ele>
                  <name>Dependent 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="AAA">
                <name>Dependent Request Validation</name>
                <usage>S</usage>
                <pos>230</pos>
                <max_use>9</max_use>
                <element xid="AAA01">
                  <data_ele>1073</data_ele>
                  <name>Valid Request 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="AAA02">
                  <data_ele>559</data_ele>
                  <name>Agency Qualifier Code</name>
                  <usage>N</usage>
                  <seq>02</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="AAA03">
                  <data_ele>901</data_ele>
                  <name>Reject Reason Code</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>15</code>
                    <code>33</code>
                    <code>58</code>
                    <code>64</code>
                    <code>65</code>
                    <code>66</code>
                    <code>67</code>
                    <code>68</code>
                    <code>71</code>
                    <code>77</code>
                    <code>95</code>
                  </valid_codes>
                </element>
                <element xid="AAA04">
                  <data_ele>889</data_ele>
                  <name>Follow-up Action 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>C</code>
                    <code>N</code>
                  </valid_codes>
                </element>
              </segment>
<!--End of AAA segment-->
              <segment xid="DMG">
                <name>Dependent Demographic Information</name>
                <usage>S</usage>
                <pos>250</pos>
                <max_use>1</max_use>
                <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>Dependent 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>Dependent Gender Code</name>
                  <usage>S</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-->
              <segment xid="INS">
                <name>Dependent Relationship</name>
                <usage>S</usage>
                <pos>260</pos>
                <max_use>1</max_use>
                <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>
                  </valid_codes>
                </element>
                <element xid="INS02">
                  <data_ele>1069</data_ele>
                  <name>Relationship to Insured</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>04</code>
                    <code>05</code>
                    <code>07</code>
                    <code>09</code>
                    <code>10</code>
                    <code>15</code>
                    <code>17</code>
                    <code>19</code>
                    <code>20</code>
                    <code>21</code>
                    <code>22</code>
                    <code>23</code>
                    <code>24</code>
                    <code>29</code>
                    <code>32</code>
                    <code>33</code>
                    <code>34</code>
                    <code>39</code>
                    <code>40</code>
                    <code>41</code>
                    <code>43</code>
                    <code>53</code>
                    <code>G8</code>
                  </valid_codes>
                </element>
                <element xid="INS03">
                  <data_ele>875</data_ele>
                  <name>Maintenance Type Code</name>
                  <usage>N</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>3</min_len>
                  <max_len>3</max_len>
                </element>
                <element xid="INS04">
                  <data_ele>1203</data_ele>
                  <name>Maintenance Reason Code</name>
                  <usage>N</usage>
                  <seq>04</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                </element>
                <element xid="INS05">
                  <data_ele>1216</data_ele>
                  <name>Benefit Status 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="INS06">
                  <data_ele>1218</data_ele>
                  <name>Medicare Plan 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="INS07">
                  <data_ele>1219</data_ele>
                  <name>Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code</name>
                  <usage>N</usage>
                  <seq>07</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="INS08">
                  <data_ele>584</data_ele>
                  <name>Employment Status Code</name>
                  <usage>N</usage>
                  <seq>08</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="INS09">
                  <data_ele>1220</data_ele>
                  <name>Student 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>
                <element xid="INS10">
                  <data_ele>1073</data_ele>
                  <name>Yes/No Condition or Response Code</name>
                  <usage>N</usage>
                  <seq>10</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
                <element xid="INS11">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>N</usage>
                  <seq>11</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                </element>
                <element xid="INS12">
                  <data_ele>1251</data_ele>
                  <name>Date Time Period</name>
                  <usage>N</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-->
            </loop>
<!--End of 2010D loop-->
          </loop>
<!--End of 2000D loop-->
          <loop xid="2000E">
            <name>Service Provider Level</name>
            <usage>R</usage>
            <pos>180</pos>
            <count>&gt;1</count>
            <segment xid="HL">
              <name>Service Provider Level</name>
              <usage>R</usage>
              <pos>010</pos>
              <max_use>1</max_use>
              <element xid="HL01">
                <data_ele>628</data_ele>
                <name>Hierarchical ID Number</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL02">
                <data_ele>734</data_ele>
                <name>Hierarchical Parent ID Number</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL03">
                <data_ele>735</data_ele>
                <name>Hierarchical Level Code</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>19</code>
                </valid_codes>
              </element>
              <element xid="HL04">
                <data_ele>736</data_ele>
                <name>Hierarchical Child 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>1</code>
                </valid_codes>
              </element>
            </segment>
<!--End of HL segment-->
            <segment xid="MSG">
              <name>Message Text</name>
              <usage>S</usage>
              <pos>160</pos>
              <max_use>1</max_use>
              <element xid="MSG01">
                <data_ele>933</data_ele>
                <name>Free Form Message Text</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>264</max_len>
              </element>
              <element xid="MSG02">
                <data_ele>934</data_ele>
                <name>Printer Carriage Control Code</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="MSG03">
                <data_ele>1470</data_ele>
