<?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: 837.4010.X098.xml,v 1.12 2005/07/12 17:34:09 johnholland Exp $
-->
<transaction>
  <id>837</id>
  <name>HIPAA Health Care Claim: Professional X098-837</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>
      </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>
      </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>HC</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>
        </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>004010X098</code>
          </valid_codes>
        </element>
      </segment>
<!--End of GS segment-->
      <loop xid="ST_LOOP" type="explicit">
        <name>Transaction Set Header</name>
        <usage>R</usage>
        <pos>020</pos>
        <repeat>&gt;1</repeat>
        <segment xid="ST">
          <name>Transaction Set Header</name>
          <usage>R</usage>
          <pos>005</pos>
          <max_use>1</max_use>
          <element xid="ST01">
            <data_ele>143</data_ele>
            <name>Transaction Set Identifier Code</name>
            <usage>R</usage>
            <seq>01</seq>
            <data_type>ID</data_type>
            <min_len>3</min_len>
            <max_len>3</max_len>
            <valid_codes>
              <code>837</code>
            </valid_codes>
          </element>
          <element xid="ST02">
            <data_ele>329</data_ele>
            <name>Transaction Set Control Number</name>
            <usage>R</usage>
            <seq>02</seq>
            <data_type>AN</data_type>
            <min_len>4</min_len>
            <max_len>9</max_len>
          </element>
        </segment>
<!--End of ST segment-->
        <loop xid="HEADER" type="wrapper">
          <name>Table 1 - Header</name>
          <usage>R</usage>
          <pos>010</pos>
          <repeat>1</repeat>
          <segment xid="BHT">
            <name>Beginning of Hierarchical Transaction</name>
            <usage>R</usage>
            <pos>010</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>0019</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>00</code>
                <code>18</code>
              </valid_codes>
            </element>
            <element xid="BHT03">
              <data_ele>127</data_ele>
              <name>Originator Application 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>
            </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>Claim or Encounter Identifier</name>
              <usage>R</usage>
              <seq>06</seq>
              <data_type>ID</data_type>
              <min_len>2</min_len>
              <max_len>2</max_len>
              <valid_codes>
                <code>CH</code>
                <code>RP</code>
              </valid_codes>
            </element>
          </segment>
<!--End of BHT segment-->
          <segment xid="REF">
            <name>Transmission Type Identification</name>
            <usage>R</usage>
            <pos>015</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>87</code>
              </valid_codes>
            </element>
            <element xid="REF02">
              <data_ele>127</data_ele>
              <name>Transmission Type 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="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-->
          <loop xid="1000A">
            <name>Submitter Name</name>
            <usage>R</usage>
            <pos>020</pos>
            <count>1</count>
            <segment xid="NM1">
              <name>Submitter Name</name>
              <usage>R</usage>
              <pos>020</pos>
              <max_use>1</max_use>
              <element xid="NM101">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>41</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>Submitter Last or Organization Name</name>
                <usage>R</usage>
                <seq>03</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>35</max_len>
              </element>
              <element xid="NM104">
                <data_ele>1036</data_ele>
                <name>Submitter 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>Submitter 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>Name Suffix</name>
                <usage>N</usage>
                <seq>07</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>10</max_len>
              </element>
              <element xid="NM108">
                <data_ele>66</data_ele>
                <name>Identification Code Qualifier</name>
                <usage>R</usage>
                <seq>08</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>46</code>
                </valid_codes>
              </element>
              <element xid="NM109">
                <data_ele>67</data_ele>
                <name>Submitter 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="N2">
              <name>Additional Submitter Name Information</name>
              <usage>S</usage>
              <pos>025</pos>
              <max_use>1</max_use>
              <element xid="N201">
                <data_ele>93</data_ele>
                <name>Additional Submitter Name</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
              <element xid="N202">
                <data_ele>93</data_ele>
                <name>Name</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
            </segment>
<!--End of N2 segment-->
            <segment xid="PER">
              <name>Submitter EDI Contact Information</name>
              <usage>R</usage>
              <pos>045</pos>
              <max_use>2</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>Submitter Contact Name</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
              <element xid="PER03">
                <data_ele>365</data_ele>
                <name>Communication Number Qualifier</name>
                <usage>R</usage>
                <seq>03</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>ED</code>
                  <code>EM</code>
                  <code>FX</code>
                  <code>TE</code>
                </valid_codes>
              </element>
              <element xid="PER04">
                <data_ele>364</data_ele>
                <name>Communication Number</name>
                <usage>R</usage>
                <seq>04</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="PER05">
                <data_ele>365</data_ele>
                <name>Communication Number Qualifier</name>
                <usage>S</usage>
                <seq>05</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>ED</code>
                  <code>EM</code>
                  <code>EX</code>
                  <code>FX</code>
                  <code>TE</code>
                </valid_codes>
              </element>
              <element xid="PER06">
                <data_ele>364</data_ele>
                <name>Communication Number</name>
                <usage>S</usage>
                <seq>06</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="PER07">
                <data_ele>365</data_ele>
                <name>Communication Number Qualifier</name>
                <usage>S</usage>
                <seq>07</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>ED</code>
                  <code>EM</code>
                  <code>EX</code>
                  <code>FX</code>
                  <code>TE</code>
                </valid_codes>
              </element>
              <element xid="PER08">
                <data_ele>364</data_ele>
                <name>Communication Number</name>
                <usage>S</usage>
                <seq>08</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>80</max_len>
              </element>
              <element xid="PER09">
                <data_ele>443</data_ele>
                <name>Contact Inquiry Reference</name>
                <usage>N</usage>
                <seq>09</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>20</max_len>
              </element>
            </segment>
<!--End of PER segment-->
          </loop>
<!--End of 1000A loop-->
          <loop xid="1000B">
            <name>Receiver Name</name>
            <usage>R</usage>
            <pos>020</pos>
            <count>1</count>
            <segment xid="NM1">
              <name>Receiver Name</name>
              <usage>R</usage>
              <pos>020</pos>
              <max_use>1</max_use>
              <element xid="NM101">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>40</code>
                </valid_codes>
              </element>
              <element xid="NM102">
                <data_ele>1065</data_ele>
                <name>Entity Type Qualifier</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>1</max_len>
                <valid_codes>
                  <code>2</code>
                </valid_codes>
              </element>
              <element xid="NM103">
                <data_ele>1035</data_ele>
                <name>Receiver Name</name>
                <usage>R</usage>
                <seq>03</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>35</max_len>
              </element>
              <element xid="NM104">
                <data_ele>1036</data_ele>
                <name>Name First</name>
                <usage>N</usage>
                <seq>04</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>25</max_len>
              </element>
              <element xid="NM105">
                <data_ele>1037</data_ele>
                <name>Name Middle</name>
                <usage>N</usage>
                <seq>05</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>25</max_len>
              </element>
              <element xid="NM106">
                <data_ele>1038</data_ele>
                <name>Name Prefix</name>
                <usage>N</usage>
                <seq>06</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>10</max_len>
              </element>
              <element xid="NM107">
                <data_ele>1039</data_ele>
                <name>Name Suffix</name>
                <usage>N</usage>
                <seq>07</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>10</max_len>
              </element>
              <element xid="NM108">
                <data_ele>66</data_ele>
                <name>Identification Code Qualifier</name>
                <usage>R</usage>
                <seq>08</seq>
                <data_type>ID</data_type>
                <min_len>1</min_len>
                <max_len>2</max_len>
                <valid_codes>
                  <code>46</code>
                </valid_codes>
              </element>
              <element xid="NM109">
                <data_ele>67</data_ele>
                <name>Receiver 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="N2">
              <name>Receiver Additional Name Information</name>
              <usage>S</usage>
              <pos>025</pos>
              <max_use>1</max_use>
              <element xid="N201">
                <data_ele>93</data_ele>
                <name>Receiver Additional Name</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
              <element xid="N202">
                <data_ele>93</data_ele>
                <name>Name</name>
                <usage>N</usage>
                <seq>02</seq>
                <data_type>AN</data_type>
                <min_len>1</min_len>
                <max_len>60</max_len>
              </element>
            </segment>
<!--End of N2 segment-->
          </loop>
<!--End of 1000B loop-->
        </loop>
<!--End of HEADER loop-->
        <loop xid="DETAIL" type="wrapper">
          <name>Table 2 - Detail</name>
          <usage>S</usage>
          <pos>020</pos>
          <repeat>&gt;1</repeat>
          <loop xid="2000A">
            <name>Billing/Pay-To Provider Hierarchical Level</name>
            <usage>R</usage>
            <pos>001</pos>
            <count>&gt;1</count>
            <segment xid="HL">
              <name>Billing/Pay-To Provider Hierarchical Level</name>
              <usage>R</usage>
              <pos>001</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="PRV">
              <name>Billing/Pay-To Provider Specialty Information</name>
              <usage>S</usage>
              <pos>003</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>BI</code>
                  <code>PT</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-->
            <segment xid="CUR">
              <name>Foreign Currency Information</name>
              <usage>S</usage>
              <pos>010</pos>
              <max_use>1</max_use>
              <element xid="CUR01">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>R</usage>
                <seq>01</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
                <valid_codes>
                  <code>85</code>
                </valid_codes>
              </element>
              <element xid="CUR02">
                <data_ele>100</data_ele>
                <name>Currency Code</name>
                <usage>R</usage>
                <seq>02</seq>
                <data_type>ID</data_type>
                <min_len>3</min_len>
                <max_len>3</max_len>
                <valid_codes external="currency"/>
              </element>
              <element xid="CUR03">
                <data_ele>280</data_ele>
                <name>Exchange Rate</name>
                <usage>N</usage>
                <seq>03</seq>
                <data_type>R</data_type>
                <min_len>4</min_len>
                <max_len>10</max_len>
              </element>
              <element xid="CUR04">
                <data_ele>98</data_ele>
                <name>Entity Identifier Code</name>
                <usage>N</usage>
                <seq>04</seq>
                <data_type>ID</data_type>
                <min_len>2</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="CUR05">
                <data_ele>100</data_ele>
                <name>Currency Code</name>
                <usage>N</usage>
                <seq>05</seq>
                <data_type>ID</data_type>
                <min_len>3</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="CUR06">
                <data_ele>669</data_ele>
                <name>Currency Market/Exchange Code</name>
                <usage>N</usage>
                <seq>06</seq>
                <data_type>ID</data_type>
                <min_len>3</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="CUR07">
                <data_ele>374</data_ele>
                <name>Date/Time Qualifier</name>
                <usage>N</usage>
                <seq>07</seq>
                <data_type>ID</data_type>
                <min_len>3</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="CUR08">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>08</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CUR09">
                <data_ele>337</data_ele>
                <name>Time</name>
                <usage>N</usage>
                <seq>09</seq>
                <data_type>TM</data_type>
                <min_len>4</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CUR10">
                <data_ele>374</data_ele>
                <name>Date/Time Qualifier</name>
                <usage>N</usage>
                <seq>10</seq>
                <data_type>ID</data_type>
                <min_len>3</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="CUR11">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>11</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CUR12">
                <data_ele>337</data_ele>
                <name>Time</name>
                <usage>N</usage>
                <seq>12</seq>
                <data_type>TM</data_type>
                <min_len>4</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CUR13">
                <data_ele>374</data_ele>
                <name>Date/Time Qualifier</name>
                <usage>N</usage>
                <seq>13</seq>
                <data_type>ID</data_type>
                <min_len>3</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="CUR14">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>14</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CUR15">
                <data_ele>337</data_ele>
                <name>Time</name>
                <usage>N</usage>
                <seq>15</seq>
                <data_type>TM</data_type>
                <min_len>4</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CUR16">
                <data_ele>374</data_ele>
                <name>Date/Time Qualifier</name>
                <usage>N</usage>
                <seq>16</seq>
                <data_type>ID</data_type>
                <min_len>3</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="CUR17">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>17</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CUR18">
                <data_ele>337</data_ele>
                <name>Time</name>
                <usage>N</usage>
                <seq>18</seq>
                <data_type>TM</data_type>
                <min_len>4</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CUR19">
                <data_ele>374</data_ele>
                <name>Date/Time Qualifier</name>
                <usage>N</usage>
                <seq>19</seq>
                <data_type>ID</data_type>
                <min_len>3</min_len>
                <max_len>3</max_len>
              </element>
              <element xid="CUR20">
                <data_ele>373</data_ele>
                <name>Date</name>
                <usage>N</usage>
                <seq>20</seq>
                <data_type>DT</data_type>
                <min_len>8</min_len>
                <max_len>8</max_len>
              </element>
              <element xid="CUR21">
                <data_ele>337</data_ele>
                <name>Time</name>
                <usage>N</usage>
                <seq>21</seq>
                <data_type>TM</data_type>
                <min_len>4</min_len>
                <max_len>8</max_len>
              </element>
            </segment>
<!--End of CUR segment-->
            <loop xid="2010AA">
              <name>Billing Provider Name</name>
              <usage>R</usage>
              <pos>015</pos>
              <count>1</count>
              <segment xid="NM1">
                <name>Billing Provider Name</name>
                <usage>R</usage>
                <pos>015</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>85</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>Billing Provider Last or Organizational Name</name>
                  <usage>R</usage>
                  <seq>03</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="NM104">
                  <data_ele>1036</data_ele>
                  <name>Billing 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>Billing 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>Billing 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>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>XX</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Billing Provider 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="N2">
                <name>Additional Billing Provider Name Information</name>
                <usage>S</usage>
                <pos>020</pos>
                <max_use>1</max_use>
                <element xid="N201">
                  <data_ele>93</data_ele>
                  <name>Billing Provider Additional Name</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>60</max_len>
                </element>
                <element xid="N202">
                  <data_ele>93</data_ele>
                  <name>Name</name>
                  <usage>N</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>60</max_len>
                </element>
              </segment>
<!--End of N2 segment-->
              <segment xid="N3">
                <name>Billing Provider Address</name>
                <usage>R</usage>
                <pos>025</pos>
                <max_use>1</max_use>
                <element xid="N301">
                  <data_ele>166</data_ele>
                  <name>Billing 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>Billing 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>Billing Provider City/State/ZIP Code</name>
                <usage>R</usage>
                <pos>030</pos>
                <max_use>1</max_use>
                <element xid="N401">
                  <data_ele>19</data_ele>
                  <name>Billing Provider City Name</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>AN</data_type>
                  <min_len>2</min_len>
                  <max_len>30</max_len>
                </element>
                <element xid="N402">
                  <data_ele>156</data_ele>
                  <name>Billing Provider State or Province Code</name>
                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes external="states"/>
                </element>
                <element xid="N403">
                  <data_ele>116</data_ele>
                  <name>Billing Provider Postal Zone or ZIP Code</name>
                  <usage>R</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>3</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="N404">
                  <data_ele>26</data_ele>
                  <name>Billing 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="REF">
                <name>Billing Provider Secondary Identification</name>
                <usage>S</usage>
                <pos>035</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>0B</code>
                    <code>1A</code>
                    <code>1B</code>
                    <code>1C</code>
                    <code>1D</code>
                    <code>1G</code>
                    <code>1H</code>
                    <code>1J</code>
                    <code>B3</code>
                    <code>BQ</code>
                    <code>EI</code>
                    <code>FH</code>
                    <code>G2</code>
                    <code>G5</code>
                    <code>LU</code>
                    <code>SY</code>
                    <code>U3</code>
                    <code>X5</code>
                  </valid_codes>
                </element>
                <element xid="REF02">
                  <data_ele>127</data_ele>
                  <name>Billing Provider Additional Identifier</name>
                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
                <element xid="REF03">
                  <data_ele>352</data_ele>
                  <name>Description</name>
                  <usage>N</usage>
                  <seq>03</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>80</max_len>
                </element>
                <composite>
                  <data_ele>C040</data_ele>
                  <name>Reference Identifier</name>
                  <usage>N</usage>
                  <seq>04</seq>
                </composite>
              </segment>
<!--End of REF segment-->
              <segment xid="REF">
                <name>Credit/Debit Card Billing Information</name>
                <usage>S</usage>
                <pos>035</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>06</code>
                    <code>8U</code>
                    <code>EM</code>
                    <code>IJ</code>
                    <code>LU</code>
                    <code>RB</code>
                    <code>ST</code>
                    <code>TT</code>
                  </valid_codes>
                </element>
                <element xid="REF02">
                  <data_ele>127</data_ele>
                  <name>Billing Provider Credit Card 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="PER">
                <name>Billing Provider Contact Information</name>
                <usage>S</usage>
                <pos>040</pos>
                <max_use>2</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>Billing Provider Contact Name</name>
                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>60</max_len>
                </element>
                <element xid="PER03">
                  <data_ele>365</data_ele>
                  <name>Communication Number Qualifier</name>
                  <usage>R</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>EM</code>
                    <code>FX</code>
                    <code>TE</code>
                  </valid_codes>
                </element>
                <element xid="PER04">
                  <data_ele>364</data_ele>
                  <name>Communication Number</name>
                  <usage>R</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>80</max_len>
                </element>
                <element xid="PER05">
                  <data_ele>365</data_ele>
                  <name>Communication Number Qualifier</name>
                  <usage>S</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>EM</code>
                    <code>EX</code>
                    <code>FX</code>
                    <code>TE</code>
                  </valid_codes>
                </element>
                <element xid="PER06">
                  <data_ele>364</data_ele>
                  <name>Communication Number</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>80</max_len>
                </element>
                <element xid="PER07">
                  <data_ele>365</data_ele>
                  <name>Communication Number Qualifier</name>
                  <usage>S</usage>
                  <seq>07</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>EM</code>
                    <code>EX</code>
                    <code>FX</code>
                    <code>TE</code>
                  </valid_codes>
                </element>
                <element xid="PER08">
                  <data_ele>364</data_ele>
                  <name>Communication Number</name>
                  <usage>S</usage>
                  <seq>08</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>80</max_len>
                </element>
                <element xid="PER09">
                  <data_ele>443</data_ele>
                  <name>Contact Inquiry Reference</name>
                  <usage>N</usage>
                  <seq>09</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>20</max_len>
                </element>
              </segment>
<!--End of PER segment-->
            </loop>
<!--End of 2010AA loop-->
            <loop xid="2010AB">
              <name>Pay-To Provider Name</name>
              <usage>S</usage>
              <pos>015</pos>
              <count>1</count>
              <segment xid="NM1">
                <name>Pay-To Provider Name</name>
                <usage>S</usage>
                <pos>015</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>87</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>Pay-To Provider Last or Organizational Name</name>
                  <usage>R</usage>
                  <seq>03</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="NM104">
                  <data_ele>1036</data_ele>
                  <name>Pay-To 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>Pay-To 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>Pay-To 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>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>XX</code>
                  </valid_codes>
                </element>
                <element xid="NM109">
                  <data_ele>67</data_ele>
                  <name>Pay-To Provider 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="N2">
                <name>Additional Pay-To Provider Name Information</name>
                <usage>S</usage>
                <pos>020</pos>
                <max_use>1</max_use>
                <element xid="N201">
                  <data_ele>93</data_ele>
                  <name>Pay-To Provider Additional Name</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>60</max_len>
                </element>
                <element xid="N202">
                  <data_ele>93</data_ele>
                  <name>Name</name>
                  <usage>N</usage>
                  <seq>02</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>60</max_len>
                </element>
              </segment>
<!--End of N2 segment-->
              <segment xid="N3">
                <name>Pay-To Provider Address</name>
                <usage>R</usage>
                <pos>025</pos>
                <max_use>1</max_use>
                <element xid="N301">
                  <data_ele>166</data_ele>
                  <name>Pay-To 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>Pay-To 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>Pay-To Provider City/State/ZIP Code</name>
                <usage>R</usage>
                <pos>030</pos>
                <max_use>1</max_use>
                <element xid="N401">
                  <data_ele>19</data_ele>
                  <name>Pay-To Provider City Name</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>AN</data_type>
                  <min_len>2</min_len>
                  <max_len>30</max_len>
                </element>
                <element xid="N402">
                  <data_ele>156</data_ele>
                  <name>Pay-To Provider State Code</name>
                  <usage>R</usage>
                  <seq>02</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                  <valid_codes external="states"/>
                </element>
                <element xid="N403">
                  <data_ele>116</data_ele>
                  <name>Pay-To Provider Postal Zone or ZIP Code</name>
                  <usage>R</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>3</min_len>
                  <max_len>15</max_len>
                </element>
                <element xid="N404">
                  <data_ele>26</data_ele>
                  <name>Pay-To 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="REF">
                <name>Pay-To Provider Secondary Identification</name>
                <usage>S</usage>
                <pos>035</pos>
                <max_use>5</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>0B</code>
                    <code>1A</code>
                    <code>1B</code>
                    <code>1C</code>
                    <code>1D</code>
                    <code>1G</code>
                    <code>1H</code>
                    <code>1J</code>
                    <code>B3</code>
                    <code>BQ</code>
                    <code>EI</code>
                    <code>FH</code>
                    <code>G2</code>
                    <code>G5</code>
                    <code>LU</code>
                    <code>SY</code>
                    <code>U3</code>
                    <code>X5</code>
                  </valid_codes>
                </element>
                <element xid="REF02">
                  <data_ele>127</data_ele>
                  <name>Pay-To Provider 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-->
            </loop>
<!--End of 2010AB loop-->
            <loop xid="2000B">
              <name>Subscriber Hierarchical Level</name>
              <usage>R</usage>
              <pos>020</pos>
              <count>&gt;1</count>
              <segment xid="HL">
                <name>Subscriber Hierarchical Level</name>
                <usage>R</usage>
                <pos>001</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>0</code>
                    <code>1</code>
                  </valid_codes>
                </element>
              </segment>
<!--End of HL segment-->
              <segment xid="SBR">
                <name>Subscriber Information</name>
                <usage>R</usage>
                <pos>005</pos>
                <max_use>1</max_use>
                <element xid="SBR01">
                  <data_ele>1138</data_ele>
                  <name>Payer Responsibility Sequence Number Code</name>
                  <usage>R</usage>
                  <seq>01</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                  <valid_codes>
                    <code>P</code>
                    <code>S</code>
                    <code>T</code>
                  </valid_codes>
                </element>
                <element xid="SBR02">
                  <data_ele>1069</data_ele>
                  <name>Relationship 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>
                    <code>18</code>
                  </valid_codes>
                </element>
                <element xid="SBR03">
                  <data_ele>127</data_ele>
                  <name>Insured Group or Policy Number</name>
                  <usage>S</usage>
                  <seq>03</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>30</max_len>
                </element>
                <element xid="SBR04">
                  <data_ele>93</data_ele>
                  <name>Insured Group Name</name>
                  <usage>S</usage>
                  <seq>04</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>60</max_len>
                </element>
                <element xid="SBR05">
                  <data_ele>1336</data_ele>
                  <name>Insurance Type Code</name>
                  <usage>S</usage>
                  <seq>05</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>3</max_len>
                  <valid_codes>
                    <code>12</code>
                    <code>13</code>
                    <code>14</code>
                    <code>15</code>
                    <code>16</code>
                    <code>41</code>
                    <code>42</code>
                    <code>43</code>
                    <code>47</code>
                  </valid_codes>
                </element>
                <element xid="SBR06">
                  <data_ele>1143</data_ele>
                  <name>Coordination of Benefits 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="SBR07">
                  <data_ele>1073</data_ele>
                  <name>Yes/No Condition or Response 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="SBR08">
                  <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="SBR09">
                  <data_ele>1032</data_ele>
                  <name>Claim Filing Indicator Code</name>
                  <usage>S</usage>
                  <seq>09</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>2</max_len>
                  <valid_codes>
                    <code>09</code>
                    <code>10</code>
                    <code>11</code>
                    <code>12</code>
                    <code>13</code>
                    <code>14</code>
                    <code>15</code>
                    <code>16</code>
                    <code>AM</code>
                    <code>BL</code>
                    <code>CH</code>
                    <code>CI</code>
                    <code>DS</code>
                    <code>HM</code>
                    <code>LI</code>
                    <code>LM</code>
                    <code>MB</code>
                    <code>MC</code>
                    <code>OF</code>
                    <code>TV</code>
                    <code>VA</code>
                    <code>WC</code>
                    <code>ZZ</code>
                  </valid_codes>
                </element>
              </segment>
<!--End of SBR segment-->
              <segment xid="PAT">
                <name>Patient Information</name>
                <usage>S</usage>
                <pos>007</pos>
                <max_use>1</max_use>
                <element xid="PAT01">
                  <data_ele>1069</data_ele>
                  <name>Individual Relationship 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="PAT02">
                  <data_ele>1384</data_ele>
                  <name>Patient Location Code</name>
                  <usage>N</usage>
                  <seq>02</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                </element>
                <element xid="PAT03">
                  <data_ele>584</data_ele>
                  <name>Employment Status Code</name>
                  <usage>N</usage>
                  <seq>03</seq>
                  <data_type>ID</data_type>
                  <min_len>2</min_len>
                  <max_len>2</max_len>
                </element>
                <element xid="PAT04">
                  <data_ele>1220</data_ele>
                  <name>Student 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="PAT05">
                  <data_ele>1250</data_ele>
                  <name>Date Time Period Format Qualifier</name>
                  <usage>S</usage>
                  <seq>05</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="PAT06">
                  <data_ele>1251</data_ele>
                  <name>Insured Individual Death Date</name>
                  <usage>S</usage>
                  <seq>06</seq>
                  <data_type>AN</data_type>
                  <min_len>1</min_len>
                  <max_len>35</max_len>
                </element>