                <name>Number</name>
                <usage>N</usage>
                <seq>03</seq>
                <data_type>N0</data_type>
                <min_len>1</min_len>
                <max_len>9</max_len>
              </element>
            </segment>
<!--End of MSG segment-->
            <loop xid="2010E">
              <name>Service Provider Name</name>
              <usage>R</usage>
              <pos>170</pos>
              <count>3</count>
              <segment xid="NM1">
                <name>Service Provider Name</name>
                <usage>R</usage>
                <pos>170</pos>
                <max_use>1</max_use>
                <element xid="NM101">
                  <data_ele>98</data_ele>
                  <name>Entity Identifier Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>1T</code>
                    <code>FA</code>
                    <code>SJ</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>Service 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>Service 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>Service 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>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>Service 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>24</code>
                    <code>34</code>
                    <code>46</code>
                    <code>XX</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Service 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>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="REF">
                <name>Service Provider Supplemental Identification</name>
                <usage>S</usage>
                <pos>180</pos>
                <max_use>7</max_use>
                <element xid="REF01">
                  <data_ele>128</data_ele>
                  <name>Reference Identification Qualifier</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>1G</code>
                    <code>1J</code>
                    <code>EI</code>
                    <code>N5</code>
                    <code>N7</code>
                    <code>SY</code>
                    <code>ZH</code>
                  </valid_codes>
                </element>
                <element xid="REF02">
                  <data_ele>127</data_ele>
                  <name>Service Provider 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="N3">
                <name>Service Provider Address</name>
                <usage>S</usage>
                <pos>200</pos>
                <max_use>1</max_use>
                <element xid="N301">
                  <data_ele>166</data_ele>
                  <name>Service Provider Address Line 1</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>Service Provider Address Line 2</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>Service Provider City/State/ZIP Code</name>
                <usage>S</usage>
                <pos>210</pos>
                <max_use>1</max_use>
                <element xid="N401">
                  <data_ele>19</data_ele>
                  <name>Service Provider City Name</name>
                  <usage>S</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>Service Provider State or Province Code</name>
                  <usage>S</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>Service Provider Postal Zone or ZIP Code</name>
                  <usage>S</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>Service Provider Country Code</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes external="country"/>
                </element>
                <element xid="N405">
                  <data_ele>309</data_ele>
                  <name>Location Qualifier</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="N406">
                  <data_ele>310</data_ele>
                  <name>Location Identifier</name>
                  <usage>N</usage>
                  <seq>06</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </segment>
<!--End of N4 segment-->
              <segment xid="PER">
                <name>Service Provider Contact Information</name>
                <usage>S</usage>
                <pos>220</pos>
                <max_use>1</max_use>
                <element xid="PER01">
                  <data_ele>366</data_ele>
                  <name>Contact Function Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>IC</code>
                  </valid_codes>
                </element>
                <element xid="PER02">
                  <data_ele>93</data_ele>
                  <name>Service Provider Contact 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="PER03">
                  <data_ele>365</data_ele>
                  <name>Communication Number Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>EM</code>
                    <code>FX</code>
                    <code>TE</code>
                  </valid_codes>
                </element>
                <element xid="PER04">
                  <data_ele>364</data_ele>
                  <name>Service Provider Contact Communication Number</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>80</max_len>
                </element>
                <element xid="PER05">
                  <data_ele>365</data_ele>
                  <name>Communication Number Qualifier</name>
                  <usage>S</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>EM</code>
                    <code>EX</code>
                    <code>FX</code>
                    <code>TE</code>
                  </valid_codes>
                </element>
                <element xid="PER06">
                  <data_ele>364</data_ele>
                  <name>Service Provider Contact 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>Service Provider Contact 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="AAA">
                <name>Service Provider Request Validation</name>
                <usage>S</usage>
                <pos>230</pos>
                <max_use>9</max_use>
                <element xid="AAA01">
                  <data_ele>1073</data_ele>
                  <name>Valid Request 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="AAA02">
                  <data_ele>559</data_ele>
                  <name>Agency Qualifier Code</name>
                  <usage>N</usage>
                  <seq>02</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="AAA03">
                  <data_ele>901</data_ele>
                  <name>Reject Reason Code</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>15</code>
                    <code>33</code>
                    <code>35</code>
                    <code>41</code>
                    <code>43</code>
                    <code>44</code>
                    <code>45</code>
                    <code>46</code>
                    <code>47</code>
                    <code>49</code>
                    <code>51</code>
                    <code>52</code>
                    <code>79</code>
                    <code>97</code>
                  </valid_codes>
                </element>
                <element xid="AAA04">
                  <data_ele>889</data_ele>
                  <name>Follow-up Action 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>C</code>
                    <code>N</code>
                  </valid_codes>
                </element>
              </segment>
<!--End of AAA segment-->
              <segment xid="PRV">
                <name>Service Provider Information</name>
                <usage>S</usage>
                <pos>240</pos>
                <max_use>1</max_use>
                <element xid="PRV01">
                  <data_ele>1221</data_ele>
                  <name>Provider 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>AD</code>
                    <code>AS</code>
                    <code>AT</code>
                    <code>CO</code>
                    <code>CV</code>
                    <code>OP</code>
                    <code>OR</code>
                    <code>OT</code>
                    <code>PC</code>
                    <code>PE</code>
                  </valid_codes>
                </element>
                <element xid="PRV02">
                  <data_ele>128</data_ele>
                  <name>Reference Identification 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>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="PRV03">
                  <data_ele>127</data_ele>
                  <name>Provider Taxonomy Code</name>
                  <usage>R</usage>
                  <seq>03</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
<!--<valid_codes external="prov_taxonomy"/>-->
                </element>
                <element xid="PRV04">
                  <data_ele>156</data_ele>
                  <name>State or Province Code</name>
                  <usage>N</usage>
                  <seq>04</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <composite>
                  <data_ele>C035</data_ele>
                  <name>Provider Specialty Information</name>
                  <usage>N</usage>
                  <seq>05</seq>
                </composite>
                <element xid="PRV06">
                  <data_ele>1223</data_ele>
                  <name>Provider Organization 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 PRV segment-->
            </loop>
<!--End of 2010E loop-->
          </loop>
<!--End of 2000E loop-->
          <loop xid="2000F">
            <name>Service Level</name>
            <usage>R</usage>
            <pos>180</pos>
            <count>&gt;1</count>
            <segment xid="HL">
              <name>Service Level</name>
              <usage>R</usage>
              <pos>010</pos>
              <max_use>1</max_use>
              <element xid="HL01">
                <data_ele>628</data_ele>
                <name>Hierarchical ID Number</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL02">
                <data_ele>734</data_ele>
                <name>Hierarchical Parent ID Number</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>12</max_len>
              </element>
              <element xid="HL03">
                <data_ele>735</data_ele>
                <name>Hierarchical Level Code</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>SS</code>
                </valid_codes>
              </element>
              <element xid="HL04">
                <data_ele>736</data_ele>
                <name>Hierarchical Child 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>0</code>
                </valid_codes>
              </element>
            </segment>
<!--End of HL segment-->
            <segment xid="TRN">
              <name>Service Trace Number</name>
              <usage>S</usage>
              <pos>020</pos>
              <max_use>3</max_use>
              <element xid="TRN01">
                <data_ele>481</data_ele>
                <name>Trace Type Code</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>1</code>
                  <code>2</code>
                </valid_codes>
              </element>
              <element xid="TRN02">
                <data_ele>127</data_ele>
                <name>Service Trace Number</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>30</max_len>
              </element>
              <element xid="TRN03">
                <data_ele>509</data_ele>
                <name>Trace Assigning Entity Identifier</name>
                <usage>R</usage>
                <seq>03</seq>
                <data_type>AN</data_type>
                <min_len>10</min_len>
                <max_len>10</max_len>
              </element>
              <element xid="TRN04">
                <data_ele>127</data_ele>
                <name>Trace Assigning Entity Additional Identifier</name>
                <usage>S</usage>
                <seq>04</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>30</max_len>
              </element>
            </segment>
<!--End of TRN segment-->
            <segment xid="AAA">
              <name>Service Request Validation</name>
              <usage>S</usage>
              <pos>030</pos>
              <max_use>9</max_use>
              <element xid="AAA01">
                <data_ele>1073</data_ele>
                <name>Valid Request 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="AAA02">
                <data_ele>559</data_ele>
                <name>Agency Qualifier Code</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="AAA03">
                <data_ele>901</data_ele>
                <name>Reject Reason Code</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>15</code>
                  <code>33</code>
                  <code>52</code>
                  <code>57</code>
                  <code>60</code>
                  <code>61</code>
                  <code>62</code>
                  <code>T5</code>
                </valid_codes>
              </element>
              <element xid="AAA04">
                <data_ele>889</data_ele>
                <name>Follow-up Action 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>C</code>
                  <code>N</code>
                </valid_codes>
              </element>
            </segment>
<!--End of AAA segment-->
            <segment xid="UM">
              <name>Health Care Services Review Information</name>
              <usage>R</usage>
              <pos>040</pos>
              <max_use>1</max_use>
              <element xid="UM01">
                <data_ele>1525</data_ele>
                <name>Request Category 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>AR</code>
                  <code>HS</code>
                  <code>SC</code>
                </valid_codes>
              </element>
              <element xid="UM02">
                <data_ele>1322</data_ele>
                <name>Certification 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>1</code>
                  <code>2</code>
                  <code>3</code>
                  <code>4</code>
                  <code>I</code>
                  <code>R</code>
                  <code>S</code>
                </valid_codes>
              </element>
              <element xid="UM03">
                <data_ele>1365</data_ele>
                <name>Service Type Code</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
                <valid_codes external="service_type"/>
              </element>
              <composite>
                <data_ele>C023</data_ele>
                <name>Health Care Service Location Information</name>
                <usage>S</usage>
                <seq>04</seq>
                <element xid="UM04-01">
                  <data_ele>1331</data_ele>
                  <name>Facility Type Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="UM04-02">
                  <data_ele>1332</data_ele>