                <element xid="PAT07">
                  <data_ele>355</data_ele>
                  <name>Unit or Basis for Measurement Code</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>GR</code>
                  </valid_codes>
                </element>
                <element xid="PAT08">
                  <data_ele>81</data_ele>
                  <name>Patient Weight</name>
                  <usage>S</usage>
                  <seq>08</seq>
                  <data_type>R</data_type>
                  <min_len>1</min_len>
                  <max_len>10</max_len>
                </element>
                <element xid="PAT09">
                  <data_ele>1073</data_ele>
                  <name>Pregnancy Indicator</name>
                  <usage>S</usage>
                  <seq>09</seq>
                  <data_type>ID</data_type>
                  <min_len>1</min_len>
                  <max_len>1</max_len>
                  <valid_codes>
                    <code>Y</code>
                  </valid_codes>
                </element>
              </segment>
<!--End of PAT segment-->
              <loop xid="2010BA">
                <name>Subscriber Name</name>
                <usage>R</usage>
                <pos>015</pos>
                <count>1</count>
                <segment xid="NM1">
                  <name>Subscriber Name</name>
                  <usage>R</usage>
                  <pos>015</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>
                      <code>2</code>
                    </valid_codes>
                  </element>
                  <element xid="NM103">
                    <data_ele>1035</data_ele>
                    <name>Subscriber Last Name</name>
                    <usage>R</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>35</max_len>
                  </element>
                  <element xid="NM104">
                    <data_ele>1036</data_ele>
                    <name>Subscriber First Name</name>
                    <usage>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>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>Subscriber 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="N2">
                  <name>Additional Subscriber Name Information</name>
                  <usage>S</usage>
                  <pos>020</pos>
                  <max_use>1</max_use>
                  <element xid="N201">
                    <data_ele>93</data_ele>
                    <name>Subscriber Supplemental Description</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>60</max_len>
                  </element>
                  <element xid="N202">
                    <data_ele>93</data_ele>
                    <name>Name</name>
                    <usage>N</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>60</max_len>
                  </element>
                </segment>
<!--End of N2 segment-->
                <segment xid="N3">
                  <name>Subscriber Address</name>
                  <usage>S</usage>
                  <pos>025</pos>
                  <max_use>1</max_use>
                  <element xid="N301">
                    <data_ele>166</data_ele>
                    <name>Subscriber 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>Subscriber 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>Subscriber City/State/ZIP Code</name>
                  <usage>S</usage>
                  <pos>030</pos>
                  <max_use>1</max_use>
                  <element xid="N401">
                    <data_ele>19</data_ele>
                    <name>Subscriber City Name</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>AN</data_type>
                    <min_len>2</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="N402">
                    <data_ele>156</data_ele>
                    <name>Subscriber State Code</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                    <valid_codes external="states"/>
                  </element>
                  <element xid="N403">
                    <data_ele>116</data_ele>
                    <name>Subscriber Postal Zone or ZIP Code</name>
                    <usage>R</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>3</min_len>
                    <max_len>15</max_len>
                  </element>
                  <element xid="N404">
                    <data_ele>26</data_ele>
                    <name>Subscriber 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="DMG">
                  <name>Subscriber Demographic Information</name>
                  <usage>S</usage>
                  <pos>032</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>R</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                    <valid_codes>
                      <code>F</code>
                      <code>M</code>
                      <code>U</code>
                    </valid_codes>
                  </element>
                  <element xid="DMG04">
                    <data_ele>1067</data_ele>
                    <name>Marital Status Code</name>
                    <usage>N</usage>
                    <seq>04</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                  </element>
                  <element xid="DMG05">
                    <data_ele>1109</data_ele>
                    <name>Race or Ethnicity Code</name>
                    <usage>N</usage>
                    <seq>05</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                  </element>
                  <element xid="DMG06">
                    <data_ele>1066</data_ele>
                    <name>Citizenship Status Code</name>
                    <usage>N</usage>
                    <seq>06</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="DMG07">
                    <data_ele>26</data_ele>
                    <name>Country Code</name>
                    <usage>N</usage>
                    <seq>07</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>3</max_len>
                  </element>
                  <element xid="DMG08">
                    <data_ele>659</data_ele>
                    <name>Basis of Verification Code</name>
                    <usage>N</usage>
                    <seq>08</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="DMG09">
                    <data_ele>380</data_ele>
                    <name>Quantity</name>
                    <usage>N</usage>
                    <seq>09</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>15</max_len>
                  </element>
                </segment>
<!--End of DMG segment-->
                <segment xid="REF">
                  <name>Subscriber Secondary Identification</name>
                  <usage>S</usage>
                  <pos>035</pos>
                  <max_use>4</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>1W</code>
                      <code>23</code>
                      <code>IG</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="REF">
                  <name>Property and Casualty Claim Number</name>
                  <usage>S</usage>
                  <pos>035</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>Y4</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Property Casualty Claim Number</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
              </loop>
<!--End of 2010BA loop-->
              <loop xid="2010BB">
                <name>Payer Name</name>
                <usage>R</usage>
                <pos>015</pos>
                <count>1</count>
                <segment xid="NM1">
                  <name>Payer Name</name>
                  <usage>R</usage>
                  <pos>015</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>PR</code>
                    </valid_codes>
                  </element>
                  <element xid="NM102">
                    <data_ele>1065</data_ele>
                    <name>Entity Type Qualifier</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                    <valid_codes>
                      <code>2</code>
                    </valid_codes>
                  </element>
                  <element xid="NM103">
                    <data_ele>1035</data_ele>
                    <name>Payer Name</name>
                    <usage>R</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>35</max_len>
                  </element>
                  <element xid="NM104">
                    <data_ele>1036</data_ele>
                    <name>Name First</name>
                    <usage>N</usage>
                    <seq>04</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>25</max_len>
                  </element>
                  <element xid="NM105">
                    <data_ele>1037</data_ele>
                    <name>Name Middle</name>
                    <usage>N</usage>
                    <seq>05</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>25</max_len>
                  </element>
                  <element xid="NM106">
                    <data_ele>1038</data_ele>
                    <name>Name Prefix</name>
                    <usage>N</usage>
                    <seq>06</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>10</max_len>
                  </element>
                  <element xid="NM107">
                    <data_ele>1039</data_ele>
                    <name>Name Suffix</name>
                    <usage>N</usage>
                    <seq>07</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>10</max_len>
                  </element>
                  <element xid="NM108">
                    <data_ele>66</data_ele>
                    <name>Identification Code Qualifier</name>
                    <usage>R</usage>
                    <seq>08</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                    <valid_codes>
                      <code>PI</code>
                      <code>XV</code>
                    </valid_codes>
                  </element>
                  <element xid="NM109">
                    <data_ele>67</data_ele>
                    <name>Payer 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="N2">
                  <name>Additional Payer Name Information</name>
                  <usage>S</usage>
                  <pos>020</pos>
                  <max_use>1</max_use>
                  <element xid="N201">
                    <data_ele>93</data_ele>
                    <name>Payer Additional Name</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>60</max_len>
                  </element>
                  <element xid="N202">
                    <data_ele>93</data_ele>
                    <name>Name</name>
                    <usage>N</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>60</max_len>
                  </element>
                </segment>
<!--End of N2 segment-->
                <segment xid="N3">
                  <name>Payer Address</name>
                  <usage>S</usage>
                  <pos>025</pos>
                  <max_use>1</max_use>
                  <element xid="N301">
                    <data_ele>166</data_ele>
                    <name>Payer 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>Payer 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>Payer City/State/ZIP Code</name>
                  <usage>S</usage>
                  <pos>030</pos>
                  <max_use>1</max_use>
                  <element xid="N401">
                    <data_ele>19</data_ele>
                    <name>Payer City Name</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>AN</data_type>
                    <min_len>2</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="N402">
                    <data_ele>156</data_ele>
                    <name>Payer State Code</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                    <valid_codes external="states"/>
                  </element>
                  <element xid="N403">
                    <data_ele>116</data_ele>
                    <name>Payer Postal Zone or ZIP Code</name>
                    <usage>R</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>3</min_len>
                    <max_len>15</max_len>
                  </element>
                  <element xid="N404">
                    <data_ele>26</data_ele>
                    <name>Payer 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="REF">
                  <name>Payer Secondary Identification</name>
                  <usage>S</usage>
                  <pos>035</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>2U</code>
                      <code>FY</code>
                      <code>NF</code>
                      <code>TJ</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Payer Additional 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-->
              </loop>
<!--End of 2010BB loop-->
              <loop xid="2010BC">
                <name>Responsible Party Name</name>
                <usage>S</usage>
                <pos>015</pos>
                <count>1</count>
                <segment xid="NM1">
                  <name>Responsible Party Name</name>
                  <usage>S</usage>
                  <pos>015</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>QD</code>
                    </valid_codes>
                  </element>
                  <element xid="NM102">
                    <data_ele>1065</data_ele>
                    <name>Entity Type Qualifier</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                    <valid_codes>
                      <code>1</code>
                      <code>2</code>
                    </valid_codes>
                  </element>
                  <element xid="NM103">
                    <data_ele>1035</data_ele>
                    <name>Responsible Party Last or Organization Name</name>
                    <usage>R</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>35</max_len>
                  </element>
                  <element xid="NM104">
                    <data_ele>1036</data_ele>
                    <name>Responsible Party First Name</name>
                    <usage>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>Responsible Party Middle Name</name>
                    <usage>S</usage>
                    <seq>05</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>25</max_len>
                  </element>
                  <element xid="NM106">
                    <data_ele>1038</data_ele>
                    <name>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>Responsible Party Suffix Name</name>
                    <usage>S</usage>
                    <seq>07</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>10</max_len>
                  </element>
                  <element xid="NM108">
                    <data_ele>66</data_ele>
                    <name>Identification Code Qualifier</name>
                    <usage>N</usage>
                    <seq>08</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="NM109">
                    <data_ele>67</data_ele>
                    <name>Identification Code</name>
                    <usage>N</usage>
                    <seq>09</seq>
                    <data_type>AN</data_type>
                    <min_len>2</min_len>
                    <max_len>80</max_len>
                  </element>
                  <element xid="NM110">
                    <data_ele>706</data_ele>
                    <name>Entity Relationship Code</name>
                    <usage>N</usage>
                    <seq>10</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="NM111">
                    <data_ele>98</data_ele>
                    <name>Entity Identifier Code</name>
                    <usage>N</usage>
                    <seq>11</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>3</max_len>
                  </element>
                </segment>
<!--End of NM1 segment-->
                <segment xid="N2">
                  <name>Additional Responsible Party Name Information</name>
                  <usage>S</usage>
                  <pos>020</pos>
                  <max_use>1</max_use>
                  <element xid="N201">
                    <data_ele>93</data_ele>
                    <name>Responsible Party Additional Name</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>60</max_len>
                  </element>
                  <element xid="N202">
                    <data_ele>93</data_ele>
                    <name>Name</name>
                    <usage>N</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>60</max_len>
                  </element>
                </segment>
<!--End of N2 segment-->
                <segment xid="N3">
                  <name>Responsible Party Address</name>
                  <usage>R</usage>
                  <pos>025</pos>
                  <max_use>1</max_use>
                  <element xid="N301">
                    <data_ele>166</data_ele>
                    <name>Responsible Party 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>Responsible Party 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>Responsible Party City/State/ZIP Code</name>
                  <usage>R</usage>
                  <pos>030</pos>
                  <max_use>1</max_use>
                  <element xid="N401">
                    <data_ele>19</data_ele>
                    <name>Responsible Party City Name</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>AN</data_type>
                    <min_len>2</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="N402">
                    <data_ele>156</data_ele>
                    <name>Responsible Party State Code</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                    <valid_codes external="states"/>
                  </element>
                  <element xid="N403">
                    <data_ele>116</data_ele>
                    <name>Responsible Party Postal Zone or ZIP Code</name>
                    <usage>R</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>3</min_len>
                    <max_len>15</max_len>
                  </element>
                  <element xid="N404">
                    <data_ele>26</data_ele>
                    <name>Responsible Party Country Code</name>
                    <usage>S</usage>
                    <seq>04</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>3</max_len>
                    <valid_codes external="country"/>
                  </element>
                  <element xid="N405">
                    <data_ele>309</data_ele>
                    <name>Location Qualifier</name>
                    <usage>N</usage>
                    <seq>05</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="N406">
                    <data_ele>310</data_ele>
                    <name>Location Identifier</name>
                    <usage>N</usage>
                    <seq>06</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                </segment>
<!--End of N4 segment-->
              </loop>
<!--End of 2010BC loop-->
              <loop xid="2010BD">
                <name>Credit/Debit Card Holder Name</name>
                <usage>S</usage>
                <pos>015</pos>
                <count>1</count>
                <segment xid="NM1">
                  <name>Credit/Debit Card Holder Name</name>
                  <usage>R</usage>
                  <pos>015</pos>
                  <max_use>1</max_use>
                  <element xid="NM101">
                    <data_ele>98</data_ele>
                    <name>Entity Identifier Code</name>
                    <usage>S</usage>
                    <seq>01</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>3</max_len>
                    <valid_codes>
                      <code>AO</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>Credit or Debit Card Holder Last or Organizational Name</name>
                    <usage>R</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>35</max_len>
                  </element>
                  <element xid="NM104">
                    <data_ele>1036</data_ele>
                    <name>Credit or Debit Card Holder 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>Credit or Debit Card Holder 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>Credit or Debit Card Holder 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>
                    </valid_codes>
                  </element>
                  <element xid="NM109">
                    <data_ele>67</data_ele>
                    <name>Credit or Debit Card Number</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="N2">
                  <name>Additional Credit/Debit Card Holder Name Information</name>
                  <usage>S</usage>
                  <pos>020</pos>
                  <max_use>1</max_use>
                  <element xid="N201">
                    <data_ele>93</data_ele>
                    <name>Credit or Debit Card Holder Additional Name</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>60</max_len>
                  </element>
                  <element xid="N202">
                    <data_ele>93</data_ele>
                    <name>Name</name>
                    <usage>N</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>60</max_len>
                  </element>
                </segment>
<!--End of N2 segment-->
                <segment xid="REF">
                  <name>Credit/Debit Card Information</name>
                  <usage>S</usage>
                  <pos>035</pos>
                  <max_use>2</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>AB</code>
                      <code>BB</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Credit or Debit Card Authorization Number</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
              </loop>
<!--End of 2010BD loop-->
              <loop xid="2300">
                <name>Claim Information</name>
                <usage>S</usage>
                <pos>130</pos>
                <count>100</count>
                <segment xid="CLM">
                  <name>Claim Information</name>
                  <usage>R</usage>
                  <pos>130</pos>
                  <max_use>1</max_use>
                  <element xid="CLM01">
                    <data_ele>1028</data_ele>
                    <name>Patient Account Number</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>38</max_len>
                  </element>
                  <element xid="CLM02">
                    <data_ele>782</data_ele>
                    <name>Total Claim Charge Amount</name>
                    <usage>R</usage>
                    <seq>2</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>18</max_len>
                  </element>
                  <element xid="CLM03">
                    <data_ele>1032</data_ele>
                    <name>Claim Filing Indicator Code</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="CLM04">
                    <data_ele>1343</data_ele>
                    <name>Non-Institutional Claim Type Code</name>
                    <usage>N</usage>
                    <seq>04</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                  </element>
                  <composite>
                    <data_ele>C023</data_ele>
                    <name>Place of Service Code</name>
                    <usage>R</usage>
                    <seq>05</seq>
                    <element xid="CLM05-01">
                      <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>
                      <valid_codes>
                        <code>11</code>
                        <code>12</code>
                        <code>21</code>
                        <code>22</code>
                        <code>23</code>
                        <code>24</code>
                        <code>25</code>
                        <code>26</code>
                        <code>31</code>
                        <code>32</code>
                        <code>33</code>
                        <code>34</code>
                        <code>41</code>
                        <code>42</code>
                        <code>51</code>
                        <code>52</code>
                        <code>53</code>
                        <code>54</code>
                        <code>55</code>
                        <code>56</code>
                        <code>50</code>
                        <code>60</code>
                        <code>61</code>
                        <code>62</code>
                        <code>65</code>
                        <code>71</code>
                        <code>72</code>
                        <code>81</code>
                        <code>99</code>
                      </valid_codes>
                    </element>
                    <element xid="CLM05-02">
                      <data_ele>1332</data_ele>
                      <name>Facility Code Qualifier</name>
                      <usage>N</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="CLM05-03">
                      <data_ele>1325</data_ele>
                      <name>Claim Frequency Code</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>1</code>
                        <code>6</code>
                        <code>7</code>
                        <code>8</code>
                      </valid_codes>
                    </element>
                  </composite>
                  <element xid="CLM06">
                    <data_ele>1073</data_ele>
                    <name>Provider or Supplier Signature Indicator</name>
                    <usage>R</usage>
                    <seq>06</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="CLM07">
                    <data_ele>1359</data_ele>
                    <name>Medicare Assignment Code</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>A</code>
                      <code>B</code>
                      <code>C</code>
                      <code>P</code>
                    </valid_codes>
                  </element>
                  <element xid="CLM08">
                    <data_ele>1073</data_ele>
                    <name>Benefits Assignment Certification Indicator</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>N</code>
                      <code>Y</code>
                    </valid_codes>
                  </element>
                  <element xid="CLM09">
                    <data_ele>1363</data_ele>
                    <name>Release of Information Code</name>
                    <usage>R</usage>
                    <seq>09</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                    <valid_codes>
                      <code>A</code>
                      <code>I</code>
                      <code>M</code>
                      <code>N</code>
                      <code>O</code>
                      <code>Y</code>
                    </valid_codes>
                  </element>
                  <element xid="CLM10">
                    <data_ele>1351</data_ele>
                    <name>Patient Signature Source Code</name>
                    <usage>S</usage>
                    <seq>10</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                    <valid_codes>
                      <code>B</code>
                      <code>C</code>
                      <code>M</code>
                      <code>P</code>
                      <code>S</code>
                    </valid_codes>
                  </element>
                  <composite>
                    <data_ele>C024</data_ele>
                    <name>Accident/Employment/Related Causes</name>
                    <usage>S</usage>
                    <seq>11</seq>
                    <element xid="CLM11-01">
                      <data_ele>1362</data_ele>
                      <name>Related Causes 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>AA</code>
                        <code>AB</code>
                        <code>AP</code>
                        <code>EM</code>
                        <code>OA</code>
                      </valid_codes>
                    </element>
                    <element xid="CLM11-02">
                      <data_ele>1362</data_ele>
                      <name>Related Causes Code</name>
                      <usage>S</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>AA</code>
                        <code>AB</code>
                        <code>AP</code>
                        <code>EM</code>
                        <code>OA</code>
                      </valid_codes>
                    </element>
                    <element xid="CLM11-03">
                      <data_ele>1362</data_ele>
                      <name>Related Causes 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>AA</code>
                        <code>AB</code>
                        <code>AP</code>
                        <code>EM</code>
                        <code>OA</code>
                      </valid_codes>
                    </element>
                    <element xid="CLM11-04">
                      <data_ele>156</data_ele>
                      <name>Auto Accident State or Province Code</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes external="states"/>
                    </element>
                    <element xid="CLM11-05">
                      <data_ele>26</data_ele>
                      <name>Country Code</name>
                      <usage>S</usage>
                      <seq>05</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                      <valid_codes external="country"/>
                    </element>
                  </composite>
                  <element xid="CLM12">
                    <data_ele>1366</data_ele>
                    <name>Special Program Indicator</name>
                    <usage>S</usage>
                    <seq>12</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>3</max_len>
                    <valid_codes>
                      <code>01</code>
                      <code>02</code>
                      <code>03</code>
                      <code>05</code>
                      <code>07</code>
                      <code>08</code>
                      <code>09</code>
                    </valid_codes>
                  </element>
                  <element xid="CLM13">
                    <data_ele>1073</data_ele>
                    <name>Yes/No Condition or Response 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="CLM14">
                    <data_ele>1338</data_ele>
                    <name>Level of Service Code</name>
                    <usage>N</usage>
                    <seq>14</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>3</max_len>
                  </element>
                  <element xid="CLM15">
                    <data_ele>1073</data_ele>
                    <name>Yes/No Condition or Response 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="CLM16">
                    <data_ele>1360</data_ele>
                    <name>Participation Agreement</name>
                    <usage>S</usage>
                    <seq>16</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                    <valid_codes>
                      <code>P</code>
                    </valid_codes>
                  </element>
                  <element xid="CLM17">
                    <data_ele>1029</data_ele>
                    <name>Claim Status Code</name>
                    <usage>N</usage>
                    <seq>17</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="CLM18">
                    <data_ele>1073</data_ele>
                    <name>Yes/No Condition or Response Code</name>
                    <usage>N</usage>
                    <seq>18</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                  </element>
                  <element xid="CLM19">
                    <data_ele>1383</data_ele>
                    <name>Claim Submission Reason Code</name>
                    <usage>N</usage>
                    <seq>19</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="CLM20">
                    <data_ele>1514</data_ele>
                    <name>Delay Reason Code</name>
                    <usage>S</usage>
                    <seq>20</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>10</code>
                      <code>11</code>
                    </valid_codes>
                  </element>
                </segment>
<!--End of CLM segment-->
                <segment xid="DTP">
                  <name>Date - Order Date</name>
                  <usage>S</usage>
                  <pos>135</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>938</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>Order 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>Date - Initial Treatment</name>
                  <usage>S</usage>
                  <pos>135</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>454</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="DTP3">
                    <data_ele>1251</data_ele>
                    <name>Initial Treatment Date</name>
                    <usage>R</usage>
                    <seq>3</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>Date - Referral Date</name>
                  <usage>S</usage>
                  <pos>135</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>330</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>Referral 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>Date - Date Last Seen</name>
                  <usage>S</usage>
                  <pos>135</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>304</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 Seen 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>Date - Onset of Current Illness/Symptom</name>
                  <usage>S</usage>
                  <pos>135</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 Illness or Injury 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>Date - Acute Manifestation</name>
                  <usage>S</usage>
                  <pos>135</pos>
                  <max_use>5</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>453</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>Acute Manifestation 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>Date - Similar Illness/Symptom Onset</name>
                  <usage>S</usage>
                  <pos>135</pos>
                  <max_use>10</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>438</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>Similar Illness or Symptom 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>Date - Accident</name>
                  <usage>S</usage>
                  <pos>135</pos>
                  <max_use>10</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>
                      <code>DT</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>Date - Last Menstrual Period</name>
                  <usage>S</usage>
                  <pos>135</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>Date - Last X-Ray</name>
                  <usage>S</usage>
                  <pos>135</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>455</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 X-Ray 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>Date - Estimated Date of Birth</name>
                  <usage>S</usage>
                  <pos>135</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>Date - Hearing and Vision Prescription Date</name>
                  <usage>S</usage>
                  <pos>135</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>471</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>Prescription 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>Date - Disability Begin</name>
                  <usage>S</usage>
                  <pos>135</pos>
                  <max_use>5</max_use>
                  <element xid="DTP01">
                    <data_ele>374</data_ele>
                    <name>Date Time Qualifier</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>ID</data_type>
                    <min_len>3</min_len>
                    <max_len>3</max_len>
                    <valid_codes>
                      <code>360</code>
                    </valid_codes>
                  </element>
                  <element xid="DTP02">
                    <data_ele>1250</data_ele>
                    <name>Date Time Period Format Qualifier</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>3</max_len>
                    <valid_codes>
                      <code>D8</code>
                    </valid_codes>
                  </element>
                  <element xid="DTP03">
                    <data_ele>1251</data_ele>
                    <name>Disability From 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>Date - Disability End</name>
                  <usage>S</usage>
                  <pos>135</pos>
                  <max_use>5</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>361</code>
                    </valid_codes>