                  <name>Facility Code Qualifier</name>
                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>A</code>
                    <code>B</code>
                  </valid_codes>
                </element>
                <element xid="UM04-03">
                  <data_ele>1325</data_ele>
                  <name>Claim Frequency Type Code</name>
                  <usage>N</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C024</data_ele>
                <name>Related Causes Information</name>
                <usage>N</usage>
                <seq>05</seq>
              </composite>
              <element xid="UM06">
                <data_ele>1338</data_ele>
                <name>Level of Service Code</name>
                <usage>S</usage>
                <seq>06</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>03</code>
                  <code>U</code>
                </valid_codes>
              </element>
              <element xid="UM07">
                <data_ele>1213</data_ele>
                <name>Current Health Condition Code</name>
                <usage>N</usage>
                <seq>07</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
              </element>
              <element xid="UM08">
                <data_ele>923</data_ele>
                <name>Prognosis 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="UM09">
                <data_ele>1363</data_ele>
                <name>Release of Information 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="UM10">
                <data_ele>1514</data_ele>
                <name>Delay Reason Code</name>
                <usage>N</usage>
                <seq>10</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
              </element>
            </segment>
<!--End of UM segment-->
            <segment xid="HCR">
              <name>Health Care Services Review</name>
              <usage>S</usage>
              <pos>050</pos>
              <max_use>1</max_use>
              <element xid="HCR01">
                <data_ele>306</data_ele>
                <name>Certification 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>A1</code>
                  <code>A3</code>
                  <code>A4</code>
                  <code>A6</code>
                  <code>CT</code>
                  <code>NA</code>
                </valid_codes>
              </element>
              <element xid="HCR02">
                <data_ele>127</data_ele>
                <name>Certification 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="HCR03">
                <data_ele>901</data_ele>
                <name>Reject Reason Code</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>35</code>
                  <code>36</code>
                  <code>37</code>
                  <code>41</code>
                  <code>53</code>
                  <code>69</code>
                  <code>70</code>
                  <code>82</code>
                  <code>83</code>
                  <code>84</code>
                  <code>85</code>
                  <code>86</code>
                  <code>87</code>
                  <code>88</code>
                  <code>89</code>
                  <code>90</code>
                  <code>91</code>
                  <code>92</code>
                  <code>96</code>
                  <code>98</code>
                  <code>E8</code>
                </valid_codes>
              </element>
              <element xid="HCR04">
                <data_ele>1073</data_ele>
                <name>Second Surgical Opinion Indicator</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>N</code>
                  <code>Y</code>
                </valid_codes>
              </element>
            </segment>
<!--End of HCR segment-->
            <segment xid="REF">
              <name>Previous Certification Identification</name>
              <usage>S</usage>
              <pos>060</pos>
              <max_use>1</max_use>
              <element xid="REF01">
                <data_ele>128</data_ele>
                <name>Reference Identification Qualifier</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>BB</code>
                </valid_codes>
              </element>
              <element xid="REF02">
                <data_ele>127</data_ele>
                <name>Previous Certification 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="DTP">
              <name>Service Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>472</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>
                  <code>RD8</code>
                </valid_codes>
              </element>
              <element xid="DTP03">
                <data_ele>1251</data_ele>
                <name>Proposed or Actual Service 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-->
            <segment xid="DTP">
              <name>Admission Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>435</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>
                  <code>RD8</code>
                </valid_codes>
              </element>
              <element xid="DTP03">
                <data_ele>1251</data_ele>
                <name>Proposed or Actual Admission 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-->
            <segment xid="DTP">
              <name>Discharge Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>096</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>Proposed or Actual Discharge 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-->
            <segment xid="DTP">
              <name>Surgery Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>456</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>Proposed or Actual Surgery 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-->
            <segment xid="DTP">
              <name>Certification Issue Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>102</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>Certification Issue 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-->
            <segment xid="DTP">
              <name>Certification Expiration Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>036</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>Certification Expiration 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-->
            <segment xid="DTP">
              <name>Certification Effective Date</name>
              <usage>S</usage>
              <pos>070</pos>
              <max_use>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>
                </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>
                  <code>RD8</code>
                </valid_codes>
              </element>
              <element xid="DTP03">
                <data_ele>1251</data_ele>
                <name>Certification 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-->
            <segment xid="HI">
              <name>Procedures</name>
              <usage>S</usage>
              <pos>080</pos>
              <max_use>1</max_use>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 1</name>
                <usage>R</usage>
                <seq>01</seq>
                <element xid="HI01-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI01-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI01-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI01-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI01-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI01-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI01-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 2</name>