                  </element>
                  <element xid="DTP02">
                    <data_ele>1250</data_ele>
                    <name>Date Time Period Format Qualifier</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>3</max_len>
                    <valid_codes>
                      <code>D8</code>
                    </valid_codes>
                  </element>
                  <element xid="DTP03">
                    <data_ele>1251</data_ele>
                    <name>Disability To 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>Date - Last Worked</name>
                  <usage>S</usage>
                  <pos>135</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>297</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 Worked 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>Date - Authorized Return to Work</name>
                  <usage>S</usage>
                  <pos>135</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>296</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>Work Return 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>Date - Admission</name>
                  <usage>S</usage>
                  <pos>135</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>
                    </valid_codes>
                  </element>
                  <element xid="DTP03">
                    <data_ele>1251</data_ele>
                    <name>Related Hospitalization 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>Date - Discharge</name>
                  <usage>S</usage>
                  <pos>135</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>Related Hospitalization 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>Date - Assumed and Relinquished Care Dates</name>
                  <usage>S</usage>
                  <pos>135</pos>
                  <max_use>2</max_use>
                  <element xid="DTP01">
                    <data_ele>374</data_ele>
                    <name>Date Time Qualifier</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>ID</data_type>
                    <min_len>3</min_len>
                    <max_len>3</max_len>
                    <valid_codes>
                      <code>090</code>
                      <code>091</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>Assumed or Relinquished Care 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="PWK">
                  <name>Claim Supplemental Information</name>
                  <usage>S</usage>
                  <pos>155</pos>
                  <max_use>10</max_use>
                  <element xid="PWK01">
                    <data_ele>755</data_ele>
                    <name>Attachment Report Type 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>77</code>
                      <code>AS</code>
                      <code>B2</code>
                      <code>B3</code>
                      <code>B4</code>
                      <code>CT</code>
                      <code>DA</code>
                      <code>DG</code>
                      <code>DS</code>
                      <code>EB</code>
                      <code>MT</code>
                      <code>NN</code>
                      <code>OB</code>
                      <code>OZ</code>
                      <code>PN</code>
                      <code>PO</code>
                      <code>PZ</code>
                      <code>RB</code>
                      <code>RR</code>
                      <code>RT</code>
                    </valid_codes>
                  </element>
                  <element xid="PWK02">
                    <data_ele>756</data_ele>
                    <name>Attachment Transmission Code</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>AA</code>
                      <code>BM</code>
                      <code>EL</code>
                      <code>EM</code>
                      <code>FX</code>
                    </valid_codes>
                  </element>
                  <element xid="PWK03">
                    <data_ele>757</data_ele>
                    <name>Report Copies Needed</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>N0</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="PWK04">
                    <data_ele>98</data_ele>
                    <name>Entity Identifier Code</name>
                    <usage>N</usage>
                    <seq>04</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>3</max_len>
                  </element>
                  <element xid="PWK05">
                    <data_ele>66</data_ele>
                    <name>Identification Code 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>AC</code>
                    </valid_codes>
                  </element>
                  <element xid="PWK06">
                    <data_ele>67</data_ele>
                    <name>Attachment Control Number</name>
                    <usage>S</usage>
                    <seq>06</seq>
                    <data_type>AN</data_type>
                    <min_len>2</min_len>
                    <max_len>80</max_len>
                  </element>
                  <element xid="PWK07">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>07</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C002</data_ele>
                    <name>Actions Indicated</name>
                    <usage>N</usage>
                    <seq>08</seq>
                  </composite>
                  <element xid="PWK09">
                    <data_ele>1525</data_ele>
                    <name>Request Category Code</name>
                    <usage>N</usage>
                    <seq>09</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                  </element>
                </segment>
<!--End of PWK segment-->
                <segment xid="CN1">
                  <name>Contract Information</name>
                  <usage>S</usage>
                  <pos>160</pos>
                  <max_use>1</max_use>
                  <element xid="CN101">
                    <data_ele>1166</data_ele>
                    <name>Contract Type 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>02</code>
                      <code>03</code>
                      <code>04</code>
                      <code>05</code>
                      <code>06</code>
                      <code>09</code>
                    </valid_codes>
                  </element>
                  <element xid="CN102">
                    <data_ele>782</data_ele>
                    <name>Contract Amount</name>
                    <usage>S</usage>
                    <seq>02</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>18</max_len>
                  </element>
                  <element xid="CN103">
                    <data_ele>332</data_ele>
                    <name>Contract Percentage</name>
                    <usage>S</usage>
                    <seq>03</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>6</max_len>
                  </element>
                  <element xid="CN104">
                    <data_ele>127</data_ele>
                    <name>Contract Code</name>
                    <usage>S</usage>
                    <seq>04</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="CN105">
                    <data_ele>338</data_ele>
                    <name>Terms Discount Percentage</name>
                    <usage>S</usage>
                    <seq>05</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>6</max_len>
                  </element>
                  <element xid="CN106">
                    <data_ele>799</data_ele>
                    <name>Contract Version Identifier</name>
                    <usage>S</usage>
                    <seq>06</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                </segment>
<!--End of CN1 segment-->
                <segment xid="AMT">
                  <name>Credit/Debit Card Maximum Amount</name>
                  <usage>S</usage>
                  <pos>175</pos>
                  <max_use>1</max_use>
                  <element xid="AMT01">
                    <data_ele>522</data_ele>
                    <name>Amount Qualifier Code</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>3</max_len>
                    <valid_codes>
                      <code>MA</code>
                    </valid_codes>
                  </element>
                  <element xid="AMT02">
                    <data_ele>782</data_ele>
                    <name>Credit or Debit Card Maximum Amount</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>18</max_len>
                  </element>
                  <element xid="AMT03">
                    <data_ele>478</data_ele>
                    <name>Credit/Debit Flag Code</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                  </element>
                </segment>
<!--End of AMT segment-->
                <segment xid="AMT">
                  <name>Patient Amount Paid</name>
                  <usage>S</usage>
                  <pos>175</pos>
                  <max_use>1</max_use>
                  <element xid="AMT01">
                    <data_ele>522</data_ele>
                    <name>Amount Qualifier Code</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>3</max_len>
                    <valid_codes>
                      <code>F5</code>
                    </valid_codes>
                  </element>
                  <element xid="AMT02">
                    <data_ele>782</data_ele>
                    <name>Patient Amount Paid</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>18</max_len>
                  </element>
                  <element xid="AMT03">
                    <data_ele>478</data_ele>
                    <name>Credit/Debit Flag Code</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                  </element>
                </segment>
<!--End of AMT segment-->
                <segment xid="AMT">
                  <name>Total Purchased Service Amount</name>
                  <usage>S</usage>
                  <pos>175</pos>
                  <max_use>1</max_use>
                  <element xid="AMT01">
                    <data_ele>522</data_ele>
                    <name>Amount Qualifier Code</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>3</max_len>
                    <valid_codes>
                      <code>NE</code>
                    </valid_codes>
                  </element>
                  <element xid="AMT02">
                    <data_ele>782</data_ele>
                    <name>Total Purchased Service Amount</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>18</max_len>
                  </element>
                  <element xid="AMT03">
                    <data_ele>478</data_ele>
                    <name>Credit/Debit Flag Code</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                  </element>
                </segment>
<!--End of AMT segment-->
                <segment xid="REF">
                  <name>Service Authorization Exception Code</name>
                  <usage>S</usage>
                  <pos>180</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>4N</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Service Authorization Exception Code</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                    <valid_codes>
                      <code>1</code>
                      <code>2</code>
                      <code>3</code>
                      <code>4</code>
                      <code>5</code>
                      <code>6</code>
                      <code>7</code>
                    </valid_codes>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Mandatory Medicare (Section 4081) Crossover Indicator</name>
                  <usage>S</usage>
                  <pos>180</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>F5</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Medicare Section 4081 Indicator</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                    <valid_codes>
                      <code>Y</code>
                      <code>N</code>
                    </valid_codes>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Mammography Certification Number</name>
                  <usage>S</usage>
                  <pos>180</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>EW</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Mammography Certification Number</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Prior Authorization or Referral Number</name>
                  <usage>S</usage>
                  <pos>180</pos>
                  <max_use>2</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>9F</code>
                      <code>G1</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Prior Authorization or Referral Number</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Original Reference Number (ICN/DCN)</name>
                  <usage>S</usage>
                  <pos>180</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>F8</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Claim Original Reference Number</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Clinical Laboratory Improvement Amendment (CLIA) Number</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>X4</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Clinical Laboratory Improvement Amendment Number</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Repriced Claim Number</name>
                  <usage>S</usage>
                  <pos>180</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>9A</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Repriced Claim Reference Number</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Adjusted Repriced Claim Number</name>
                  <usage>S</usage>
                  <pos>180</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>9C</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Adjusted Repriced Claim Reference Number</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Investigational Device Exemption Number</name>
                  <usage>S</usage>
                  <pos>180</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>LX</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Investigational Device Exemption Identifier</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Claim Identification Number for Clearing Houses and Other Transmission Intermediaries</name>
                  <usage>S</usage>
                  <pos>180</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>D9</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Clearinghouse 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="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Ambulatory Patient Group (APG)</name>
                  <usage>S</usage>
                  <pos>180</pos>
                  <max_use>4</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>1S</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Ambulatory Patient Group Number</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Medical Record Number</name>
                  <usage>S</usage>
                  <pos>180</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>EA</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Medical Record Number</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="REF03">
                    <data_ele>352</data_ele>
                    <name>Description</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <composite>
                    <data_ele>C040</data_ele>
                    <name>Reference Identifier</name>
                    <usage>N</usage>
                    <seq>04</seq>
                  </composite>
                </segment>
<!--End of REF segment-->
                <segment xid="REF">
                  <name>Demonstration Project Identifier</name>
                  <usage>S</usage>
                  <pos>180</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>P4</code>
                    </valid_codes>
                  </element>
                  <element xid="REF02">
                    <data_ele>127</data_ele>
                    <name>Demonstration Project 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="K3">
                  <name>File Information</name>
                  <usage>S</usage>
                  <pos>185</pos>
                  <max_use>10</max_use>
                  <element xid="K301">
                    <data_ele>449</data_ele>
                    <name>Fixed Format Information</name>
                    <usage>R</usage>
                    <seq>01</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                  <element xid="K302">
                    <data_ele>1333</data_ele>
                    <name>Record Format Code</name>
                    <usage>N</usage>
                    <seq>02</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>2</max_len>
                  </element>
                  <composite>
                    <data_ele>C001</data_ele>
                    <name>Composite Unit of Measure</name>
                    <usage>N</usage>
                    <seq>03</seq>
                  </composite>
                </segment>
<!--End of K3 segment-->
                <segment xid="NTE">
                  <name>Claim Note</name>
                  <usage>S</usage>
                  <pos>190</pos>
                  <max_use>1</max_use>
                  <element xid="NTE01">
                    <data_ele>363</data_ele>
                    <name>Note Reference 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>ADD</code>
                      <code>CER</code>
                      <code>DCP</code>
                      <code>DGN</code>
                      <code>PMT</code>
                      <code>TPO</code>
                    </valid_codes>
                  </element>
                  <element xid="NTE02">
                    <data_ele>352</data_ele>
                    <name>Claim Note Text</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>80</max_len>
                  </element>
                </segment>
<!--End of NTE segment-->
                <segment xid="CR1">
                  <name>Ambulance Transport Information</name>
                  <usage>S</usage>
                  <pos>195</pos>
                  <max_use>1</max_use>
                  <element xid="CR101">
                    <data_ele>355</data_ele>
                    <name>Unit or Basis for Measurement Code</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>LB</code>
                    </valid_codes>
                  </element>
                  <element xid="CR102">
                    <data_ele>81</data_ele>
                    <name>Patient Weight</name>
                    <usage>S</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>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>B</code>
                      <code>C</code>
                      <code>D</code>
                      <code>E</code>
                    </valid_codes>
                  </element>
                  <element xid="CR105">
                    <data_ele>355</data_ele>
                    <name>Unit or Basis for Measurement Code</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>DH</code>
                    </valid_codes>
                  </element>
                  <element xid="CR106">
                    <data_ele>380</data_ele>
                    <name>Transport Distance</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="CR107">
                    <data_ele>166</data_ele>
                    <name>Address Information</name>
                    <usage>N</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>Address Information</name>
                    <usage>N</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>Round Trip Purpose Description</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="CR110">
                    <data_ele>352</data_ele>
                    <name>Stretcher Purpose Description</name>
                    <usage>S</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>200</pos>
                  <max_use>1</max_use>
                  <element xid="CR201">
                    <data_ele>609</data_ele>
                    <name>Treatment Series Number</name>
                    <usage>R</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>R</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>R</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>R</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>R</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>Patient Condition 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>A</code>
                      <code>C</code>
                      <code>D</code>
                      <code>E</code>
                      <code>F</code>
                      <code>G</code>
                      <code>M</code>
                    </valid_codes>
                  </element>
                  <element xid="CR209">
                    <data_ele>1073</data_ele>
                    <name>Complication Indicator</name>
                    <usage>R</usage>
                    <seq>09</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="CR210">
                    <data_ele>352</data_ele>
                    <name>Patient Condition Description</name>
                    <usage>S</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>Patient Condition Description</name>
                    <usage>S</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>X-ray Availability Indicator</name>
                    <usage>R</usage>
                    <seq>12</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 CR2 segment-->
                <segment xid="CRC">
                  <name>Ambulance Certification</name>
                  <usage>S</usage>
                  <pos>220</pos>
                  <max_use>3</max_use>
                  <element xid="CRC01">
                    <data_ele>1136</data_ele>
                    <name>Code Category</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>07</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC02">
                    <data_ele>1073</data_ele>
                    <name>Certification Condition Indicator</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>N</code>
                      <code>Y</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC03">
                    <data_ele>1321</data_ele>
                    <name>Condition 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>01</code>
                      <code>02</code>
                      <code>03</code>
                      <code>04</code>
                      <code>05</code>
                      <code>06</code>
                      <code>07</code>
                      <code>08</code>
                      <code>09</code>
                      <code>60</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC04">
                    <data_ele>1321</data_ele>
                    <name>Condition Code</name>
                    <usage>S</usage>
                    <seq>04</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                    <valid_codes>
                      <code>01</code>
                      <code>02</code>
                      <code>03</code>
                      <code>04</code>
                      <code>05</code>
                      <code>06</code>
                      <code>07</code>
                      <code>08</code>
                      <code>09</code>
                      <code>60</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC05">
                    <data_ele>1321</data_ele>
                    <name>Condition Code</name>
                    <usage>S</usage>
                    <seq>05</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                    <valid_codes>
                      <code>01</code>
                      <code>02</code>
                      <code>03</code>
                      <code>04</code>
                      <code>05</code>
                      <code>06</code>
                      <code>07</code>
                      <code>08</code>
                      <code>09</code>
                      <code>60</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC06">
                    <data_ele>1321</data_ele>
                    <name>Condition 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>01</code>
                      <code>02</code>
                      <code>03</code>
                      <code>04</code>
                      <code>05</code>
                      <code>06</code>
                      <code>07</code>
                      <code>08</code>
                      <code>09</code>
                      <code>60</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC07">
                    <data_ele>1321</data_ele>
                    <name>Condition Code</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>01</code>
                      <code>02</code>
                      <code>03</code>
                      <code>04</code>
                      <code>05</code>
                      <code>06</code>
                      <code>07</code>
                      <code>08</code>
                      <code>09</code>
                      <code>60</code>
                    </valid_codes>
                  </element>
                </segment>
<!--End of CRC segment-->
                <segment xid="CRC">
                  <name>Patient Condition Information:  Vision</name>
                  <usage>S</usage>
                  <pos>220</pos>
                  <max_use>3</max_use>
                  <element xid="CRC01">
                    <data_ele>1136</data_ele>
                    <name>Code Category</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>E1</code>
                      <code>E2</code>
                      <code>E3</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC02">
                    <data_ele>1073</data_ele>
                    <name>Certification Condition Indicator</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>N</code>
                      <code>Y</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC03">
                    <data_ele>1321</data_ele>
                    <name>Condition 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>L1</code>
                      <code>L2</code>
                      <code>L3</code>
                      <code>L4</code>
                      <code>L5</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC04">
                    <data_ele>1321</data_ele>
                    <name>Condition Code</name>
                    <usage>S</usage>
                    <seq>04</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                    <valid_codes>
                      <code>L1</code>
                      <code>L2</code>
                      <code>L3</code>
                      <code>L4</code>
                      <code>L5</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC05">
                    <data_ele>1321</data_ele>
                    <name>Condition 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>L1</code>
                      <code>L2</code>
                      <code>L3</code>
                      <code>L4</code>
                      <code>L5</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC06">
                    <data_ele>1321</data_ele>
                    <name>Condition 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>L1</code>
                      <code>L2</code>
                      <code>L3</code>
                      <code>L4</code>
                      <code>L5</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC07">
                    <data_ele>1321</data_ele>
                    <name>Condition Code</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>L1</code>
                      <code>L2</code>
                      <code>L3</code>
                      <code>L4</code>
                      <code>L5</code>
                    </valid_codes>
                  </element>
                </segment>
<!--End of CRC segment-->
                <segment xid="CRC">
                  <name>Homebound Indicator</name>
                  <usage>S</usage>
                  <pos>220</pos>
                  <max_use>1</max_use>
                  <element xid="CRC01">
                    <data_ele>1136</data_ele>
                    <name>Code Category</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>75</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC02">
                    <data_ele>1073</data_ele>
                    <name>Certification Condition Indicator</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>Y</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC03">
                    <data_ele>1321</data_ele>
                    <name>Homebound Indicator</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>IH</code>
                    </valid_codes>
                  </element>
                  <element xid="CRC04">
                    <data_ele>1321</data_ele>
                    <name>Condition Indicator</name>
                    <usage>N</usage>
                    <seq>04</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="CRC05">
                    <data_ele>1321</data_ele>
                    <name>Condition Indicator</name>
                    <usage>N</usage>
                    <seq>05</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="CRC06">
                    <data_ele>1321</data_ele>
                    <name>Condition Indicator</name>
                    <usage>N</usage>
                    <seq>06</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="CRC07">
                    <data_ele>1321</data_ele>
                    <name>Condition Indicator</name>
                    <usage>N</usage>
                    <seq>07</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                </segment>
<!--End of CRC segment-->
                <segment xid="HI">
                  <name>Health Care Diagnosis Code</name>
                  <usage>S</usage>
                  <pos>231</pos>
                  <max_use>1</max_use>
                  <composite>
                    <data_ele>C022</data_ele>
                    <name>Principal Diagnosis</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>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>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="HI01-04">
                      <data_ele>1251</data_ele>
                      <name>Date Time Period</name>
                      <usage>N</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</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>
                      </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>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="HI02-04">
                      <data_ele>1251</data_ele>
                      <name>Date Time Period</name>
                      <usage>N</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</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>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="HI03-04">
                      <data_ele>1251</data_ele>
                      <name>Date Time Period</name>
                      <usage>N</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</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>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="HI04-04">
                      <data_ele>1251</data_ele>
                      <name>Date Time Period</name>
                      <usage>N</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</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>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="HI05-04">
                      <data_ele>1251</data_ele>
                      <name>Date Time Period</name>
                      <usage>N</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</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>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="HI06-04">
                      <data_ele>1251</data_ele>
                      <name>Date Time Period</name>
                      <usage>N</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</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>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="HI07-04">
                      <data_ele>1251</data_ele>
                      <name>Date Time Period</name>
                      <usage>N</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</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>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="HI08-04">
                      <data_ele>1251</data_ele>
                      <name>Date Time Period</name>
                      <usage>N</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>Health Care Code Information</name>
                    <usage>N</usage>
                    <seq>09</seq>
                  </composite>
                  <composite>
                    <data_ele>C022</data_ele>
                    <name>Health Care Code Information</name>
                    <usage>N</usage>
                    <seq>10</seq>
                  </composite>
                  <composite>
                    <data_ele>C022</data_ele>
                    <name>Health Care Code Information</name>
                    <usage>N</usage>
                    <seq>11</seq>
                  </composite>
                  <composite>
                    <data_ele>C022</data_ele>
                    <name>Health Care Code Information</name>
                    <usage>N</usage>
                    <seq>12</seq>
                  </composite>
                </segment>
<!--End of HI segment-->
                <segment xid="HCP">
                  <name>Claim Pricing/Repricing Information</name>
                  <usage>S</usage>
                  <pos>241</pos>
                  <max_use>1</max_use>
                  <element xid="HCP01">
                    <data_ele>1473</data_ele>
                    <name>Pricing/Repricing Methodology</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>01</code>
                      <code>02</code>
                      <code>03</code>
                      <code>04</code>
                      <code>05</code>
                      <code>07</code>
                      <code>08</code>
                      <code>09</code>
                      <code>10</code>
                      <code>11</code>
                      <code>12</code>
                      <code>13</code>
                      <code>14</code>
                    </valid_codes>
                  </element>
                  <element xid="HCP02">
                    <data_ele>782</data_ele>
                    <name>Repriced Allowed Amount</name>
                    <usage>R</usage>
                    <seq>02</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>18</max_len>
                  </element>
                  <element xid="HCP03">
                    <data_ele>782</data_ele>
                    <name>Repriced Saving Amount</name>
                    <usage>S</usage>
                    <seq>03</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>18</max_len>
                  </element>
                  <element xid="HCP04">
                    <data_ele>127</data_ele>
                    <name>Repricing Organization Identifier</name>
                    <usage>S</usage>
                    <seq>04</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="HCP05">
                    <data_ele>118</data_ele>
                    <name>Repricing Per Diem or Flat Rate Amount</name>
                    <usage>S</usage>
                    <seq>05</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>9</max_len>
                  </element>
                  <element xid="HCP06">
                    <data_ele>127</data_ele>
                    <name>Repriced Approved Ambulatory Patient Group Code</name>
                    <usage>S</usage>
                    <seq>06</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>30</max_len>
                  </element>
                  <element xid="HCP7">
                    <data_ele>782</data_ele>
                    <name>Repriced Approved Ambulatory Patient Group Amount</name>
                    <usage>S</usage>
                    <seq>7</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>18</max_len>
                  </element>
                  <element xid="HCP08">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>08</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                  <element xid="HCP09">
                    <data_ele>235</data_ele>
                    <name>Product/Service ID Qualifier</name>
                    <usage>N</usage>
                    <seq>09</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="HCP10">
                    <data_ele>234</data_ele>
                    <name>Product/Service ID</name>
                    <usage>N</usage>
                    <seq>10</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>48</max_len>
                  </element>
                  <element xid="HCP11">
                    <data_ele>355</data_ele>
                    <name>Unit or Basis for Measurement Code</name>
                    <usage>N</usage>
                    <seq>11</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="HCP12">
                    <data_ele>380</data_ele>
                    <name>Quantity</name>
                    <usage>N</usage>
                    <seq>12</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>15</max_len>
                  </element>
                  <element xid="HCP13">
                    <data_ele>901</data_ele>
                    <name>Reject Reason Code</name>
                    <usage>S</usage>
                    <seq>13</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                    <valid_codes>
                      <code>T1</code>
                      <code>T2</code>
                      <code>T3</code>
                      <code>T4</code>
                      <code>T5</code>
                      <code>T6</code>
                    </valid_codes>
                  </element>
                  <element xid="HCP14">
                    <data_ele>1526</data_ele>
                    <name>Policy Compliance Code</name>
                    <usage>S</usage>
                    <seq>14</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>
                    </valid_codes>
                  </element>
                  <element xid="HCP15">
                    <data_ele>1527</data_ele>
                    <name>Exception Code</name>
                    <usage>S</usage>
                    <seq>15</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>
                    </valid_codes>
                  </element>
                </segment>
<!--End of HCP segment-->
                <loop xid="2305">
                  <name>Home Health Care Plan Information</name>
                  <usage>S</usage>
                  <pos>242</pos>
                  <count>6</count>
                  <segment xid="CR7">
                    <name>Home Health Care Plan Information</name>
                    <usage>S</usage>
                    <pos>242</pos>
                    <max_use>1</max_use>
                    <element xid="CR701">
                      <data_ele>921</data_ele>
                      <name>Discipline Type 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>AI</code>
                        <code>MS</code>
                        <code>OT</code>
                        <code>PT</code>
                        <code>SN</code>
                        <code>ST</code>
                      </valid_codes>
                    </element>
                    <element xid="CR702">
                      <data_ele>1470</data_ele>
                      <name>Total Visits Rendered Count</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>N0</data_type>
                      <min_len>1</min_len>
                      <max_len>9</max_len>
                    </element>
                    <element xid="CR703">
                      <data_ele>1470</data_ele>
                      <name>Certification Period Projected Visit Count</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>N0</data_type>
                      <min_len>1</min_len>
                      <max_len>9</max_len>
                    </element>
                  </segment>
<!--End of CR7 segment-->
                  <segment xid="HSD">
                    <name>Health Care Services Delivery</name>
                    <usage>S</usage>
                    <pos>243</pos>
                    <max_use>3</max_use>
                    <element xid="HSD01">
                      <data_ele>673</data_ele>
                      <name>Visits</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>VS</code>
                      </valid_codes>
                    </element>
                    <element xid="HSD02">
                      <data_ele>380</data_ele>
                      <name>Number of Visits</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>Frequency Period</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>Q1</code>
                        <code>WK</code>
                      </valid_codes>
                    </element>
                    <element xid="HSD04">
                      <data_ele>1167</data_ele>
                      <name>Frequency Count</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>Duration of Visits Units</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>7</code>
                        <code>35</code>
                      </valid_codes>
                    </element>
                    <element xid="HSD06">
                      <data_ele>616</data_ele>
                      <name>Duration of Visits, Number of Units</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>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>N</code>
                        <code>O</code>
                        <code>S</code>
                        <code>W</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>
                      </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>D</code>
                        <code>E</code>
                        <code>F</code>
                      </valid_codes>
                    </element>
                  </segment>
<!--End of HSD segment-->
                </loop>
<!--End of 2305 loop-->
                <loop xid="2310A">
                  <name>Referring Provider Name</name>
                  <usage>S</usage>
                  <pos>250</pos>
                  <count>2</count>
                  <segment xid="NM1">
                    <name>Referring Provider Name</name>
                    <usage>S</usage>
                    <pos>250</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>DN</code>
                        <code>P3</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>Referring Provider Last Name</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>35</max_len>
                    </element>
                    <element xid="NM104">
                      <data_ele>1036</data_ele>
                      <name>Referring 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>Referring 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>Referring 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>XX</code>
                      </valid_codes>
                    </element>
                    <element xid="NM109">
                      <data_ele>67</data_ele>
                      <name>Referring 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="PRV">
                    <name>Referring Provider Specialty Information</name>
                    <usage>S</usage>
                    <pos>255</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>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-->
                  <segment xid="N2">
                    <name>Additional Referring Provider Name Information</name>
                    <usage>S</usage>
                    <pos>260</pos>
                    <max_use>1</max_use>
                    <element xid="N201">
                      <data_ele>93</data_ele>
                      <name>Referring Provider Name Additional Text</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>60</max_len>
                    </element>
                    <element xid="N202">
                      <data_ele>93</data_ele>
                      <name>Name</name>
                      <usage>N</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>60</max_len>
                    </element>
                  </segment>
<!--End of N2 segment-->
                  <segment xid="REF">
                    <name>Referring Provider Secondary Identification</name>
                    <usage>S</usage>
                    <pos>271</pos>
                    <max_use>5</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>0B</code>
                        <code>1B</code>
                        <code>1C</code>
                        <code>1D</code>
                        <code>1G</code>
                        <code>1H</code>
                        <code>EI</code>
                        <code>G2</code>
                        <code>LU</code>
                        <code>N5</code>
                        <code>SY</code>
                        <code>X5</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Referring Provider Secondary 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-->
                </loop>
<!--End of 2310A loop-->
                <loop xid="2310B">
                  <name>Rendering Provider Name</name>
                  <usage>S</usage>
                  <pos>250</pos>
                  <count>1</count>
                  <segment xid="NM1">
                    <name>Rendering Provider Name</name>
                    <usage>S</usage>
                    <pos>250</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>82</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>Rendering Provider Last or Organization Name</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>35</max_len>
                    </element>
                    <element xid="NM104">
                      <data_ele>1036</data_ele>
                      <name>Rendering 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>Rendering 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>Rendering 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>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>XX</code>
                      </valid_codes>
                    </element>
                    <element xid="NM109">
                      <data_ele>67</data_ele>
                      <name>Rendering Provider 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="PRV">
                    <name>Rendering Provider Specialty Information</name>
                    <usage>R</usage>
                    <pos>255</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>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-->
                  <segment xid="N2">
                    <name>Additional Rendering Provider Name Information</name>
                    <usage>S</usage>
                    <pos>260</pos>
                    <max_use>1</max_use>
                    <element xid="N201">
                      <data_ele>93</data_ele>
                      <name>Rendering Provider Name Additional Text</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>60</max_len>
                    </element>
                    <element xid="N202">
                      <data_ele>93</data_ele>
                      <name>Name</name>
                      <usage>N</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>60</max_len>
                    </element>
                  </segment>
<!--End of N2 segment-->
                  <segment xid="REF">
                    <name>Rendering Provider Secondary Identification</name>
                    <usage>S</usage>
                    <pos>271</pos>
                    <max_use>5</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>0B</code>
                        <code>1B</code>
                        <code>1C</code>
                        <code>1D</code>
                        <code>1G</code>
                        <code>1H</code>
                        <code>EI</code>
                        <code>G2</code>
                        <code>LU</code>
                        <code>N5</code>
                        <code>SY</code>
                        <code>X5</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Rendering Provider Secondary 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-->
                </loop>
<!--End of 2310B loop-->
                <loop xid="2310C">
                  <name>Purchased Service Provider Name</name>
                  <usage>S</usage>
                  <pos>250</pos>
                  <count>1</count>
                  <segment xid="NM1">
                    <name>Purchased Service Provider Name</name>
                    <usage>S</usage>
                    <pos>250</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>QB</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>Name Last or Organization Name</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>35</max_len>
                    </element>
                    <element xid="NM104">
                      <data_ele>1036</data_ele>
                      <name>Name First</name>
                      <usage>N</usage>
                      <seq>04</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>25</max_len>
                    </element>
                    <element xid="NM105">
                      <data_ele>1037</data_ele>
                      <name>Name Middle</name>
                      <usage>N</usage>
                      <seq>05</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>25</max_len>
                    </element>
                    <element xid="NM106">
                      <data_ele>1038</data_ele>
                      <name>Name Prefix</name>
                      <usage>N</usage>
                      <seq>06</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>10</max_len>
                    </element>
                    <element xid="NM107">
                      <data_ele>1039</data_ele>
                      <name>Name Suffix</name>
                      <usage>N</usage>
                      <seq>07</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>10</max_len>
                    </element>
                    <element xid="NM108">
                      <data_ele>66</data_ele>
                      <name>Identification Code Qualifier</name>
                      <usage>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>XX</code>
                      </valid_codes>
                    </element>
                    <element xid="NM109">
                      <data_ele>67</data_ele>
                      <name>Purchased 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>Purchased Service Provider Secondary Identification</name>
                    <usage>S</usage>
                    <pos>271</pos>
                    <max_use>5</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>0B</code>
                        <code>1A</code>
                        <code>1B</code>
                        <code>1C</code>
                        <code>1D</code>
                        <code>1G</code>
                        <code>1H</code>
                        <code>EI</code>
                        <code>G2</code>
                        <code>LU</code>
                        <code>N5</code>
                        <code>SY</code>
                        <code>U3</code>
                        <code>X5</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Purchased Service Provider Secondary 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-->
                </loop>
<!--End of 2310C loop-->
                <loop xid="2310D">
                  <name>Service Facility Location</name>
                  <usage>S</usage>
                  <pos>250</pos>
                  <count>1</count>
                  <segment xid="NM1">
                    <name>Service Facility Location</name>
                    <usage>S</usage>
                    <pos>250</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>77</code>
                        <code>FA</code>
                        <code>LI</code>
                        <code>TL</code>
                      </valid_codes>
                    </element>
                    <element xid="NM102">
                      <data_ele>1065</data_ele>
                      <name>Entity Type Qualifier</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>2</code>
                      </valid_codes>
                    </element>
                    <element xid="NM103">
                      <data_ele>1035</data_ele>
                      <name>Laboratory or Facility 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>Name First</name>
                      <usage>N</usage>
                      <seq>04</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>25</max_len>
                    </element>
                    <element xid="NM105">
                      <data_ele>1037</data_ele>
                      <name>Name Middle</name>
                      <usage>N</usage>
                      <seq>05</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>25</max_len>
                    </element>
                    <element xid="NM106">
                      <data_ele>1038</data_ele>
                      <name>Name Prefix</name>
                      <usage>N</usage>
                      <seq>06</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>10</max_len>
                    </element>
                    <element xid="NM107">
                      <data_ele>1039</data_ele>
                      <name>Name Suffix</name>
                      <usage>N</usage>
                      <seq>07</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>10</max_len>
                    </element>
                    <element xid="NM108">
                      <data_ele>66</data_ele>
                      <name>Identification Code Qualifier</name>
                      <usage>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>XX</code>
                      </valid_codes>
                    </element>
                    <element xid="NM109">
                      <data_ele>67</data_ele>
                      <name>Laboratory or Facility 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="N2">
                    <name>Additional Service Facility Location Name Information</name>
                    <usage>S</usage>
                    <pos>260</pos>
                    <max_use>1</max_use>
                    <element xid="N201">
                      <data_ele>93</data_ele>
                      <name>Laboratory or Facility Name Additional Text</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>60</max_len>
                    </element>
                    <element xid="N202">
                      <data_ele>93</data_ele>
                      <name>Name</name>
                      <usage>N</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>60</max_len>
                    </element>
                  </segment>
<!--End of N2 segment-->
                  <segment xid="N3">
                    <name>Service Facility Location Address</name>
                    <usage>R</usage>
                    <pos>265</pos>
                    <max_use>1</max_use>
                    <element xid="N301">
                      <data_ele>166</data_ele>
                      <name>Laboratory or Facility 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>Laboratory or Facility 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 Facility Location City/State/ZIP</name>
                    <usage>R</usage>
                    <pos>270</pos>
                    <max_use>1</max_use>
                    <element xid="N401">
                      <data_ele>19</data_ele>
                      <name>Laboratory or Facility City Name</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>2</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="N402">
                      <data_ele>156</data_ele>
                      <name>Laboratory or Facility State or Province Code</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes external="states"/>
                    </element>
                    <element xid="N403">
                      <data_ele>116</data_ele>
                      <name>Laboratory or Facility Postal Zone or ZIP Code</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>3</min_len>
                      <max_len>15</max_len>
                    </element>
                    <element xid="N404">
                      <data_ele>26</data_ele>
                      <name>Laboratory/Facility 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="REF">
                    <name>Service Facility Location Secondary Identification</name>
                    <usage>S</usage>
                    <pos>271</pos>
                    <max_use>5</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>0B</code>
                        <code>1A</code>
                        <code>1B</code>
                        <code>1C</code>
                        <code>1D</code>
                        <code>1G</code>
                        <code>1H</code>
                        <code>G2</code>
                        <code>LU</code>
                        <code>N5</code>
                        <code>TJ</code>
                        <code>X4</code>
                        <code>X5</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Laboratory or Facility Secondary 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-->
                </loop>
<!--End of 2310D loop-->
                <loop xid="2310E">
                  <name>Supervising Provider Name</name>
                  <usage>S</usage>
                  <pos>250</pos>
                  <count>1</count>
                  <segment xid="NM1">
                    <name>Supervising Provider Name</name>
                    <usage>S</usage>
                    <pos>250</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>DQ</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>Supervising Provider Last Name</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>35</max_len>
                    </element>
                    <element xid="NM104">
                      <data_ele>1036</data_ele>
                      <name>Supervising Provider First Name</name>
                      <usage>R</usage>
                      <seq>04</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>25</max_len>
                    </element>
                    <element xid="NM105">
                      <data_ele>1037</data_ele>
                      <name>Supervising 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>Supervising 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>XX</code>
                      </valid_codes>
                    </element>
                    <element xid="NM109">
                      <data_ele>67</data_ele>
                      <name>Supervising 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="N2">
                    <name>Additional Supervising Provider Name Information</name>
                    <usage>S</usage>
                    <pos>260</pos>
                    <max_use>1</max_use>
                    <element xid="N201">
                      <data_ele>93</data_ele>
                      <name>Supervising Provider Name Additional Text</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>60</max_len>
                    </element>
                    <element xid="N202">
                      <data_ele>93</data_ele>
                      <name>Name</name>
                      <usage>N</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>60</max_len>
                    </element>
                  </segment>
<!--End of N2 segment-->
                  <segment xid="REF">
                    <name>Supervising Provider Secondary Identification</name>
                    <usage>S</usage>
                    <pos>271</pos>
                    <max_use>5</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>0B</code>
                        <code>1B</code>
                        <code>1C</code>
                        <code>1D</code>
                        <code>1G</code>
                        <code>1H</code>
                        <code>EI</code>
                        <code>G2</code>
                        <code>LU</code>
                        <code>N5</code>
                        <code>SY</code>
                        <code>X5</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Supervising Provider Secondary 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-->
                </loop>
<!--End of 2310E loop-->
                <loop xid="2320">
                  <name>Other Subscriber Information</name>
                  <usage>S</usage>
                  <pos>290</pos>
                  <count>10</count>
                  <segment xid="SBR">
                    <name>Other Subscriber Information</name>
                    <usage>S</usage>
                    <pos>290</pos>
                    <max_use>1</max_use>
                    <element xid="SBR01">
                      <data_ele>1138</data_ele>
                      <name>Payer Responsibility Sequence Number Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>P</code>
                        <code>S</code>
                        <code>T</code>
                      </valid_codes>
                    </element>
                    <element xid="SBR02">
                      <data_ele>1069</data_ele>
                      <name>Individual Relationship Code</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>01</code>
                        <code>04</code>
                        <code>05</code>
                        <code>07</code>
                        <code>10</code>
                        <code>15</code>
                        <code>17</code>
                        <code>18</code>
                        <code>19</code>
                        <code>20</code>
                        <code>21</code>
                        <code>22</code>
                        <code>23</code>
                        <code>24</code>
                        <code>29</code>
                        <code>32</code>
                        <code>33</code>
                        <code>36</code>
                        <code>39</code>
                        <code>40</code>
                        <code>41</code>
                        <code>43</code>
                        <code>53</code>
                        <code>G8</code>
                      </valid_codes>
                    </element>
                    <element xid="SBR03">
                      <data_ele>127</data_ele>
                      <name>Insured Group or Policy Number</name>
                      <usage>S</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="SBR04">
                      <data_ele>93</data_ele>
                      <name>Other Insured Group Name</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>60</max_len>
                    </element>
                    <element xid="SBR05">
                      <data_ele>1336</data_ele>
                      <name>Insurance Type Code</name>
                      <usage>R</usage>
                      <seq>05</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>AP</code>
                        <code>C1</code>
                        <code>CP</code>
                        <code>GP</code>
                        <code>HM</code>
                        <code>IP</code>
                        <code>LD</code>
                        <code>LT</code>
                        <code>MB</code>
                        <code>MC</code>
                        <code>MI</code>
                        <code>MP</code>
                        <code>OT</code>
                        <code>PP</code>
                        <code>SP</code>
                      </valid_codes>
                    </element>
                    <element xid="SBR06">
                      <data_ele>1143</data_ele>
                      <name>Coordination of Benefits 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="SBR07">
                      <data_ele>1073</data_ele>
                      <name>Yes/No Condition or Response 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="SBR08">
                      <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="SBR09">
                      <data_ele>1032</data_ele>
                      <name>Claim Filing Indicator Code</name>
                      <usage>S</usage>
                      <seq>09</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>09</code>
                        <code>10</code>
                        <code>11</code>
                        <code>12</code>
                        <code>13</code>
                        <code>14</code>
                        <code>15</code>
                        <code>16</code>
                        <code>AM</code>
                        <code>BL</code>
                        <code>CH</code>
                        <code>CI</code>
                        <code>DS</code>
                        <code>HM</code>
                        <code>LI</code>
                        <code>LM</code>
                        <code>MB</code>
                        <code>MC</code>
                        <code>OF</code>
                        <code>TV</code>
                        <code>VA</code>
                        <code>WC</code>
                        <code>ZZ</code>
                      </valid_codes>
                    </element>
                  </segment>
<!--End of SBR segment-->
                  <segment xid="CAS">
                    <name>Claim Level Adjustments</name>
                    <usage>S</usage>
                    <pos>295</pos>
                    <max_use>5</max_use>
                    <element xid="CAS01">
                      <data_ele>1033</data_ele>
                      <name>Claim Adjustment Group 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>CO</code>
                        <code>CR</code>
                        <code>OA</code>
                        <code>PI</code>
                        <code>PR</code>
                      </valid_codes>
                    </element>
                    <element xid="CAS02">
                      <data_ele>1034</data_ele>
                      <name>Adjustment Reason Code</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>5</max_len>
                      <valid_codes external="adjustment_reason"/>
                    </element>
                    <element xid="CAS03">
                      <data_ele>782</data_ele>
                      <name>Adjustment Amount</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="CAS04">
                      <data_ele>380</data_ele>
                      <name>Adjustment Quantity</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                    <element xid="CAS05">
                      <data_ele>1034</data_ele>
                      <name>Adjustment Reason Code</name>
                      <usage>S</usage>
                      <seq>05</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>5</max_len>
                      <valid_codes external="adjustment_reason"/>
                    </element>
                    <element xid="CAS06">
                      <data_ele>782</data_ele>
                      <name>Adjustment Amount</name>
                      <usage>S</usage>
                      <seq>06</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="CAS07">
                      <data_ele>380</data_ele>
                      <name>Adjustment Quantity</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="CAS08">
                      <data_ele>1034</data_ele>
                      <name>Adjustment Reason Code</name>
                      <usage>S</usage>
                      <seq>08</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>5</max_len>
                      <valid_codes external="adjustment_reason"/>
                    </element>
                    <element xid="CAS09">
                      <data_ele>782</data_ele>
                      <name>Adjustment Amount</name>
                      <usage>S</usage>
                      <seq>09</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="CAS10">
                      <data_ele>380</data_ele>
                      <name>Adjustment Quantity</name>
                      <usage>S</usage>
                      <seq>10</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                    <element xid="CAS11">
                      <data_ele>1034</data_ele>
                      <name>Adjustment Reason Code</name>
                      <usage>S</usage>
                      <seq>11</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>5</max_len>
                      <valid_codes external="adjustment_reason"/>
                    </element>
                    <element xid="CAS12">
                      <data_ele>782</data_ele>
                      <name>Adjustment Amount</name>
                      <usage>S</usage>
                      <seq>12</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="CAS13">
                      <data_ele>380</data_ele>
                      <name>Adjustment Quantity</name>
                      <usage>S</usage>
                      <seq>13</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                    <element xid="CAS14">
                      <data_ele>1034</data_ele>
                      <name>Adjustment Reason Code</name>
                      <usage>S</usage>
                      <seq>14</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>5</max_len>
                      <valid_codes external="adjustment_reason"/>
                    </element>
                    <element xid="CAS15">
                      <data_ele>782</data_ele>
                      <name>Adjustment Amount</name>
                      <usage>S</usage>
                      <seq>15</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="CAS16">
                      <data_ele>380</data_ele>
                      <name>Adjustment Quantity</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="CAS17">
                      <data_ele>1034</data_ele>
                      <name>Adjustment Reason Code</name>
                      <usage>S</usage>
                      <seq>17</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>5</max_len>
                      <valid_codes external="adjustment_reason"/>
                    </element>
                    <element xid="CAS18">
                      <data_ele>782</data_ele>
                      <name>Adjustment Amount</name>
                      <usage>S</usage>
                      <seq>18</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="CAS19">
                      <data_ele>380</data_ele>
                      <name>Adjustment Quantity</name>
                      <usage>S</usage>
                      <seq>19</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                  </segment>
<!--End of CAS segment-->
                  <segment xid="AMT">
                    <name>Coordination of Benefits (COB) Payer Paid Amount</name>
                    <usage>S</usage>
                    <pos>300</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>D</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Payer Paid Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Coordination of Benefits (COB) Approved Amount</name>
                    <usage>S</usage>
                    <pos>300</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>AAE</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Approved Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Coordination of Benefits (COB) Allowed Amount</name>
                    <usage>S</usage>
                    <pos>300</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>B6</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Allowed Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Coordination of Benefits (COB) Patient Responsibility Amount</name>
                    <usage>S</usage>
                    <pos>300</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>F2</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Other Payer Patient Responsibility Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Coordination of Benefits (COB) Covered Amount</name>
                    <usage>S</usage>
                    <pos>300</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>AU</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Other Payer Covered Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Coordination of Benefits (COB) Discount Amount</name>
                    <usage>S</usage>
                    <pos>300</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>D8</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Other Payer Discount Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Coordination of Benefits (COB) Per Day Limit Amount</name>
                    <usage>S</usage>
                    <pos>300</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>DY</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Other Payer Per Day Limit Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Coordination of Benefits (COB) Patient Paid Amount</name>
                    <usage>S</usage>
                    <pos>300</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>F5</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Other Payer Patient Paid Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Coordination of Benefits (COB) Tax Amount</name>