                <usage>S</usage>
                <seq>02</seq>
                <element xid="HI02-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI02-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI02-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI02-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI02-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI02-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI02-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 3</name>
                <usage>S</usage>
                <seq>03</seq>
                <element xid="HI03-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI03-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI03-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI03-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI03-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI03-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI03-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 4</name>
                <usage>S</usage>
                <seq>04</seq>
                <element xid="HI04-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI04-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI04-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI04-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI04-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI04-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI04-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 5</name>
                <usage>S</usage>
                <seq>05</seq>
                <element xid="HI05-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI05-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI05-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI05-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI05-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI05-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI05-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 6</name>
                <usage>S</usage>
                <seq>06</seq>
                <element xid="HI06-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI06-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI06-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI06-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI06-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI06-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI06-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 7</name>
                <usage>S</usage>
                <seq>07</seq>
                <element xid="HI07-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI07-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI07-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI07-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI07-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI07-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI07-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 8</name>
                <usage>S</usage>
                <seq>08</seq>
                <element xid="HI08-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI08-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI08-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI08-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI08-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI08-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI08-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 9</name>
                <usage>S</usage>
                <seq>09</seq>
                <element xid="HI09-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI09-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI09-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI09-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI09-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI09-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI09-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 10</name>
                <usage>S</usage>
                <seq>10</seq>
                <element xid="HI10-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI10-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI10-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI10-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI10-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI10-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI10-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 11</name>
                <usage>S</usage>
                <seq>11</seq>
                <element xid="HI11-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI11-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI11-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI11-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI11-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI11-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI11-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
              <composite>
                <data_ele>C022</data_ele>
                <name>Procedure Code 12</name>
                <usage>S</usage>
                <seq>12</seq>
                <element xid="HI12-01">
                  <data_ele>1270</data_ele>
                  <name>Code List 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>BO</code>
                    <code>BQ</code>
                    <code>JP</code>
                    <code>NDC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
                <element xid="HI12-02">
                  <data_ele>1271</data_ele>
                  <name>Procedure 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="HI12-03">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>D8</code>
                    <code>RD8</code>
                  </valid_codes>
                </element>
                <element xid="HI12-04">
                  <data_ele>1251</data_ele>
                  <name>Procedure Date</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="HI12-05">
                  <data_ele>782</data_ele>
                  <name>Monetary Amount</name>
                  <usage>N</usage>
                  <seq>05</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>18</max_len>
                </element>
                <element xid="HI12-06">
                  <data_ele>380</data_ele>
                  <name>Procedure Quantity</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="HI12-07">
                  <data_ele>799</data_ele>
                  <name>Version, Release, or Industry Identifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
              </composite>
            </segment>
<!--End of HI segment-->
            <segment xid="HSD">
              <name>Health Care Services Delivery</name>
              <usage>S</usage>
              <pos>090</pos>
              <max_use>1</max_use>
              <element xid="HSD01">
                <data_ele>673</data_ele>
                <name>Quantity Qualifier</name>
                <usage>S</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>DY</code>
                  <code>FL</code>
                  <code>HS</code>
                  <code>MN</code>
                  <code>VS</code>