                    <usage>S</usage>
                    <pos>300</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>T</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Other Payer Tax Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Coordination of Benefits (COB) Total Claim Before Taxes Amount</name>
                    <usage>S</usage>
                    <pos>300</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>T2</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Other Payer Pre-Tax Claim Total Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="DMG">
                    <name>Subscriber Demographic Information</name>
                    <usage>S</usage>
                    <pos>305</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>Other Insured Birth Date</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>35</max_len>
                    </element>
                    <element xid="DMG03">
                      <data_ele>1068</data_ele>
                      <name>Other Insured Gender Code</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>F</code>
                        <code>M</code>
                        <code>U</code>
                      </valid_codes>
                    </element>
                    <element xid="DMG04">
                      <data_ele>1067</data_ele>
                      <name>Marital Status Code</name>
                      <usage>N</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="DMG05">
                      <data_ele>1109</data_ele>
                      <name>Race or Ethnicity Code</name>
                      <usage>N</usage>
                      <seq>05</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="DMG6">
                      <data_ele>1066</data_ele>
                      <name>Citizenship Status Code</name>
                      <usage>N</usage>
                      <seq>6</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="OI">
                    <name>Other Insurance Coverage Information</name>
                    <usage>R</usage>
                    <pos>310</pos>
                    <max_use>1</max_use>
                    <element xid="OI01">
                      <data_ele>1032</data_ele>
                      <name>Claim Filing Indicator Code</name>
                      <usage>N</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="OI02">
                      <data_ele>1383</data_ele>
                      <name>Claim Submission Reason 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="OI03">
                      <data_ele>1073</data_ele>
                      <name>Benefits Assignment Certification Indicator</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>N</code>
                        <code>Y</code>
                      </valid_codes>
                    </element>
                    <element xid="OI04">
                      <data_ele>1351</data_ele>
                      <name>Patient Signature Source Code</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>B</code>
                        <code>C</code>
                        <code>M</code>
                        <code>P</code>
                        <code>S</code>
                      </valid_codes>
                    </element>
                    <element xid="OI05">
                      <data_ele>1360</data_ele>
                      <name>Provider Agreement 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="OI06">
                      <data_ele>1363</data_ele>
                      <name>Release of Information Code</name>
                      <usage>R</usage>
                      <seq>06</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>A</code>
                        <code>I</code>
                        <code>M</code>
                        <code>N</code>
                        <code>O</code>
                        <code>Y</code>
                      </valid_codes>
                    </element>
                  </segment>
<!--End of OI segment-->
                  <segment xid="MOA">
                    <name>Medicare Outpatient Adjudication Information</name>
                    <usage>S</usage>
                    <pos>320</pos>
                    <max_use>1</max_use>
                    <element xid="MOA01">
                      <data_ele>954</data_ele>
                      <name>Reimbursement Rate</name>
                      <usage>S</usage>
                      <seq>01</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>10</max_len>
                    </element>
                    <element xid="MOA02">
                      <data_ele>782</data_ele>
                      <name>HCPCS Payable Amount</name>
                      <usage>S</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="MOA03">
                      <data_ele>127</data_ele>
                      <name>Remark Code</name>
                      <usage>S</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                      <valid_codes external="remark_code"/>
                    </element>
                    <element xid="MOA04">
                      <data_ele>127</data_ele>
                      <name>Remark Code</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                      <valid_codes external="remark_code"/>
                    </element>
                    <element xid="MOA05">
                      <data_ele>127</data_ele>
                      <name>Remark Code</name>
                      <usage>S</usage>
                      <seq>05</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                      <valid_codes external="remark_code"/>
                    </element>
                    <element xid="MOA06">
                      <data_ele>127</data_ele>
                      <name>Remark Code</name>
                      <usage>S</usage>
                      <seq>06</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                      <valid_codes external="remark_code"/>
                    </element>
                    <element xid="MOA07">
                      <data_ele>127</data_ele>
                      <name>Remark Code</name>
                      <usage>S</usage>
                      <seq>07</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                      <valid_codes external="remark_code"/>
                    </element>
                    <element xid="MOA08">
                      <data_ele>782</data_ele>
                      <name>End Stage Renal Disease Payment Amount</name>
                      <usage>S</usage>
                      <seq>08</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="MOA09">
                      <data_ele>782</data_ele>
                      <name>Non-Payable Professional Component Billed Amount</name>
                      <usage>S</usage>
                      <seq>09</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                  </segment>
<!--End of MOA segment-->
                  <loop xid="2330A">
                    <name>Other Subscriber Name</name>
                    <usage>R</usage>
                    <pos>325</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Other Subscriber Name</name>
                      <usage>R</usage>
                      <pos>325</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>
                          <code>2</code>
                        </valid_codes>
                      </element>
                      <element xid="NM103">
                        <data_ele>1035</data_ele>
                        <name>Other Insured Last Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Other Insured 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>Other Insured Middle Name</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>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>Other Insured Name Suffix</name>
                        <usage>S</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>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>Other Insured 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="N2">
                      <name>Additional Other Subscriber Name Information</name>
                      <usage>S</usage>
                      <pos>330</pos>
                      <max_use>1</max_use>
                      <element xid="N201">
                        <data_ele>93</data_ele>
                        <name>Other Insured Additional Name</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="N202">
                        <data_ele>93</data_ele>
                        <name>Name</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                    </segment>
<!--End of N2 segment-->
                    <segment xid="N3">
                      <name>Other Subscriber Address</name>
                      <usage>S</usage>
                      <pos>332</pos>
                      <max_use>1</max_use>
                      <element xid="N301">
                        <data_ele>166</data_ele>
                        <name>Other Insured 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>Other Insured 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>Other Subscriber City/State/ZIP Code</name>
                      <usage>S</usage>
                      <pos>340</pos>
                      <max_use>1</max_use>
                      <element xid="N401">
                        <data_ele>19</data_ele>
                        <name>Other Insured 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>Other Insured State 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>Other Insured 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>Subscriber 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="REF">
                      <name>Other Subscriber Secondary Identification</name>
                      <usage>S</usage>
                      <pos>355</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>1W</code>
                          <code>23</code>
                          <code>IG</code>
                          <code>SY</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Other Insured Additional 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-->
                  </loop>
<!--End of 2330A loop-->
                  <loop xid="2330B">
                    <name>Other Payer Name</name>
                    <usage>R</usage>
                    <pos>325</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Other Payer Name</name>
                      <usage>R</usage>
                      <pos>325</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>PR</code>
                        </valid_codes>
                      </element>
                      <element xid="NM102">
                        <data_ele>1065</data_ele>
                        <name>Entity Type Qualifier</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>2</code>
                        </valid_codes>
                      </element>
                      <element xid="NM103">
                        <data_ele>1035</data_ele>
                        <name>Other Payer Last or Organization Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>R</usage>
                        <seq>08</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>PI</code>
                          <code>XV</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Other Payer 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="N2">
                      <name>Additional Other Payer Name Information</name>
                      <usage>S</usage>
                      <pos>330</pos>
                      <max_use>1</max_use>
                      <element xid="N201">
                        <data_ele>93</data_ele>
                        <name>Other Payer Additional Name Text</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="N202">
                        <data_ele>93</data_ele>
                        <name>Name</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                    </segment>
<!--End of N2 segment-->
                    <segment xid="PER">
                      <name>Other Payer Contact Information</name>
                      <usage>S</usage>
                      <pos>345</pos>
                      <max_use>2</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>Other Payer Contact Name</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="PER03">
                        <data_ele>365</data_ele>
                        <name>Communication Number Qualifier</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>ED</code>
                          <code>EM</code>
                          <code>FX</code>
                          <code>TE</code>
                        </valid_codes>
                      </element>
                      <element xid="PER04">
                        <data_ele>364</data_ele>
                        <name>Communication Number</name>
                        <usage>R</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="PER05">
                        <data_ele>365</data_ele>
                        <name>Communication Number Qualifier</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>ED</code>
                          <code>EM</code>
                          <code>EX</code>
                          <code>FX</code>
                          <code>TE</code>
                        </valid_codes>
                      </element>
                      <element xid="PER06">
                        <data_ele>364</data_ele>
                        <name>Communication Number</name>
                        <usage>S</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="PER07">
                        <data_ele>365</data_ele>
                        <name>Communication Number Qualifier</name>
                        <usage>S</usage>
                        <seq>07</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>ED</code>
                          <code>EM</code>
                          <code>EX</code>
                          <code>FX</code>
                          <code>TE</code>
                        </valid_codes>
                      </element>
                      <element xid="PER08">
                        <data_ele>364</data_ele>
                        <name>Communication Number</name>
                        <usage>S</usage>
                        <seq>08</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="PER09">
                        <data_ele>443</data_ele>
                        <name>Contact Inquiry Reference</name>
                        <usage>N</usage>
                        <seq>09</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>20</max_len>
                      </element>
                    </segment>
<!--End of PER segment-->
                    <segment xid="DTP">
                      <name>Claim Adjudication Date</name>
                      <usage>S</usage>
                      <pos>345</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>573</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>Adjudication or Payment 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="REF">
                      <name>Other Payer Secondary Identifier</name>
                      <usage>S</usage>
                      <pos>355</pos>
                      <max_use>2</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>2U</code>
                          <code>F8</code>
                          <code>FY</code>
                          <code>NF</code>
                          <code>TJ</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Other Payer Secondary Identifier</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Other Payer Prior Authorization or Referral Number</name>
                      <usage>S</usage>
                      <pos>355</pos>
                      <max_use>2</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>9F</code>
                          <code>G1</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Other Payer Prior Authorization or Referral Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Other Payer Claim Adjustment Indicator</name>
                      <usage>S</usage>
                      <pos>355</pos>
                      <max_use>2</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>T4</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Other Payer Claim Adjustment Indicator</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                        <valid_codes>
                          <code>Y</code>
                        </valid_codes>
                      </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-->
                  </loop>
<!--End of 2330B loop-->
                  <loop xid="2330C">
                    <name>Other Payer Patient Information</name>
                    <usage>S</usage>
                    <pos>325</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Other Payer Patient Information</name>
                      <usage>S</usage>
                      <pos>325</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>Patient Last Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>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>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Other Payer Patient 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>Other Payer Patient Identification</name>
                      <usage>S</usage>
                      <pos>355</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>1W</code>
                          <code>23</code>
                          <code>IG</code>
                          <code>SY</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Other Payer Patient Secondary 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-->
                  </loop>
<!--End of 2330C loop-->
                  <loop xid="2330D">
                    <name>Other Payer Referring Provider</name>
                    <usage>S</usage>
                    <pos>325</pos>
                    <count>2</count>
                    <segment xid="NM1">
                      <name>Other Payer Referring Provider</name>
                      <usage>S</usage>
                      <pos>325</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>DN</code>
                          <code>P3</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>Referring Provider Last Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>N</usage>
                        <seq>08</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Identification Code</name>
                        <usage>N</usage>
                        <seq>09</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="NM110">
                        <data_ele>706</data_ele>
                        <name>Entity Relationship Code</name>
                        <usage>N</usage>
                        <seq>10</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="NM111">
                        <data_ele>98</data_ele>
                        <name>Entity Identifier Code</name>
                        <usage>N</usage>
                        <seq>11</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                    </segment>
<!--End of NM1 segment-->
                    <segment xid="REF">
                      <name>Other Payer Referring Provider Identification</name>
                      <usage>R</usage>
                      <pos>355</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>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Other Payer Referring Provider 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-->
                  </loop>
<!--End of 2330D loop-->
                  <loop xid="2330E">
                    <name>Other Payer Rendering Provider</name>
                    <usage>S</usage>
                    <pos>325</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Other Payer Rendering Provider</name>
                      <usage>S</usage>
                      <pos>325</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>82</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>Rendering Provider Last or Organization Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>N</usage>
                        <seq>08</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Identification Code</name>
                        <usage>N</usage>
                        <seq>09</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="NM110">
                        <data_ele>706</data_ele>
                        <name>Entity Relationship Code</name>
                        <usage>N</usage>
                        <seq>10</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="NM111">
                        <data_ele>98</data_ele>
                        <name>Entity Identifier Code</name>
                        <usage>N</usage>
                        <seq>11</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                    </segment>
<!--End of NM1 segment-->
                    <segment xid="REF">
                      <name>Other Payer Rendering Provider Secondary Identification</name>
                      <usage>R</usage>
                      <pos>355</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>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Other Payer Rendering Provider Secondary 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-->
                  </loop>
<!--End of 2330E loop-->
                  <loop xid="2330F">
                    <name>Other Payer Purchased Service Provider</name>
                    <usage>S</usage>
                    <pos>325</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Other Payer Purchased Service Provider</name>
                      <usage>S</usage>
                      <pos>325</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>QB</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>Purchased Service Provider Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>N</usage>
                        <seq>08</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Identification Code</name>
                        <usage>N</usage>
                        <seq>09</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="NM110">
                        <data_ele>706</data_ele>
                        <name>Entity Relationship Code</name>
                        <usage>N</usage>
                        <seq>10</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="NM111">
                        <data_ele>98</data_ele>
                        <name>Entity Identifier Code</name>
                        <usage>N</usage>
                        <seq>11</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                    </segment>
<!--End of NM1 segment-->
                    <segment xid="REF">
                      <name>Other Payer Purchased Service Provider Identification</name>
                      <usage>R</usage>
                      <pos>355</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>1A</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Other Payer Purchased Service Provider 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-->
                  </loop>
<!--End of 2330F loop-->
                  <loop xid="2330G">
                    <name>Other Payer Service Facility Location</name>
                    <usage>S</usage>
                    <pos>325</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Other Payer Service Facility Location</name>
                      <usage>S</usage>
                      <pos>325</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>77</code>
                          <code>FA</code>
                          <code>LI</code>
                          <code>TL</code>
                        </valid_codes>
                      </element>
                      <element xid="NM102">
                        <data_ele>1065</data_ele>
                        <name>Entity Type Qualifier</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>2</code>
                        </valid_codes>
                      </element>
                      <element xid="NM103">
                        <data_ele>1035</data_ele>
                        <name>Service Facility Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>N</usage>
                        <seq>08</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Identification Code</name>
                        <usage>N</usage>
                        <seq>09</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="NM110">
                        <data_ele>706</data_ele>
                        <name>Entity Relationship Code</name>
                        <usage>N</usage>
                        <seq>10</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="NM111">
                        <data_ele>98</data_ele>
                        <name>Entity Identifier Code</name>
                        <usage>N</usage>
                        <seq>11</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                    </segment>
<!--End of NM1 segment-->
                    <segment xid="REF">
                      <name>Other Payer Service Facility Location Identification</name>
                      <usage>R</usage>
                      <pos>355</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>1A</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Other Payer Service Facility Location 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-->
                  </loop>
<!--End of 2330G loop-->
                  <loop xid="2330H">
                    <name>Other Payer Supervising Provider</name>
                    <usage>S</usage>
                    <pos>325</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Other Payer Supervising Provider</name>
                      <usage>S</usage>
                      <pos>325</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>DQ</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>Supervising Provider Last Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>N</usage>
                        <seq>08</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Identification Code</name>
                        <usage>N</usage>
                        <seq>09</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="NM110">
                        <data_ele>706</data_ele>
                        <name>Entity Relationship Code</name>
                        <usage>N</usage>
                        <seq>10</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="NM111">
                        <data_ele>98</data_ele>
                        <name>Entity Identifier Code</name>
                        <usage>N</usage>
                        <seq>11</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                    </segment>
<!--End of NM1 segment-->
                    <segment xid="REF">
                      <name>Other Payer Supervising Provider Identification</name>
                      <usage>R</usage>
                      <pos>355</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>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>N5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Other Payer Supervising Provider 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-->
                  </loop>
<!--End of 2330H loop-->
                </loop>
<!--End of 2320 loop-->
                <loop xid="2400">
                  <name>Service Line</name>
                  <usage>R</usage>
                  <pos>365</pos>
                  <count>50</count>
                  <segment xid="LX">
                    <name>Service Line</name>
                    <usage>R</usage>
                    <pos>365</pos>
                    <max_use>1</max_use>
                    <element xid="LX01">
                      <data_ele>554</data_ele>
                      <name>Line Counter</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>N0</data_type>
                      <min_len>1</min_len>
                      <max_len>6</max_len>
                    </element>
                  </segment>
<!--End of LX segment-->
                  <segment xid="SV1">
                    <name>Professional Service</name>
                    <usage>R</usage>
                    <pos>370</pos>
                    <max_use>1</max_use>
                    <composite>
                      <data_ele>C003</data_ele>
                      <name>Procedure Identifier</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <element xid="SV101-01">
                        <data_ele>235</data_ele>
                        <name>Product or Service ID 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>HC</code>
                          <code>IV</code>
                          <code>N1</code>
                          <code>N2</code>
                          <code>N3</code>
                          <code>N4</code>
                          <code>ZZ</code>
                        </valid_codes>
                      </element>
                      <element xid="SV101-02">
                        <data_ele>234</data_ele>
                        <name>Procedure Code</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>48</max_len>
                      </element>
                      <element xid="SV101-03">
                        <data_ele>1339</data_ele>
                        <name>Procedure Modifier 1</name>
                        <usage>S</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SV101-04">
                        <data_ele>1339</data_ele>
                        <name>Procedure Modifier 2</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SV101-05">
                        <data_ele>1339</data_ele>
                        <name>Procedure Modifier 3</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SV101-06">
                        <data_ele>1339</data_ele>
                        <name>Procedure Modifier 4</name>
                        <usage>S</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SV101-07">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                    </composite>
                    <element xid="SV102">
                      <data_ele>782</data_ele>
                      <name>Line Item Change Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="SV103">
                      <data_ele>355</data_ele>
                      <name>Unit or Basis for Measurement 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>F2</code>
                        <code>MJ</code>
                        <code>UN</code>
                      </valid_codes>
                    </element>
                    <element xid="SV104">
                      <data_ele>380</data_ele>
                      <name>Service Unit Count</name>
                      <usage>R</usage>
                      <seq>04</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                    <element xid="SV105">
                      <data_ele>1331</data_ele>
                      <name>Place of Service Code</name>
                      <usage>S</usage>
                      <seq>05</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>11</code>
                        <code>12</code>
                        <code>21</code>
                        <code>22</code>
                        <code>23</code>
                        <code>24</code>
                        <code>25</code>
                        <code>26</code>
                        <code>31</code>
                        <code>32</code>
                        <code>33</code>
                        <code>34</code>
                        <code>41</code>
                        <code>42</code>
                        <code>50</code>
                        <code>51</code>
                        <code>52</code>
                        <code>53</code>
                        <code>54</code>
                        <code>55</code>
                        <code>56</code>
                        <code>60</code>
                        <code>61</code>
                        <code>62</code>
                        <code>65</code>
                        <code>71</code>
                        <code>72</code>
                        <code>81</code>
                        <code>99</code>
                      </valid_codes>
                    </element>
                    <element xid="SV106">
                      <data_ele>1365</data_ele>
                      <name>Service Type Code</name>
                      <usage>N</usage>
                      <seq>06</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>C004</data_ele>
                      <name>Diagnosis Code Pointer</name>
                      <usage>S</usage>
                      <seq>07</seq>
                      <element xid="SV107-01">
                        <data_ele>1328</data_ele>
                        <name>Diagnosis Code Pointer</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>N0</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>1</code>
                          <code>2</code>
                          <code>3</code>
                          <code>4</code>
                          <code>5</code>
                          <code>6</code>
                          <code>7</code>
                          <code>8</code>
                        </valid_codes>
                      </element>
                      <element xid="SV107-02">
                        <data_ele>1328</data_ele>
                        <name>Diagnosis Code Pointer</name>
                        <usage>S</usage>
                        <seq>02</seq>
                        <data_type>N0</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>1</code>
                          <code>2</code>
                          <code>3</code>
                          <code>4</code>
                          <code>5</code>
                          <code>6</code>
                          <code>7</code>
                          <code>8</code>
                        </valid_codes>
                      </element>
                      <element xid="SV107-03">
                        <data_ele>1328</data_ele>
                        <name>Diagnosis Code Pointer</name>
                        <usage>S</usage>
                        <seq>03</seq>
                        <data_type>N0</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>1</code>
                          <code>2</code>
                          <code>3</code>
                          <code>4</code>
                          <code>5</code>
                          <code>6</code>
                          <code>7</code>
                          <code>8</code>
                        </valid_codes>
                      </element>
                      <element xid="SV107-04">
                        <data_ele>1328</data_ele>
                        <name>Diagnosis Code Pointer</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>N0</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>1</code>
                          <code>2</code>
                          <code>3</code>
                          <code>4</code>
                          <code>5</code>
                          <code>6</code>
                          <code>7</code>
                          <code>8</code>
                        </valid_codes>
                      </element>
                    </composite>
                    <element xid="SV108">
                      <data_ele>782</data_ele>
                      <name>Monetary Amount</name>
                      <usage>N</usage>
                      <seq>08</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="SV109">
                      <data_ele>1073</data_ele>
                      <name>Emergency Indicator</name>
                      <usage>R</usage>
                      <seq>09</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="SV110">
                      <data_ele>1340</data_ele>
                      <name>Multiple Procedure Code</name>
                      <usage>N</usage>
                      <seq>10</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SV111">
                      <data_ele>1073</data_ele>
                      <name>EPSDT Indicator</name>
                      <usage>S</usage>
                      <seq>11</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>Y</code>
                      </valid_codes>
                    </element>
                    <element xid="SV112">
                      <data_ele>1073</data_ele>
                      <name>Family Planning Indicator</name>
                      <usage>S</usage>
                      <seq>12</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>Y</code>
                      </valid_codes>
                    </element>
                    <element xid="SV113">
                      <data_ele>1364</data_ele>
                      <name>Review Code</name>
                      <usage>N</usage>
                      <seq>13</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SV114">
                      <data_ele>1341</data_ele>
                      <name>National or Local Assigned Review Value</name>
                      <usage>N</usage>
                      <seq>14</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SV115">
                      <data_ele>1327</data_ele>
                      <name>Co-Pay Status Code</name>
                      <usage>S</usage>
                      <seq>15</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>0</code>
                      </valid_codes>
                    </element>
                    <element xid="SV116">
                      <data_ele>1334</data_ele>
                      <name>Health Care Professional Shortage Area Code</name>
                      <usage>N</usage>
                      <seq>16</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="SV117">
                      <data_ele>127</data_ele>
                      <name>Reference Identification</name>
                      <usage>N</usage>
                      <seq>17</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="SV118">
                      <data_ele>116</data_ele>
                      <name>Postal Code</name>
                      <usage>N</usage>
                      <seq>18</seq>
                      <data_type>ID</data_type>
                      <min_len>3</min_len>
                      <max_len>15</max_len>
                    </element>
                    <element xid="SV119">
                      <data_ele>782</data_ele>
                      <name>Monetary Amount</name>
                      <usage>N</usage>
                      <seq>19</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="SV120">
                      <data_ele>1337</data_ele>
                      <name>Level of Care Code</name>
                      <usage>N</usage>
                      <seq>20</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="SV121">
                      <data_ele>1360</data_ele>
                      <name>Provider Agreement Code</name>
                      <usage>N</usage>
                      <seq>21</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of SV1 segment-->
                  <segment xid="SV4">
                    <name>Prescription Number</name>
                    <usage>S</usage>
                    <pos>385</pos>
                    <max_use>1</max_use>
                    <element xid="SV401">
                      <data_ele>127</data_ele>
                      <name>Prescription Number</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <composite>
                      <data_ele>C003</data_ele>
                      <name>Composite Medical Procedure Identifier</name>
                      <usage>N</usage>
                      <seq>02</seq>
                    </composite>
                    <element xid="SV403">
                      <data_ele>127</data_ele>
                      <name>Reference Identification</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="SV404">
                      <data_ele>1073</data_ele>
                      <name>Yes/No Condition or Response 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="SV405">
                      <data_ele>1329</data_ele>
                      <name>Dispense as Written 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="SV406">
                      <data_ele>1338</data_ele>
                      <name>Level of Service Code</name>
                      <usage>N</usage>
                      <seq>06</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="SV407">
                      <data_ele>1356</data_ele>
                      <name>Prescription Origin 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="SV408">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>08</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <element xid="SV409">
                      <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="SV410">
                      <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="SV411">
                      <data_ele>1370</data_ele>
                      <name>Unit Dose Code</name>
                      <usage>N</usage>
                      <seq>11</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="SV412">
                      <data_ele>1319</data_ele>
                      <name>Basis of Cost Determination Code</name>
                      <usage>N</usage>
                      <seq>12</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SV413">
                      <data_ele>1320</data_ele>
                      <name>Basis of Days Supply Determination 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="SV414">
                      <data_ele>1330</data_ele>
                      <name>Dosage Form Code</name>
                      <usage>N</usage>
                      <seq>14</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="SV415">
                      <data_ele>1327</data_ele>
                      <name>Copay Status 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="SV416">
                      <data_ele>1384</data_ele>
                      <name>Patient Location Code</name>
                      <usage>N</usage>
                      <seq>16</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="SV417">
                      <data_ele>1337</data_ele>
                      <name>Level of Care 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="SV418">
                      <data_ele>1357</data_ele>
                      <name>Prior Authorization Type Code</name>
                      <usage>N</usage>
                      <seq>18</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of SV4 segment-->
                  <segment xid="PWK">
                    <name>DMERC CMN Indicator</name>
                    <usage>S</usage>
                    <pos>420</pos>
                    <max_use>1</max_use>
                    <element xid="PWK01">
                      <data_ele>755</data_ele>
                      <name>Attachment Report Type 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>CT</code>
                      </valid_codes>
                    </element>
                    <element xid="PWK02">
                      <data_ele>756</data_ele>
                      <name>Attachment Transmission Code</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>AB</code>
                        <code>AD</code>
                        <code>AF</code>
                        <code>AG</code>
                        <code>NS</code>
                      </valid_codes>
                    </element>
                    <element xid="PWK03">
                      <data_ele>757</data_ele>
                      <name>Report Copies Needed</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>N0</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="PWK04">
                      <data_ele>98</data_ele>
                      <name>Entity Identifier Code</name>
                      <usage>N</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="PWK05">
                      <data_ele>66</data_ele>
                      <name>Identification Code 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="PWK06">
                      <data_ele>67</data_ele>
                      <name>Identification Code</name>
                      <usage>N</usage>
                      <seq>06</seq>
                      <data_type>AN</data_type>
                      <min_len>2</min_len>
                      <max_len>80</max_len>
                    </element>
                    <element xid="PWK07">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>07</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C002</data_ele>
                      <name>Actions Indicated</name>
                      <usage>N</usage>
                      <seq>08</seq>
                    </composite>
                    <element xid="PWK09">
                      <data_ele>1525</data_ele>
                      <name>Request Category Code</name>
                      <usage>N</usage>
                      <seq>09</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                  </segment>
<!--End of PWK segment-->
                  <segment xid="CR1">
                    <name>Ambulance Transport Information</name>
                    <usage>S</usage>
                    <pos>425</pos>
                    <max_use>1</max_use>
                    <element xid="CR101">
                      <data_ele>355</data_ele>
                      <name>Unit or Basis for Measurement Code</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>LB</code>
                      </valid_codes>
                    </element>
                    <element xid="CR102">
                      <data_ele>81</data_ele>
                      <name>Patient Weight</name>
                      <usage>S</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>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>B</code>
                        <code>C</code>
                        <code>D</code>
                        <code>E</code>
                      </valid_codes>
                    </element>
                    <element xid="CR105">
                      <data_ele>355</data_ele>
                      <name>Unit or Basis for Measurement Code</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>DH</code>
                      </valid_codes>
                    </element>
                    <element xid="CR106">
                      <data_ele>380</data_ele>
                      <name>Transport Distance</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="CR107">
                      <data_ele>166</data_ele>
                      <name>Address Information</name>
                      <usage>N</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>Address Information</name>
                      <usage>N</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>Round Trip Purpose Description</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="CR110">
                      <data_ele>352</data_ele>
                      <name>Stretcher Purpose Description</name>
                      <usage>S</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>430</pos>
                    <max_use>5</max_use>
                    <element xid="CR201">
                      <data_ele>609</data_ele>
                      <name>Treatment Series Number</name>
                      <usage>R</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>R</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>R</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>R</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>R</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>Patient Condition 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>A</code>
                        <code>C</code>
                        <code>D</code>
                        <code>E</code>
                        <code>F</code>
                        <code>G</code>
                        <code>M</code>
                      </valid_codes>
                    </element>
                    <element xid="CR209">
                      <data_ele>1073</data_ele>
                      <name>Complication Indicator</name>
                      <usage>R</usage>
                      <seq>09</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="CR210">
                      <data_ele>352</data_ele>
                      <name>Patient Condition Description</name>
                      <usage>S</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>Patient Condition Description</name>
                      <usage>S</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>X-ray Availability Indicator</name>
                      <usage>R</usage>
                      <seq>12</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 CR2 segment-->
                  <segment xid="CR3">
                    <name>Durable Medical Equipment Certification</name>
                    <usage>S</usage>
                    <pos>435</pos>
                    <max_use>1</max_use>
                    <element xid="CR301">
                      <data_ele>1322</data_ele>
                      <name>Certification Type Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>I</code>
                        <code>R</code>
                        <code>S</code>
                      </valid_codes>
                    </element>
                    <element xid="CR302">
                      <data_ele>355</data_ele>
                      <name>Unit or Basis for Measurement 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>MO</code>
                      </valid_codes>
                    </element>
                    <element xid="CR303">
                      <data_ele>380</data_ele>
                      <name>Durable Medical Equipment Duration</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                    <element xid="CR304">
                      <data_ele>1335</data_ele>
                      <name>Insulin Dependent 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="CR305">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>05</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                  </segment>
<!--End of CR3 segment-->
                  <segment xid="CR5">
                    <name>Home Oxygen Therapy Information</name>
                    <usage>S</usage>
                    <pos>445</pos>
                    <max_use>1</max_use>
                    <element xid="CR501">
                      <data_ele>1322</data_ele>
                      <name>Certification Type Code.Oxygen Therapy</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>I</code>
                        <code>R</code>
                        <code>S</code>
                      </valid_codes>
                    </element>
                    <element xid="CR502">
                      <data_ele>380</data_ele>
                      <name>Treatment Period Count</name>
                      <usage>R</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>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="CR504">
                      <data_ele>1348</data_ele>
                      <name>Oxygen Equipment Type 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="CR505">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>05</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <element xid="CR506">
                      <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="CR507">
                      <data_ele>380</data_ele>
                      <name>Quantity</name>
                      <usage>N</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>Quantity</name>
                      <usage>N</usage>
                      <seq>08</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                    <element xid="CR509">
                      <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="CR510">
                      <data_ele>380</data_ele>
                      <name>Arterial Blood Gas Quantity</name>
                      <usage>S</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>Oxygen Saturation Quantity</name>
                      <usage>S</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>R</usage>
                      <seq>12</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>E</code>
                        <code>R</code>
                        <code>S</code>
                      </valid_codes>
                    </element>
                    <element xid="CR513">
                      <data_ele>1350</data_ele>
                      <name>Oxygen Test Finding Code</name>
                      <usage>S</usage>
                      <seq>13</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="CR514">
                      <data_ele>1350</data_ele>
                      <name>Oxygen Test Finding Code</name>
                      <usage>S</usage>
                      <seq>14</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>2</code>
                      </valid_codes>
                    </element>
                    <element xid="CR515">
                      <data_ele>1350</data_ele>
                      <name>Oxygen Test Finding Code</name>
                      <usage>S</usage>
                      <seq>15</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>3</code>
                      </valid_codes>
                    </element>
                    <element xid="CR516">
                      <data_ele>380</data_ele>
                      <name>Quantity</name>
                      <usage>N</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>N</usage>
                      <seq>17</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="CR518">
                      <data_ele>1348</data_ele>
                      <name>Oxygen Equipment Type Code</name>
                      <usage>N</usage>
                      <seq>18</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of CR5 segment-->
                  <segment xid="CRC">
                    <name>Ambulance Certification</name>
                    <usage>S</usage>
                    <pos>450</pos>
                    <max_use>3</max_use>
                    <element xid="CRC01">
                      <data_ele>1136</data_ele>
                      <name>Code Category</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>07</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC02">
                      <data_ele>1073</data_ele>
                      <name>Certification Condition Indicator</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>N</code>
                        <code>Y</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC03">
                      <data_ele>1321</data_ele>
                      <name>Condition 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>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>60</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC04">
                      <data_ele>1321</data_ele>
                      <name>Condition Code</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>60</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC05">
                      <data_ele>1321</data_ele>
                      <name>Condition Code</name>
                      <usage>S</usage>
                      <seq>05</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>60</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC06">
                      <data_ele>1321</data_ele>
                      <name>Condition 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>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>60</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC07">
                      <data_ele>1321</data_ele>
                      <name>Condition Code</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>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>60</code>
                      </valid_codes>
                    </element>
                  </segment>
<!--End of CRC segment-->
                  <segment xid="CRC">
                    <name>Hospice Employee Indicator</name>
                    <usage>S</usage>
                    <pos>450</pos>
                    <max_use>1</max_use>
                    <element xid="CRC01">
                      <data_ele>1136</data_ele>
                      <name>Code Category</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>70</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC02">
                      <data_ele>1073</data_ele>
                      <name>Hospice Employed Provider Indicator</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>N</code>
                        <code>Y</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC03">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</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>65</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC04">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</name>
                      <usage>N</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="CRC05">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</name>
                      <usage>N</usage>
                      <seq>05</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="CRC06">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</name>
                      <usage>N</usage>
                      <seq>06</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="CRC07">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</name>
                      <usage>N</usage>
                      <seq>07</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                  </segment>
<!--End of CRC segment-->
                  <segment xid="CRC">
                    <name>DMERC Condition Indicator</name>
                    <usage>S</usage>
                    <pos>450</pos>
                    <max_use>2</max_use>
                    <element xid="CRC01">
                      <data_ele>1136</data_ele>
                      <name>Code Category</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>09</code>
                        <code>11</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC02">
                      <data_ele>1073</data_ele>
                      <name>Certification Condition Indicator</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>N</code>
                        <code>Y</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC03">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</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>37</code>
                        <code>38</code>
                        <code>AL</code>
                        <code>P1</code>
                        <code>ZV</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC04">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>37</code>
                        <code>38</code>
                        <code>AL</code>
                        <code>P1</code>
                        <code>ZV</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC05">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</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>37</code>
                        <code>38</code>
                        <code>AL</code>
                        <code>P1</code>
                        <code>ZV</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC06">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</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>37</code>
                        <code>38</code>
                        <code>AL</code>
                        <code>P1</code>
                        <code>ZV</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC07">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</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>37</code>
                        <code>38</code>
                        <code>AL</code>
                        <code>P1</code>
                        <code>ZV</code>
                      </valid_codes>
                    </element>
                  </segment>
<!--End of CRC segment-->
                  <segment xid="DTP">
                    <name>Date - Service Date</name>
                    <usage>R</usage>
                    <pos>455</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>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>Date - Certification Revision Date</name>
                    <usage>S</usage>
                    <pos>455</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>607</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 Revision 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>Date - Referral Date</name>
                    <usage>S</usage>
                    <pos>455</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>330</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>Referral 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>Date - Begin Therapy Date</name>
                    <usage>S</usage>
                    <pos>455</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>463</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>Begin Therapy 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>Date - Last Certification Date</name>
                    <usage>S</usage>
                    <pos>455</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>461</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 Certification 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>Date - Order Date</name>
                    <usage>S</usage>
                    <pos>455</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>938</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>Order 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>Date - Date Last Seen</name>
                    <usage>S</usage>
                    <pos>455</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>304</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 Seen 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>Date - Test</name>
                    <usage>S</usage>
                    <pos>455</pos>
                    <max_use>2</max_use>
                    <element xid="DTP01">
                      <data_ele>374</data_ele>
                      <name>Date Time Qualifier</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>3</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>738</code>
                        <code>739</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>Test Performed 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>Date - Oxygen Saturation/Arterial Blood Gas Test</name>
                    <usage>S</usage>
                    <pos>455</pos>
                    <max_use>3</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>119</code>
                        <code>480</code>
                        <code>481</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>Oxygen Saturation Test 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>Date - Shipped</name>
                    <usage>S</usage>
                    <pos>455</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>011</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>Shipped 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>Date - Onset of Current Symptom/Illness</name>
                    <usage>S</usage>
                    <pos>455</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 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>Date - Last X-ray</name>
                    <usage>S</usage>
                    <pos>455</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>455</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 X-Ray 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>Date - Acute Manifestation</name>
                    <usage>S</usage>
                    <pos>455</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>453</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>Acute Manifestation 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>Date - Initial Treatment</name>
                    <usage>S</usage>
                    <pos>455</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>454</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>Initial Treatment 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>Date - Similar Illness/Symptom Onset</name>
                    <usage>S</usage>
                    <pos>455</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>438</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>Similar Illness or Symptom 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="QTY">
                    <name>Anesthesia Modifying Units</name>
                    <usage>S</usage>
                    <pos>460</pos>
                    <max_use>5</max_use>
                    <element xid="QTY01">
                      <data_ele>673</data_ele>
                      <name>Quantity 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>BF</code>
                        <code>EC</code>
                        <code>EM</code>
                        <code>HM</code>
                        <code>HO</code>
                        <code>HP</code>
                        <code>P3</code>
                        <code>P4</code>
                        <code>P5</code>
                        <code>SG</code>
                      </valid_codes>
                    </element>
                    <element xid="QTY02">
                      <data_ele>380</data_ele>
                      <name>Anesthesia Modifying Units</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                    <composite>
                      <data_ele>C001</data_ele>
                      <name>Composite Unit of Measure</name>
                      <usage>N</usage>
                      <seq>03</seq>
                    </composite>
                    <element xid="QTY04">
                      <data_ele>61</data_ele>
                      <name>Free-Form Message</name>
                      <usage>N</usage>
                      <seq>04</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                  </segment>
<!--End of QTY segment-->
                  <segment xid="MEA">
                    <name>Test Result</name>
                    <usage>S</usage>
                    <pos>462</pos>
                    <max_use>20</max_use>
                    <element xid="MEA01">
                      <data_ele>737</data_ele>
                      <name>Measurement Reference Identification 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>OG</code>
                        <code>TR</code>
                      </valid_codes>
                    </element>
                    <element xid="MEA02">
                      <data_ele>738</data_ele>
                      <name>Measurement Qualifier</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>CON</code>
                        <code>GRA</code>
                        <code>HT</code>
                        <code>R1</code>
                        <code>R2</code>
                        <code>R3</code>
                        <code>R4</code>
                        <code>ZO</code>
                      </valid_codes>
                    </element>
                    <element xid="MEA03">
                      <data_ele>739</data_ele>
                      <name>Test Results</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>20</max_len>
                    </element>
                    <composite>
                      <data_ele>C001</data_ele>
                      <name>Composite Unit of Measure</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                    <element xid="MEA05">
                      <data_ele>740</data_ele>
                      <name>Range Minimum</name>
                      <usage>N</usage>
                      <seq>05</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>20</max_len>
                    </element>
                    <element xid="MEA06">
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                      <name>Range Maximum</name>
                      <usage>N</usage>
                      <seq>06</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>20</max_len>
                    </element>
                    <element xid="MEA07">
                      <data_ele>935</data_ele>
                      <name>Measurement Significance Code</name>
                      <usage>N</usage>
                      <seq>07</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="MEA08">
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                      <name>Measurement Attribute 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="MEA09">
                      <data_ele>752</data_ele>
                      <name>Surface/Layer/Position Code</name>
                      <usage>N</usage>
                      <seq>09</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="MEA10">
                      <data_ele>1373</data_ele>
                      <name>Measurement Method or Device</name>
                      <usage>N</usage>
                      <seq>10</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>4</max_len>
                    </element>
                  </segment>
<!--End of MEA segment-->
                  <segment xid="CN1">
                    <name>Contract Information</name>
                    <usage>S</usage>
                    <pos>465</pos>
                    <max_use>1</max_use>
                    <element xid="CN101">
                      <data_ele>1166</data_ele>
                      <name>Contract Type 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>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>09</code>
                      </valid_codes>
                    </element>
                    <element xid="CN102">
                      <data_ele>782</data_ele>
                      <name>Contract Amount</name>
                      <usage>S</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="CN103">
                      <data_ele>332</data_ele>
                      <name>Contract Percentage</name>
                      <usage>S</usage>
                      <seq>03</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>6</max_len>
                    </element>
                    <element xid="CN104">
                      <data_ele>127</data_ele>
                      <name>Contract Code</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="CN105">
                      <data_ele>338</data_ele>
                      <name>Terms Discount Percentage</name>
                      <usage>S</usage>
                      <seq>05</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>6</max_len>
                    </element>
                    <element xid="CN106">
                      <data_ele>799</data_ele>
                      <name>Contract Version Identifier</name>
                      <usage>S</usage>
                      <seq>06</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                  </segment>
<!--End of CN1 segment-->
                  <segment xid="REF">
                    <name>Repriced Line Item Reference Number</name>
                    <usage>S</usage>
                    <pos>470</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>9B</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Repriced Line Item Reference Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Adjusted Repriced Line Item Reference Number</name>
                    <usage>S</usage>
                    <pos>470</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>9D</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Adjusted Repriced Line Item Reference Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
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                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Prior Authorization or Referral Number</name>
                    <usage>S</usage>
                    <pos>470</pos>
                    <max_use>2</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>9F</code>
                        <code>G1</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Prior Authorization or Referral Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>4</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Line Item Control Number</name>
                    <usage>S</usage>
                    <pos>470</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>6R</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Line Item Control Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Mammography Certification Number</name>
                    <usage>S</usage>
                    <pos>470</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>EW</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Mammography Certification Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Clinical Laboratory Improvement Amendment (CLIA) Identification</name>
                    <usage>S</usage>
                    <pos>470</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>X4</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Clinical Laboratory Improvement Amendment Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Referring Clinical Laboratory Improvement Amendment (CLIA) Facility Identification</name>
                    <usage>S</usage>
                    <pos>470</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>F4</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Referring CLIA Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Immunization Batch Number</name>
                    <usage>S</usage>
                    <pos>470</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>BT</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Immunization Batch Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Ambulatory Patient Group (APG)</name>