                </valid_codes>
              </element>
              <element xid="HSD02">
                <data_ele>380</data_ele>
                <name>Service Unit Count</name>
                <usage>S</usage>
                <seq>02</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="HSD03">
                <data_ele>355</data_ele>
                <name>Unit or Basis for Measurement Code</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>DA</code>
                  <code>MO</code>
                  <code>WK</code>
                </valid_codes>
              </element>
              <element xid="HSD04">
                <data_ele>1167</data_ele>
                <name>Sample Selection Modulus</name>
                <usage>S</usage>
                <seq>04</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>6</max_len>
              </element>
              <element xid="HSD05">
                <data_ele>615</data_ele>
                <name>Time Period 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>6</code>
                  <code>7</code>
                  <code>21</code>
                  <code>26</code>
                  <code>27</code>
                  <code>34</code>
                  <code>35</code>
                </valid_codes>
              </element>
              <element xid="HSD06">
                <data_ele>616</data_ele>
                <name>Period Count</name>
                <usage>S</usage>
                <seq>06</seq>
                <data_type>N0</data_type>
                <min_len>1</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="HSD07">
                <data_ele>678</data_ele>
                <name>Ship, Delivery or Calendar Pattern 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>
                  <code>9</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>J</code>
                  <code>K</code>
                  <code>L</code>
                  <code>M</code>
                  <code>N</code>
                  <code>O</code>
                  <code>P</code>
                  <code>Q</code>
                  <code>R</code>
                  <code>S</code>
                  <code>SA</code>
                  <code>SB</code>
                  <code>SC</code>
                  <code>SD</code>
                  <code>SG</code>
                  <code>SL</code>
                  <code>SP</code>
                  <code>SX</code>
                  <code>SY</code>
                  <code>SZ</code>
                  <code>T</code>
                  <code>U</code>
                  <code>V</code>
                  <code>W</code>
                  <code>X</code>
                  <code>Y</code>
                </valid_codes>
              </element>
              <element xid="HSD08">
                <data_ele>679</data_ele>
                <name>Delivery Pattern Time Code</name>
                <usage>S</usage>
                <seq>08</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>
                  <code>F</code>
                  <code>G</code>
                  <code>Y</code>
                </valid_codes>
              </element>
            </segment>
<!--End of HSD segment-->
            <segment xid="CL1">
              <name>Institutional Claim Code</name>
              <usage>S</usage>
              <pos>110</pos>
              <max_use>1</max_use>
              <element xid="CL101">
                <data_ele>1315</data_ele>
                <name>Admission Type Code</name>
                <usage>S</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
              </element>
              <element xid="CL102">
                <data_ele>1314</data_ele>
                <name>Admission Source Code</name>
                <usage>S</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
              </element>
              <element xid="CL103">
                <data_ele>1352</data_ele>
                <name>Patient Status Code</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="CL104">
                <data_ele>1345</data_ele>
                <name>Nursing Home Residential 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>1</code>
                  <code>2</code>
                  <code>3</code>
                  <code>4</code>
                  <code>5</code>
                  <code>6</code>
                  <code>7</code>
                  <code>8</code>
                  <code>9</code>
                </valid_codes>
              </element>
            </segment>
<!--End of CL1 segment-->
            <segment xid="CR1">
              <name>Ambulance Transport Information</name>
              <usage>S</usage>
              <pos>120</pos>
              <max_use>1</max_use>
              <element xid="CR101">
                <data_ele>355</data_ele>
                <name>Unit or Basis for Measurement Code</name>
                <usage>N</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="CR102">
                <data_ele>81</data_ele>
                <name>Weight</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>10</max_len>
              </element>
              <element xid="CR103">
                <data_ele>1316</data_ele>
                <name>Ambulance Transport 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>I</code>
                  <code>R</code>
                  <code>T</code>
                  <code>X</code>
                </valid_codes>
              </element>
              <element xid="CR104">
                <data_ele>1317</data_ele>
                <name>Ambulance Transport Reason 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="CR105">
                <data_ele>355</data_ele>
                <name>Unit or Basis for Measurement 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>DH</code>
                  <code>DK</code>
                </valid_codes>
              </element>
              <element xid="CR106">
                <data_ele>380</data_ele>
                <name>Transport Distance</name>
                <usage>S</usage>
                <seq>06</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="CR107">
                <data_ele>166</data_ele>
                <name>Ambulance Trip Origin Address</name>
                <usage>S</usage>
                <seq>07</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>55</max_len>
              </element>
              <element xid="CR108">
                <data_ele>166</data_ele>
                <name>Ambulance Trip Destination Address</name>
                <usage>S</usage>
                <seq>08</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>55</max_len>
              </element>
              <element xid="CR109">
                <data_ele>352</data_ele>
                <name>Description</name>
                <usage>N</usage>
                <seq>09</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="CR110">
                <data_ele>352</data_ele>
                <name>Description</name>
                <usage>N</usage>
                <seq>10</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
            </segment>
<!--End of CR1 segment-->
            <segment xid="CR2">
              <name>Spinal Manipulation Service Information</name>
              <usage>S</usage>
              <pos>130</pos>
              <max_use>1</max_use>
              <element xid="CR201">
                <data_ele>609</data_ele>
                <name>Treatment Series Number</name>
                <usage>S</usage>
                <seq>01</seq>
                <data_type>N0</data_type>
                <min_len>1</min_len>
                <max_len>9</max_len>
              </element>
              <element xid="CR202">
                <data_ele>380</data_ele>
                <name>Treatment Count</name>
                <usage>S</usage>
                <seq>02</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="CR203">
                <data_ele>1367</data_ele>
                <name>Subluxation Level Code</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>C1</code>
                  <code>C2</code>
                  <code>C3</code>
                  <code>C4</code>
                  <code>C5</code>
                  <code>C6</code>
                  <code>C7</code>
                  <code>CO</code>
                  <code>IL</code>
                  <code>L1</code>
                  <code>L2</code>
                  <code>L3</code>
                  <code>L4</code>
                  <code>L5</code>
                  <code>OC</code>
                  <code>SA</code>
                  <code>T1</code>
                  <code>T2</code>
                  <code>T3</code>
                  <code>T4</code>
                  <code>T5</code>
                  <code>T6</code>
                  <code>T7</code>
                  <code>T8</code>
                  <code>T9</code>
                  <code>T10</code>
                  <code>T11</code>
                  <code>T12</code>
                </valid_codes>
              </element>
              <element xid="CR204">
                <data_ele>1367</data_ele>
                <name>Subluxation Level 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>C1</code>
                  <code>C2</code>
                  <code>C3</code>
                  <code>C4</code>
                  <code>C5</code>
                  <code>C6</code>
                  <code>C7</code>
                  <code>CO</code>
                  <code>IL</code>
                  <code>L1</code>
                  <code>L2</code>
                  <code>L3</code>
                  <code>L4</code>
                  <code>L5</code>
                  <code>OC</code>
                  <code>SA</code>
                  <code>T1</code>
                  <code>T2</code>
                  <code>T3</code>
                  <code>T4</code>
                  <code>T5</code>
                  <code>T6</code>
                  <code>T7</code>
                  <code>T8</code>
                  <code>T9</code>
                  <code>T10</code>
                  <code>T11</code>
                  <code>T12</code>
                </valid_codes>
              </element>
              <element xid="CR205">
                <data_ele>355</data_ele>
                <name>Unit or Basis for Measurement 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>DA</code>
                  <code>MO</code>
                  <code>WK</code>
                  <code>YR</code>
                </valid_codes>
              </element>
              <element xid="CR206">
                <data_ele>380</data_ele>
                <name>Treatment Period Count</name>
                <usage>S</usage>
                <seq>06</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="CR207">
                <data_ele>380</data_ele>
                <name>Monthly Treatment Count</name>
                <usage>S</usage>
                <seq>07</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="CR208">
                <data_ele>1342</data_ele>
                <name>Nature of Condition 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="CR209">
                <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="CR210">
                <data_ele>352</data_ele>
                <name>Description</name>
                <usage>N</usage>
                <seq>10</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="CR211">
                <data_ele>352</data_ele>
                <name>Description</name>
                <usage>N</usage>
                <seq>11</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="CR212">
                <data_ele>1073</data_ele>
                <name>Yes/No Condition or Response Code</name>
                <usage>N</usage>
                <seq>12</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
              </element>
            </segment>
<!--End of CR2 segment-->
            <segment xid="CR5">
              <name>Home Oxygen Therapy Information</name>
              <usage>S</usage>
              <pos>140</pos>
              <max_use>1</max_use>
              <element xid="CR501">
                <data_ele>1322</data_ele>
                <name>Certification Type Code</name>
                <usage>N</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
              </element>
              <element xid="CR502">
                <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="CR503">
                <data_ele>1348</data_ele>
                <name>Oxygen Equipment Type Code</name>
                <usage>S</usage>
                <seq>03</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>
                  <code>O</code>
                </valid_codes>
              </element>
              <element xid="CR504">
                <data_ele>1348</data_ele>
                <name>Oxygen Equipment Type 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>A</code>
                  <code>B</code>
                  <code>C</code>
                  <code>D</code>
                  <code>E</code>
                  <code>O</code>
                </valid_codes>
              </element>
              <element xid="CR505">
                <data_ele>352</data_ele>
                <name>Equipment Reason Description</name>
                <usage>S</usage>
                <seq>05</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="CR506">
                <data_ele>380</data_ele>
                <name>Oxygen Flow Rate</name>
                <usage>R</usage>
                <seq>06</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="CR507">
                <data_ele>380</data_ele>
                <name>Daily Oxygen Use Count</name>
                <usage>S</usage>
                <seq>07</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="CR508">
                <data_ele>380</data_ele>
                <name>Oxygen Use Period Hour Count</name>
                <usage>S</usage>
                <seq>08</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="CR509">
                <data_ele>352</data_ele>
                <name>Respiratory Therapist Order Text</name>
                <usage>S</usage>
                <seq>09</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="CR510">
                <data_ele>380</data_ele>
                <name>Quantity</name>
                <usage>N</usage>
                <seq>10</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="CR511">
                <data_ele>380</data_ele>
                <name>Quantity</name>
                <usage>N</usage>
                <seq>11</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="CR512">
                <data_ele>1349</data_ele>
                <name>Oxygen Test Condition Code</name>
                <usage>N</usage>
                <seq>12</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