                    <usage>S</usage>
                    <pos>470</pos>
                    <max_use>4</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>1S</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Ambulatory Patient Group Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Oxygen Flow Rate</name>
                    <usage>S</usage>
                    <pos>470</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>TP</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Oxygen Flow Rate</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Universal Product Number (UPN)</name>
                    <usage>S</usage>
                    <pos>470</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>OZ</code>
                        <code>VP</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Universal Product Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="AMT">
                    <name>Sales Tax Amount</name>
                    <usage>S</usage>
                    <pos>475</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>T</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Sales Tax Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Approved Amount</name>
                    <usage>S</usage>
                    <pos>475</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>AAE</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Approved Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Postage Claimed Amount</name>
                    <usage>S</usage>
                    <pos>475</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>F4</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Postage Claimed Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="K3">
                    <name>File Information</name>
                    <usage>S</usage>
                    <pos>480</pos>
                    <max_use>10</max_use>
                    <element xid="K301">
                      <data_ele>449</data_ele>
                      <name>Fixed Format Information</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <element xid="K302">
                      <data_ele>1333</data_ele>
                      <name>Record Format Code</name>
                      <usage>N</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <composite>
                      <data_ele>C001</data_ele>
                      <name>Composite Unit of Measure</name>
                      <usage>N</usage>
                      <seq>03</seq>
                    </composite>
                  </segment>
<!--End of K3 segment-->
                  <segment xid="NTE">
                    <name>Line Note</name>
                    <usage>S</usage>
                    <pos>485</pos>
                    <max_use>1</max_use>
                    <element xid="NTE01">
                      <data_ele>363</data_ele>
                      <name>Note Reference 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>ADD</code>
                        <code>DCP</code>
                        <code>PMT</code>
                        <code>TPO</code>
                      </valid_codes>
                    </element>
                    <element xid="NTE02">
                      <data_ele>352</data_ele>
                      <name>Line Note Text</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                  </segment>
<!--End of NTE segment-->
                  <segment xid="PS1">
                    <name>Purchased Service Information</name>
                    <usage>S</usage>
                    <pos>488</pos>
                    <max_use>1</max_use>
                    <element xid="PS101">
                      <data_ele>127</data_ele>
                      <name>Purchased Service Provider Identifier</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="PS102">
                      <data_ele>782</data_ele>
                      <name>Purchased Service Charge Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="PS103">
                      <data_ele>156</data_ele>
                      <name>State or Province Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                  </segment>
<!--End of PS1 segment-->
                  <segment xid="HSD">
                    <name>Health Care Services Delivery</name>
                    <usage>S</usage>
                    <pos>491</pos>
                    <max_use>1</max_use>
                    <element xid="HSD01">
                      <data_ele>673</data_ele>
                      <name>Visits</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>VS</code>
                      </valid_codes>
                    </element>
                    <element xid="HSD02">
                      <data_ele>380</data_ele>
                      <name>Number of Visits</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>Frequency Period</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>Q1</code>
                        <code>WK</code>
                      </valid_codes>
                    </element>
                    <element xid="HSD04">
                      <data_ele>1167</data_ele>
                      <name>Frequency Count</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>Duration of Visits Units</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>7</code>
                        <code>34</code>
                        <code>35</code>
                      </valid_codes>
                    </element>
                    <element xid="HSD06">
                      <data_ele>616</data_ele>
                      <name>Duration of Visits, Number of Units</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>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>N</code>
                        <code>O</code>
                        <code>W</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>
                      </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>D</code>
                        <code>E</code>
                        <code>F</code>
                      </valid_codes>
                    </element>
                  </segment>
<!--End of HSD segment-->
                  <segment xid="HCP">
                    <name>Line Pricing/Repricing Information</name>
                    <usage>S</usage>
                    <pos>492</pos>
                    <max_use>1</max_use>
                    <element xid="HCP01">
                      <data_ele>1473</data_ele>
                      <name>Pricing/Repricing Methodology</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>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>10</code>
                        <code>11</code>
                        <code>12</code>
                        <code>13</code>
                        <code>14</code>
                      </valid_codes>
                    </element>
                    <element xid="HCP02">
                      <data_ele>782</data_ele>
                      <name>Repriced Allowed Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="HCP03">
                      <data_ele>782</data_ele>
                      <name>Repriced Saving Amount</name>
                      <usage>S</usage>
                      <seq>03</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="HCP04">
                      <data_ele>127</data_ele>
                      <name>Repricing Organization Identifier</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="HCP05">
                      <data_ele>118</data_ele>
                      <name>Repricing Per Diem or Flat Rate Amount</name>
                      <usage>S</usage>
                      <seq>05</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>9</max_len>
                    </element>
                    <element xid="HCP06">
                      <data_ele>127</data_ele>
                      <name>Repriced Approved Ambulatory Patient Group Code</name>
                      <usage>S</usage>
                      <seq>06</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="HCP7">
                      <data_ele>782</data_ele>
                      <name>Repriced Approved Ambulatory Patient Group Amount</name>
                      <usage>S</usage>
                      <seq>7</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="HCP08">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>08</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="HCP09">
                      <data_ele>235</data_ele>
                      <name>Product or Service ID Qualifier</name>
                      <usage>S</usage>
                      <seq>09</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>HC</code>
                        <code>IV</code>
                        <code>ZZ</code>
                      </valid_codes>
                    </element>
                    <element xid="HCP10">
                      <data_ele>234</data_ele>
                      <name>Producedure Code</name>
                      <usage>S</usage>
                      <seq>10</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="HCP11">
                      <data_ele>355</data_ele>
                      <name>Unit or Basis for Measurement Code</name>
                      <usage>S</usage>
                      <seq>11</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>DA</code>
                        <code>UN</code>
                      </valid_codes>
                    </element>
                    <element xid="HCP12">
                      <data_ele>380</data_ele>
                      <name>Repriced Approved Service Unit Count</name>
                      <usage>S</usage>
                      <seq>12</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                    <element xid="HCP13">
                      <data_ele>901</data_ele>
                      <name>Reject Reason Code</name>
                      <usage>S</usage>
                      <seq>13</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>T1</code>
                        <code>T2</code>
                        <code>T3</code>
                        <code>T4</code>
                        <code>T5</code>
                        <code>T6</code>
                      </valid_codes>
                    </element>
                    <element xid="HCP14">
                      <data_ele>1526</data_ele>
                      <name>Policy Compliance Code</name>
                      <usage>S</usage>
                      <seq>14</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>
                      </valid_codes>
                    </element>
                    <element xid="HCP15">
                      <data_ele>1527</data_ele>
                      <name>Exception Code</name>
                      <usage>S</usage>
                      <seq>15</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>
                      </valid_codes>
                    </element>
                  </segment>
<!--End of HCP segment-->
                  <loop xid="2420A">
                    <name>Rendering Provider Name</name>
                    <usage>S</usage>
                    <pos>500</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Rendering Provider Name</name>
                      <usage>S</usage>
                      <pos>500</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>82</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>Rendering Provider Last or Organization Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Rendering 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>Rendering 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>Rendering 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>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>XX</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Rendering Provider 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="PRV">
                      <name>Rendering Provider Specialty Information</name>
                      <usage>R</usage>
                      <pos>505</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>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>5</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-->
                    <segment xid="N2">
                      <name>Additional Rendering Provider Name Information</name>
                      <usage>S</usage>
                      <pos>510</pos>
                      <max_use>1</max_use>
                      <element xid="N201">
                        <data_ele>93</data_ele>
                        <name>Rendering Provider Name Additional Text</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="N202">
                        <data_ele>93</data_ele>
                        <name>Name</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                    </segment>
<!--End of N2 segment-->
                    <segment xid="REF">
                      <name>Rendering Provider Secondary Identification</name>
                      <usage>S</usage>
                      <pos>525</pos>
                      <max_use>5</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>0B</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>1G</code>
                          <code>1H</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                          <code>SY</code>
                          <code>X5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Rendering Provider Secondary 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-->
                  </loop>
<!--End of 2420A loop-->
                  <loop xid="2420B">
                    <name>Purchased Service Provider Name</name>
                    <usage>S</usage>
                    <pos>500</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Purchased Service Provider Name</name>
                      <usage>S</usage>
                      <pos>500</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>QB</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>Name Last or Organization Name</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>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>XX</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Purchased 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>Purchased Service Provider Secondary Identification</name>
                      <usage>S</usage>
                      <pos>525</pos>
                      <max_use>5</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>0B</code>
                          <code>1A</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>1G</code>
                          <code>1H</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                          <code>SY</code>
                          <code>U3</code>
                          <code>X5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Purchased Service Provider Secondary 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-->
                  </loop>
<!--End of 2420B loop-->
                  <loop xid="2420C">
                    <name>Service Facility Location</name>
                    <usage>S</usage>
                    <pos>500</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Service Facility Location</name>
                      <usage>S</usage>
                      <pos>500</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>77</code>
                          <code>FA</code>
                          <code>LI</code>
                          <code>TL</code>
                        </valid_codes>
                      </element>
                      <element xid="NM102">
                        <data_ele>1065</data_ele>
                        <name>Entity Type Qualifier</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>2</code>
                        </valid_codes>
                      </element>
                      <element xid="NM103">
                        <data_ele>1035</data_ele>
                        <name>Laboratory or Facility 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>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>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>XX</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Laboratory or Facility 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="N2">
                      <name>Additional Service Facility Location Name Information</name>
                      <usage>S</usage>
                      <pos>510</pos>
                      <max_use>1</max_use>
                      <element xid="N201">
                        <data_ele>93</data_ele>
                        <name>Laboratory or Facility Name Additional Text</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="N202">
                        <data_ele>93</data_ele>
                        <name>Name</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                    </segment>
<!--End of N2 segment-->
                    <segment xid="N3">
                      <name>Service Facility Location Address</name>
                      <usage>R</usage>
                      <pos>514</pos>
                      <max_use>1</max_use>
                      <element xid="N301">
                        <data_ele>166</data_ele>
                        <name>Laboratory or Facility 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>Laboratory or Facility 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 Facility Location City/State/ZIP</name>
                      <usage>R</usage>
                      <pos>520</pos>
                      <max_use>1</max_use>
                      <element xid="N401">
                        <data_ele>19</data_ele>
                        <name>Laboratory or Facility City Name</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="N402">
                        <data_ele>156</data_ele>
                        <name>Laboratory or Facility State or Province Code</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes external="states"/>
                      </element>
                      <element xid="N403">
                        <data_ele>116</data_ele>
                        <name>Laboratory or Facility Postal Zone or ZIP Code</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>3</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="N404">
                        <data_ele>26</data_ele>
                        <name>Service Facility Location 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="REF">
                      <name>Service Facility Location Secondary Identification</name>
                      <usage>S</usage>
                      <pos>525</pos>
                      <max_use>5</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>0B</code>
                          <code>1A</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>1G</code>
                          <code>1H</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                          <code>TJ</code>
                          <code>X4</code>
                          <code>X5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Service Facility Location Secondary 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-->
                  </loop>
<!--End of 2420C loop-->
                  <loop xid="2420D">
                    <name>Supervising Provider Name</name>
                    <usage>S</usage>
                    <pos>500</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Supervising Provider Name</name>
                      <usage>S</usage>
                      <pos>500</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>DQ</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>Supervising Provider Last Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Supervising Provider First Name</name>
                        <usage>R</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Supervising 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>Supervising 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>XX</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Supervising 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="N2">
                      <name>Additional Supervising Provider Name Information</name>
                      <usage>S</usage>
                      <pos>510</pos>
                      <max_use>1</max_use>
                      <element xid="N201">
                        <data_ele>93</data_ele>
                        <name>Supervising Provider Name Additional Text</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="N202">
                        <data_ele>93</data_ele>
                        <name>Name</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                    </segment>
<!--End of N2 segment-->
                    <segment xid="REF">
                      <name>Supervising Provider Secondary Identification</name>
                      <usage>S</usage>
                      <pos>525</pos>
                      <max_use>5</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>0B</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>1G</code>
                          <code>1H</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                          <code>SY</code>
                          <code>X5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Supervising Provider Secondary 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-->
                  </loop>
<!--End of 2420D loop-->
                  <loop xid="2420E">
                    <name>Ordering Provider Name</name>
                    <usage>S</usage>
                    <pos>500</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Ordering Provider Name</name>
                      <usage>S</usage>
                      <pos>500</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>DK</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>Ordering Provider Last Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Ordering Provider First Name</name>
                        <usage>R</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Ordering 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>Ordering 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>XX</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Ordering 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="N2">
                      <name>Additional Ordering Provider Name Information</name>
                      <usage>S</usage>
                      <pos>510</pos>
                      <max_use>1</max_use>
                      <element xid="N201">
                        <data_ele>93</data_ele>
                        <name>Ordering Provider Name Additional Text</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="N202">
                        <data_ele>93</data_ele>
                        <name>Name</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                    </segment>
<!--End of N2 segment-->
                    <segment xid="N3">
                      <name>Ordering Provider Address</name>
                      <usage>S</usage>
                      <pos>514</pos>
                      <max_use>1</max_use>
                      <element xid="N301">
                        <data_ele>166</data_ele>
                        <name>Ordering 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>Ordering 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>Ordering Provider City/State/ZIP Code</name>
                      <usage>S</usage>
                      <pos>520</pos>
                      <max_use>1</max_use>
                      <element xid="N401">
                        <data_ele>19</data_ele>
                        <name>Ordering Provider City Name</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="N402">
                        <data_ele>156</data_ele>
                        <name>Ordering Provider State Code</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes external="states"/>
                      </element>
                      <element xid="N403">
                        <data_ele>116</data_ele>
                        <name>Ordering Provider Postal Zone or ZIP Code</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>3</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="N404">
                        <data_ele>26</data_ele>
                        <name>Ordering 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="REF">
                      <name>Ordering Provider Secondary Identification</name>
                      <usage>S</usage>
                      <pos>525</pos>
                      <max_use>5</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>0B</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>1G</code>
                          <code>1H</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                          <code>SY</code>
                          <code>X5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Ordering Provider Secondary 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="PER">
                      <name>Ordering Provider Contact Information</name>
                      <usage>S</usage>
                      <pos>530</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>Ordering Provider Contact Name</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="PER03">
                        <data_ele>365</data_ele>
                        <name>Communication Number Qualifier</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>EM</code>
                          <code>FX</code>
                          <code>TE</code>
                        </valid_codes>
                      </element>
                      <element xid="PER04">
                        <data_ele>364</data_ele>
                        <name>Communication Number</name>
                        <usage>R</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="PER05">
                        <data_ele>365</data_ele>
                        <name>Communication Number Qualifier</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>EM</code>
                          <code>EX</code>
                          <code>FX</code>
                          <code>TE</code>
                        </valid_codes>
                      </element>
                      <element xid="PER06">
                        <data_ele>364</data_ele>
                        <name>Communication Number</name>
                        <usage>S</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="PER07">
                        <data_ele>365</data_ele>
                        <name>Communication Number Qualifier</name>
                        <usage>S</usage>
                        <seq>07</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>EM</code>
                          <code>EX</code>
                          <code>FX</code>
                          <code>TE</code>
                        </valid_codes>
                      </element>
                      <element xid="PER08">
                        <data_ele>364</data_ele>
                        <name>Communication Number</name>
                        <usage>S</usage>
                        <seq>08</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="PER09">
                        <data_ele>443</data_ele>
                        <name>Contact Inquiry Reference</name>
                        <usage>N</usage>
                        <seq>09</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>20</max_len>
                      </element>
                    </segment>
<!--End of PER segment-->
                  </loop>
<!--End of 2420E loop-->
                  <loop xid="2420F">
                    <name>Referring Provider Name</name>
                    <usage>S</usage>
                    <pos>500</pos>
                    <count>2</count>
                    <segment xid="NM1">
                      <name>Referring Provider Name</name>
                      <usage>S</usage>
                      <pos>500</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>DN</code>
                          <code>P3</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>Referring Provider Last Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Referring Provider First Name</name>
                        <usage>R</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Referring 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>Referring 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>XX</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Referring 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="PRV">
                      <name>Referring Provider Specialty Information</name>
                      <usage>S</usage>
                      <pos>505</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>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-->
                    <segment xid="N2">
                      <name>Additional Referring Provider Name Information</name>
                      <usage>S</usage>
                      <pos>510</pos>
                      <max_use>1</max_use>
                      <element xid="N201">
                        <data_ele>93</data_ele>
                        <name>Referring Provider Name Additional Text</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="N202">
                        <data_ele>93</data_ele>
                        <name>Name</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                    </segment>
<!--End of N2 segment-->
                    <segment xid="REF">
                      <name>Referring Provider Secondary Identification</name>
                      <usage>S</usage>
                      <pos>525</pos>
                      <max_use>5</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>0B</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>1G</code>
                          <code>1H</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                          <code>SY</code>
                          <code>X5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Referring Provider Secondary 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-->
                  </loop>
<!--End of 2420F loop-->
                  <loop xid="2420G">
                    <name>Other Payer Prior Authorization or Referral Number</name>
                    <usage>S</usage>
                    <pos>500</pos>
                    <count>4</count>
                    <segment xid="NM1">
                      <name>Other Payer Prior Authorization or Referral Number</name>
                      <usage>S</usage>
                      <pos>500</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>PR</code>
                        </valid_codes>
                      </element>
                      <element xid="NM102">
                        <data_ele>1065</data_ele>
                        <name>Entity Type Qualifier</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>2</code>
                        </valid_codes>
                      </element>
                      <element xid="NM103">
                        <data_ele>1035</data_ele>
                        <name>Payer Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>R</usage>
                        <seq>08</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>PI</code>
                          <code>XV</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Other Payer Identification Number</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>Other Payer Prior Authorization or Referral Number</name>
                      <usage>R</usage>
                      <pos>525</pos>
                      <max_use>2</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>9F</code>
                          <code>G1</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Other Payer Prior Authorization or Referral Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                  </loop>
<!--End of 2420G loop-->
                  <loop xid="2430">
                    <name>Line Adjudication Information</name>
                    <usage>S</usage>
                    <pos>540</pos>
                    <count>25</count>
                    <segment xid="SVD">
                      <name>Line Adjudication Information</name>
                      <usage>S</usage>
                      <pos>540</pos>
                      <max_use>1</max_use>
                      <element xid="SVD01">
                        <data_ele>67</data_ele>
                        <name>Other Payer Primary Identifier</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="SVD02">
                        <data_ele>782</data_ele>
                        <name>Service Line Paid Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <composite>
                        <data_ele>C003</data_ele>
                        <name>Procedure Identifier</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <element xid="SVD03-01">
                          <data_ele>235</data_ele>
                          <name>Product or Service ID 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>HC</code>
                            <code>IV</code>
                            <code>N1</code>
                            <code>N2</code>
                            <code>N3</code>
                            <code>N4</code>
                            <code>ZZ</code>
                          </valid_codes>
                        </element>
                        <element xid="SVD03-02">
                          <data_ele>234</data_ele>
                          <name>Procedure Code</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>48</max_len>
                        </element>
                        <element xid="SVD03-03">
                          <data_ele>1339</data_ele>
                          <name>Procedure Modifier 1</name>
                          <usage>S</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="SVD03-04">
                          <data_ele>1339</data_ele>
                          <name>Procedure Modifier 2</name>
                          <usage>S</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="SVD03-05">
                          <data_ele>1339</data_ele>
                          <name>Procedure Modifier 3</name>
                          <usage>S</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="SVD03-06">
                          <data_ele>1339</data_ele>
                          <name>Procedure Modifier 4</name>
                          <usage>S</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="SVD03-07">
                          <data_ele>352</data_ele>
                          <name>Procedure Code Description</name>
                          <usage>S</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>80</max_len>
                        </element>
                      </composite>
                      <element xid="SVD04">
                        <data_ele>234</data_ele>
                        <name>Product/Service ID</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>48</max_len>
                      </element>
                      <element xid="SVD05">
                        <data_ele>380</data_ele>
                        <name>Paid Service Unit Count</name>
                        <usage>R</usage>
                        <seq>05</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="SVD06">
                        <data_ele>554</data_ele>
                        <name>Bundled or Unbundled Line Number</name>
                        <usage>S</usage>
                        <seq>06</seq>
                        <data_type>N0</data_type>
                        <min_len>1</min_len>
                        <max_len>6</max_len>
                      </element>
                    </segment>
<!--End of SVD segment-->
                    <segment xid="CAS">
                      <name>Line Adjustment</name>
                      <usage>S</usage>
                      <pos>545</pos>
                      <max_use>99</max_use>
                      <element xid="CAS01">
                        <data_ele>1033</data_ele>
                        <name>Adjustment Group 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>CO</code>
                          <code>CR</code>
                          <code>OA</code>
                          <code>PI</code>
                          <code>PR</code>
                        </valid_codes>
                      </element>
                      <element xid="CAS02">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS03">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS04">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="CAS05">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS06">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>S</usage>
                        <seq>06</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS07">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</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="CAS08">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>S</usage>