              </element>
              <element xid="CR513">
                <data_ele>1350</data_ele>
                <name>Oxygen Test Findings 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="CR514">
                <data_ele>1350</data_ele>
                <name>Oxygen Test Findings Code</name>
                <usage>N</usage>
                <seq>14</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
              </element>
              <element xid="CR515">
                <data_ele>1350</data_ele>
                <name>Oxygen Test Findings Code</name>
                <usage>N</usage>
                <seq>15</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
              </element>
              <element xid="CR516">
                <data_ele>380</data_ele>
                <name>Portable Oxygen System Flow Rate</name>
                <usage>S</usage>
                <seq>16</seq>
                <data_type>R</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="CR517">
                <data_ele>1382</data_ele>
                <name>Oxygen Delivery System Code</name>
                <usage>R</usage>
                <seq>17</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="CR518">
                <data_ele>1348</data_ele>
                <name>Oxygen Equipment Type Code</name>
                <usage>S</usage>
                <seq>18</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>
                  <code>O</code>
                </valid_codes>
              </element>
            </segment>
<!--End of CR5 segment-->
            <segment xid="CR6">
              <name>Home Health Care Information</name>
              <usage>S</usage>
              <pos>150</pos>
              <max_use>1</max_use>
              <element xid="CR601">
                <data_ele>923</data_ele>
                <name>Prognosis 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>5</code>
                  <code>6</code>
                  <code>7</code>
                  <code>8</code>
                </valid_codes>
              </element>
              <element xid="CR602">
                <data_ele>373</data_ele>
                <name>Service From Date</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
                <valid_codes>
                  <code/>
                </valid_codes>
              </element>
              <element xid="CR603">
                <data_ele>1250</data_ele>
                <name>Date Time Period Format Qualifier</name>
                <usage>S</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>RD8</code>
                </valid_codes>
              </element>
              <element xid="CR604">
                <data_ele>1251</data_ele>
                <name>Home Health Certification Period</name>
                <usage>S</usage>
                <seq>04</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>35</max_len>
              </element>
              <element xid="CR605">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>05</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CR606">
                <data_ele>1073</data_ele>
                <name>Yes/No Condition or Response 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="CR607">
                <data_ele>1073</data_ele>
                <name>Medicare Coverage Indicator</name>
                <usage>R</usage>
                <seq>07</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
                <valid_codes>
                  <code>N</code>
                  <code>U</code>
                  <code>Y</code>
                </valid_codes>
              </element>
              <element xid="CR608">
                <data_ele>1322</data_ele>
                <name>Certification Type Code</name>
                <usage>R</usage>
                <seq>08</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>I</code>
                  <code>R</code>
                  <code>S</code>
                </valid_codes>
              </element>
              <element xid="CR609">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>09</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CR610">
                <data_ele>235</data_ele>
                <name>Product/Service ID Qualifier</name>
                <usage>N</usage>
                <seq>10</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="CR611">
                <data_ele>1137</data_ele>
                <name>Medical Code Value</name>
                <usage>N</usage>
                <seq>11</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>15</max_len>
              </element>
              <element xid="CR612">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>12</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CR613">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>13</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CR614">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>14</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CR615">
                <data_ele>1250</data_ele>
                <name>Date Time Period Format Qualifier</name>
                <usage>N</usage>
                <seq>15</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="CR616">
                <data_ele>1251</data_ele>
                <name>Date Time Period</name>
                <usage>N</usage>
                <seq>16</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>35</max_len>
              </element>
              <element xid="CR617">
                <data_ele>1384</data_ele>
                <name>Patient Location Code</name>
                <usage>N</usage>
                <seq>17</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
              </element>
              <element xid="CR618">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>18</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CR619">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>19</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CR620">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>20</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CR621">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>21</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
            </segment>
<!--End of CR6 segment-->
            <segment xid="MSG">
              <name>Message Text</name>
              <usage>S</usage>
              <pos>160</pos>
              <max_use>1</max_use>
              <element xid="MSG01">
                <data_ele>933</data_ele>
                <name>Free Form Message Text</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>264</max_len>
              </element>
              <element xid="MSG02">
                <data_ele>934</data_ele>
                <name>Printer Carriage Control Code</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
              </element>
              <element xid="MSG03">
                <data_ele>1470</data_ele>
                <name>Number</name>
                <usage>N</usage>
                <seq>03</seq>
                <data_type>N0</data_type>
                <min_len>1</min_len>
                <max_len>9</max_len>
              </element>
            </segment>
<!--End of MSG segment-->
          </loop>
<!--End of 2000F 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>280</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>