                        <seq>08</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS09">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>S</usage>
                        <seq>09</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS10">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</name>
                        <usage>S</usage>
                        <seq>10</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="CAS11">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>S</usage>
                        <seq>11</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS12">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>S</usage>
                        <seq>12</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS13">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</name>
                        <usage>S</usage>
                        <seq>13</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="CAS14">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>S</usage>
                        <seq>14</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS15">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>S</usage>
                        <seq>15</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS16">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</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="CAS17">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>S</usage>
                        <seq>17</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS18">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>S</usage>
                        <seq>18</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS19">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</name>
                        <usage>S</usage>
                        <seq>19</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                    </segment>
<!--End of CAS segment-->
                    <segment xid="DTP">
                      <name>Line Adjudication Date</name>
                      <usage>R</usage>
                      <pos>550</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>573</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>Adjudication or Payment Date</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                    </segment>
<!--End of DTP segment-->
                  </loop>
<!--End of 2430 loop-->
                  <loop xid="2440">
                    <name>Form Identification Code</name>
                    <usage>S</usage>
                    <pos>551</pos>
                    <count>5</count>
                    <segment xid="LQ">
                      <name>Form Identification Code</name>
                      <usage>S</usage>
                      <pos>551</pos>
                      <max_use>1</max_use>
                      <element xid="LQ01">
                        <data_ele>1270</data_ele>
                        <name>Form Identification 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>AS</code>
                          <code>UT</code>
                        </valid_codes>
                      </element>
                      <element xid="LQ02">
                        <data_ele>1271</data_ele>
                        <name>Form Identifier</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                    </segment>
<!--End of LQ segment-->
                    <segment xid="FRM">
                      <name>Supporting Documentation</name>
                      <usage>R</usage>
                      <pos>552</pos>
                      <max_use>99</max_use>
                      <element xid="FRM01">
                        <data_ele>350</data_ele>
                        <name>Question Number/Letter</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>20</max_len>
                      </element>
                      <element xid="FRM02">
                        <data_ele>1073</data_ele>
                        <name>Question Response</name>
                        <usage>S</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>N</code>
                          <code>W</code>
                          <code>Y</code>
                        </valid_codes>
                      </element>
                      <element xid="FRM03">
                        <data_ele>127</data_ele>
                        <name>Question Response</name>
                        <usage>S</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="FRM04">
                        <data_ele>373</data_ele>
                        <name>Question Response</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>DT</data_type>
                        <min_len>8</min_len>
                        <max_len>8</max_len>
                      </element>
                      <element xid="FRM05">
                        <data_ele>332</data_ele>
                        <name>Question Response</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>6</max_len>
                      </element>
                    </segment>
<!--End of FRM segment-->
                  </loop>
<!--End of 2440 loop-->
                </loop>
<!--End of 2400 loop-->
              </loop>
<!--End of 2300 loop-->
              <loop xid="2000C">
                <name>Patient Hierarchical Level</name>
                <usage>S</usage>
                <pos>140</pos>
                <count>&gt;1</count>
                <segment xid="HL">
                  <name>Patient Hierarchical Level</name>
                  <usage>R</usage>
                  <pos>001</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>0</code>
                    </valid_codes>
                  </element>
                </segment>
<!--End of HL segment-->
                <segment xid="PAT">
                  <name>Patient Information</name>
                  <usage>R</usage>
                  <pos>007</pos>
                  <max_use>1</max_use>
                  <element xid="PAT01">
                    <data_ele>1069</data_ele>
                    <name>Patients Relationship to Insured</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>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>36</code>
                      <code>39</code>
                      <code>40</code>
                      <code>41</code>
                      <code>43</code>
                      <code>53</code>
                      <code>G8</code>
                    </valid_codes>
                  </element>
                  <element xid="PAT02">
                    <data_ele>1384</data_ele>
                    <name>Patient Location Code</name>
                    <usage>N</usage>
                    <seq>02</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                  </element>
                  <element xid="PAT03">
                    <data_ele>584</data_ele>
                    <name>Employment Status Code</name>
                    <usage>N</usage>
                    <seq>03</seq>
                    <data_type>ID</data_type>
                    <min_len>2</min_len>
                    <max_len>2</max_len>
                  </element>
                  <element xid="PAT04">
                    <data_ele>1220</data_ele>
                    <name>Student 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="PAT05">
                    <data_ele>1250</data_ele>
                    <name>Date Time Period Format Qualifier</name>
                    <usage>S</usage>
                    <seq>05</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="PAT06">
                    <data_ele>1251</data_ele>
                    <name>Patient Death Date</name>
                    <usage>S</usage>
                    <seq>06</seq>
                    <data_type>AN</data_type>
                    <min_len>1</min_len>
                    <max_len>35</max_len>
                  </element>
                  <element xid="PAT07">
                    <data_ele>355</data_ele>
                    <name>Unit or Basis for Measurement Code</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>GR</code>
                    </valid_codes>
                  </element>
                  <element xid="PAT08">
                    <data_ele>81</data_ele>
                    <name>Patient Weight</name>
                    <usage>S</usage>
                    <seq>08</seq>
                    <data_type>R</data_type>
                    <min_len>1</min_len>
                    <max_len>10</max_len>
                  </element>
                  <element xid="PAT09">
                    <data_ele>1073</data_ele>
                    <name>Pregnancy Indicator</name>
                    <usage>S</usage>
                    <seq>09</seq>
                    <data_type>ID</data_type>
                    <min_len>1</min_len>
                    <max_len>1</max_len>
                    <valid_codes>
                      <code>Y</code>
                    </valid_codes>
                  </element>
                </segment>
<!--End of PAT segment-->
                <loop xid="2010CA">
                  <name>Patient Name</name>
                  <usage>R</usage>
                  <pos>015</pos>
                  <count>1</count>
                  <segment xid="NM1">
                    <name>Patient Name</name>
                    <usage>S</usage>
                    <pos>015</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>Patient Last Name</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>35</max_len>
                    </element>
                    <element xid="NM104">
                      <data_ele>1036</data_ele>
                      <name>Patient First Name</name>
                      <usage>R</usage>
                      <seq>04</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>25</max_len>
                    </element>
                    <element xid="NM105">
                      <data_ele>1037</data_ele>
                      <name>Patient 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>Patient 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>Patient 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="N2">
                    <name>Additional Patient Name Information</name>
                    <usage>S</usage>
                    <pos>020</pos>
                    <max_use>1</max_use>
                    <element xid="N201">
                      <data_ele>93</data_ele>
                      <name>Patient Additional Name</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>60</max_len>
                    </element>
                    <element xid="N202">
                      <data_ele>93</data_ele>
                      <name>Name</name>
                      <usage>N</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>60</max_len>
                    </element>
                  </segment>
<!--End of N2 segment-->
                  <segment xid="N3">
                    <name>Patient Address</name>
                    <usage>R</usage>
                    <pos>025</pos>
                    <max_use>1</max_use>
                    <element xid="N301">
                      <data_ele>166</data_ele>
                      <name>Patient 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>Patient 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>Patient City/State/ZIP Code</name>
                    <usage>R</usage>
                    <pos>030</pos>
                    <max_use>1</max_use>
                    <element xid="N401">
                      <data_ele>19</data_ele>
                      <name>Patient City Name</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>2</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="N402">
                      <data_ele>156</data_ele>
                      <name>Patient State Code</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes external="states"/>
                    </element>
                    <element xid="N403">
                      <data_ele>116</data_ele>
                      <name>Patient Postal Zone or ZIP Code</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>3</min_len>
                      <max_len>15</max_len>
                    </element>
                    <element xid="N404">
                      <data_ele>26</data_ele>
                      <name>Patient 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="DMG">
                    <name>Patient Demographic Information</name>
                    <usage>R</usage>
                    <pos>032</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>Patient 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>Patient Gender Code</name>
                      <usage>R</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>F</code>
                        <code>M</code>
                        <code>U</code>
                      </valid_codes>
                    </element>
                    <element xid="DMG04">
                      <data_ele>1067</data_ele>
                      <name>Marital Status Code</name>
                      <usage>N</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="DMG05">
                      <data_ele>1109</data_ele>
                      <name>Race or Ethnicity Code</name>
                      <usage>N</usage>
                      <seq>05</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="DMG06">
                      <data_ele>1066</data_ele>
                      <name>Citizenship Status Code</name>
                      <usage>N</usage>
                      <seq>06</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="DMG07">
                      <data_ele>26</data_ele>
                      <name>Country Code</name>
                      <usage>N</usage>
                      <seq>07</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="DMG08">
                      <data_ele>659</data_ele>
                      <name>Basis of Verification Code</name>
                      <usage>N</usage>
                      <seq>08</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="DMG09">
                      <data_ele>380</data_ele>
                      <name>Quantity</name>
                      <usage>N</usage>
                      <seq>09</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                  </segment>
<!--End of DMG segment-->
                  <segment xid="REF">
                    <name>Patient Secondary Identification</name>
                    <usage>S</usage>
                    <pos>035</pos>
                    <max_use>5</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>1W</code>
                        <code>23</code>
                        <code>IG</code>
                        <code>SY</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Patient Secondary Identifier</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Property and Casualty Claim Number</name>
                    <usage>S</usage>
                    <pos>035</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>Y4</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Property Casualty Claim Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                </loop>
<!--End of 2010CA loop-->
                <loop xid="2300">
                  <name>Claim Information</name>
                  <usage>R</usage>
                  <pos>130</pos>
                  <count>100</count>
                  <segment xid="CLM">
                    <name>Claim Information</name>
                    <usage>R</usage>
                    <pos>130</pos>
                    <max_use>1</max_use>
                    <element xid="CLM01">
                      <data_ele>1028</data_ele>
                      <name>Patient Account Number</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>38</max_len>
                    </element>
                    <element xid="CLM02">
                      <data_ele>782</data_ele>
                      <name>Total Claim Charge Amount</name>
                      <usage>R</usage>
                      <seq>2</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="CLM03">
                      <data_ele>1032</data_ele>
                      <name>Claim Filing Indicator Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="CLM04">
                      <data_ele>1343</data_ele>
                      <name>Non-Institutional Claim Type Code</name>
                      <usage>N</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <composite>
                      <data_ele>C023</data_ele>
                      <name>Place of Service Code</name>
                      <usage>R</usage>
                      <seq>05</seq>
                      <element xid="CLM05-01">
                        <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>
                        <valid_codes>
                          <code>11</code>
                          <code>12</code>
                          <code>21</code>
                          <code>22</code>
                          <code>23</code>
                          <code>24</code>
                          <code>25</code>
                          <code>26</code>
                          <code>31</code>
                          <code>32</code>
                          <code>33</code>
                          <code>34</code>
                          <code>41</code>
                          <code>42</code>
                          <code>51</code>
                          <code>52</code>
                          <code>53</code>
                          <code>54</code>
                          <code>55</code>
                          <code>56</code>
                          <code>50</code>
                          <code>60</code>
                          <code>61</code>
                          <code>62</code>
                          <code>65</code>
                          <code>71</code>
                          <code>72</code>
                          <code>81</code>
                          <code>99</code>
                        </valid_codes>
                      </element>
                      <element xid="CLM05-02">
                        <data_ele>1332</data_ele>
                        <name>Facility Code Qualifier</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="CLM05-03">
                        <data_ele>1325</data_ele>
                        <name>Claim Frequency Code</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>1</code>
                          <code>6</code>
                          <code>7</code>
                          <code>8</code>
                        </valid_codes>
                      </element>
                    </composite>
                    <element xid="CLM06">
                      <data_ele>1073</data_ele>
                      <name>Provider or Supplier Signature Indicator</name>
                      <usage>R</usage>
                      <seq>06</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="CLM07">
                      <data_ele>1359</data_ele>
                      <name>Medicare Assignment Code</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>A</code>
                        <code>B</code>
                        <code>C</code>
                        <code>P</code>
                      </valid_codes>
                    </element>
                    <element xid="CLM08">
                      <data_ele>1073</data_ele>
                      <name>Benefits Assignment Certification Indicator</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>N</code>
                        <code>Y</code>
                      </valid_codes>
                    </element>
                    <element xid="CLM09">
                      <data_ele>1363</data_ele>
                      <name>Release of Information Code</name>
                      <usage>R</usage>
                      <seq>09</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>A</code>
                        <code>I</code>
                        <code>M</code>
                        <code>N</code>
                        <code>O</code>
                        <code>Y</code>
                      </valid_codes>
                    </element>
                    <element xid="CLM10">
                      <data_ele>1351</data_ele>
                      <name>Patient Signature Source Code</name>
                      <usage>S</usage>
                      <seq>10</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>B</code>
                        <code>C</code>
                        <code>M</code>
                        <code>P</code>
                        <code>S</code>
                      </valid_codes>
                    </element>
                    <composite>
                      <data_ele>C024</data_ele>
                      <name>Accident/Employment/Related Causes</name>
                      <usage>S</usage>
                      <seq>11</seq>
                      <element xid="CLM11-01">
                        <data_ele>1362</data_ele>
                        <name>Related Causes 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>AA</code>
                          <code>AB</code>
                          <code>AP</code>
                          <code>EM</code>
                          <code>OA</code>
                        </valid_codes>
                      </element>
                      <element xid="CLM11-02">
                        <data_ele>1362</data_ele>
                        <name>Related Causes Code</name>
                        <usage>S</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>AA</code>
                          <code>AB</code>
                          <code>AP</code>
                          <code>EM</code>
                          <code>OA</code>
                        </valid_codes>
                      </element>
                      <element xid="CLM11-03">
                        <data_ele>1362</data_ele>
                        <name>Related Causes 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>AA</code>
                          <code>AB</code>
                          <code>AP</code>
                          <code>EM</code>
                          <code>OA</code>
                        </valid_codes>
                      </element>
                      <element xid="CLM11-04">
                        <data_ele>156</data_ele>
                        <name>Auto Accident State or Province Code</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes external="states"/>
                      </element>
                      <element xid="CLM11-05">
                        <data_ele>26</data_ele>
                        <name>Country Code</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                        <valid_codes external="country"/>
                      </element>
                    </composite>
                    <element xid="CLM12">
                      <data_ele>1366</data_ele>
                      <name>Special Program Indicator</name>
                      <usage>S</usage>
                      <seq>12</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>05</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                      </valid_codes>
                    </element>
                    <element xid="CLM13">
                      <data_ele>1073</data_ele>
                      <name>Yes/No Condition or Response 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="CLM14">
                      <data_ele>1338</data_ele>
                      <name>Level of Service Code</name>
                      <usage>N</usage>
                      <seq>14</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="CLM15">
                      <data_ele>1073</data_ele>
                      <name>Yes/No Condition or Response 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="CLM16">
                      <data_ele>1360</data_ele>
                      <name>Participation Agreement</name>
                      <usage>S</usage>
                      <seq>16</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                      <valid_codes>
                        <code>P</code>
                      </valid_codes>
                    </element>
                    <element xid="CLM17">
                      <data_ele>1029</data_ele>
                      <name>Claim Status Code</name>
                      <usage>N</usage>
                      <seq>17</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="CLM18">
                      <data_ele>1073</data_ele>
                      <name>Yes/No Condition or Response Code</name>
                      <usage>N</usage>
                      <seq>18</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                    <element xid="CLM19">
                      <data_ele>1383</data_ele>
                      <name>Claim Submission Reason Code</name>
                      <usage>N</usage>
                      <seq>19</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="CLM20">
                      <data_ele>1514</data_ele>
                      <name>Delay Reason Code</name>
                      <usage>S</usage>
                      <seq>20</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>10</code>
                        <code>11</code>
                      </valid_codes>
                    </element>
                  </segment>
<!--End of CLM segment-->
                  <segment xid="DTP">
                    <name>Date - Order Date</name>
                    <usage>S</usage>
                    <pos>135</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>938</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>Order 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>Date - Initial Treatment</name>
                    <usage>S</usage>
                    <pos>135</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>454</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="DTP3">
                      <data_ele>1251</data_ele>
                      <name>Initial Treatment Date</name>
                      <usage>R</usage>
                      <seq>3</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>Date - Referral Date</name>
                    <usage>S</usage>
                    <pos>135</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>330</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>Referral 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>Date - Date Last Seen</name>
                    <usage>S</usage>
                    <pos>135</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>304</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 Seen 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>Date - Onset of Current Illness/Symptom</name>
                    <usage>S</usage>
                    <pos>135</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 Illness or Injury 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>Date - Acute Manifestation</name>
                    <usage>S</usage>
                    <pos>135</pos>
                    <max_use>5</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>453</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>Acute Manifestation 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>Date - Similar Illness/Symptom Onset</name>
                    <usage>S</usage>
                    <pos>135</pos>
                    <max_use>10</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>438</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>Similar Illness or Symptom 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>Date - Accident</name>
                    <usage>S</usage>
                    <pos>135</pos>
                    <max_use>10</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>
                        <code>DT</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>Date - Last Menstrual Period</name>
                    <usage>S</usage>
                    <pos>135</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>Date - Last X-Ray</name>
                    <usage>S</usage>
                    <pos>135</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>455</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 X-Ray 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>Date - Estimated Date of Birth</name>
                    <usage>S</usage>
                    <pos>135</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>Date - Hearing and Vision Prescription Date</name>
                    <usage>S</usage>
                    <pos>135</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>471</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>Prescription 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>Date - Disability Begin</name>
                    <usage>S</usage>
                    <pos>135</pos>
                    <max_use>5</max_use>
                    <element xid="DTP01">
                      <data_ele>374</data_ele>
                      <name>Date Time Qualifier</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>3</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>360</code>
                      </valid_codes>
                    </element>
                    <element xid="DTP02">
                      <data_ele>1250</data_ele>
                      <name>Date Time Period Format Qualifier</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>D8</code>
                      </valid_codes>
                    </element>
                    <element xid="DTP03">
                      <data_ele>1251</data_ele>
                      <name>Disability From 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>Date - Disability End</name>
                    <usage>S</usage>
                    <pos>135</pos>
                    <max_use>5</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>361</code>
                      </valid_codes>
                    </element>
                    <element xid="DTP02">
                      <data_ele>1250</data_ele>
                      <name>Date Time Period Format Qualifier</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>D8</code>
                      </valid_codes>
                    </element>
                    <element xid="DTP03">
                      <data_ele>1251</data_ele>
                      <name>Disability To 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>Date - Last Worked</name>
                    <usage>S</usage>
                    <pos>135</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>297</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 Worked 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>Date - Authorized Return to Work</name>
                    <usage>S</usage>
                    <pos>135</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>296</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>Work Return 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>Date - Admission</name>
                    <usage>S</usage>
                    <pos>135</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>
                      </valid_codes>
                    </element>
                    <element xid="DTP03">
                      <data_ele>1251</data_ele>
                      <name>Related Hospitalization 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>Date - Discharge</name>
                    <usage>S</usage>
                    <pos>135</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>Related Hospitalization 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>Date - Assumed and Relinquished Care Dates</name>
                    <usage>S</usage>
                    <pos>135</pos>
                    <max_use>2</max_use>
                    <element xid="DTP01">
                      <data_ele>374</data_ele>
                      <name>Date Time Qualifier</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>3</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>090</code>
                        <code>091</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>Assumed or Relinquished Care 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="PWK">
                    <name>Claim Supplemental Information</name>
                    <usage>S</usage>
                    <pos>155</pos>
                    <max_use>10</max_use>
                    <element xid="PWK01">
                      <data_ele>755</data_ele>
                      <name>Attachment Report Type 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>77</code>
                        <code>AS</code>
                        <code>B2</code>
                        <code>B3</code>
                        <code>B4</code>
                        <code>CT</code>
                        <code>DA</code>
                        <code>DG</code>
                        <code>DS</code>
                        <code>EB</code>
                        <code>MT</code>
                        <code>NN</code>
                        <code>OB</code>
                        <code>OZ</code>
                        <code>PN</code>
                        <code>PO</code>
                        <code>PZ</code>
                        <code>RB</code>
                        <code>RR</code>
                        <code>RT</code>
                      </valid_codes>
                    </element>
                    <element xid="PWK02">
                      <data_ele>756</data_ele>
                      <name>Attachment Transmission Code</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>AA</code>
                        <code>BM</code>
                        <code>EL</code>
                        <code>EM</code>
                        <code>FX</code>
                      </valid_codes>
                    </element>
                    <element xid="PWK03">
                      <data_ele>757</data_ele>
                      <name>Report Copies Needed</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>N0</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="PWK04">
                      <data_ele>98</data_ele>
                      <name>Entity Identifier Code</name>
                      <usage>N</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>3</max_len>
                    </element>
                    <element xid="PWK05">
                      <data_ele>66</data_ele>
                      <name>Identification Code 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>AC</code>
                      </valid_codes>
                    </element>
                    <element xid="PWK06">
                      <data_ele>67</data_ele>
                      <name>Attachment Control Number</name>
                      <usage>S</usage>
                      <seq>06</seq>
                      <data_type>AN</data_type>
                      <min_len>2</min_len>
                      <max_len>80</max_len>
                    </element>
                    <element xid="PWK07">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>07</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C002</data_ele>
                      <name>Actions Indicated</name>
                      <usage>N</usage>
                      <seq>08</seq>
                    </composite>
                    <element xid="PWK09">
                      <data_ele>1525</data_ele>
                      <name>Request Category Code</name>
                      <usage>N</usage>
                      <seq>09</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                  </segment>
<!--End of PWK segment-->
                  <segment xid="CN1">
                    <name>Contract Information</name>
                    <usage>S</usage>
                    <pos>160</pos>
                    <max_use>1</max_use>
                    <element xid="CN101">
                      <data_ele>1166</data_ele>
                      <name>Contract Type 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>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>09</code>
                      </valid_codes>
                    </element>
                    <element xid="CN102">
                      <data_ele>782</data_ele>
                      <name>Contract Amount</name>
                      <usage>S</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="CN103">
                      <data_ele>332</data_ele>
                      <name>Contract Percentage</name>
                      <usage>S</usage>
                      <seq>03</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>6</max_len>
                    </element>
                    <element xid="CN104">
                      <data_ele>127</data_ele>
                      <name>Contract Code</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="CN105">
                      <data_ele>338</data_ele>
                      <name>Terms Discount Percentage</name>
                      <usage>S</usage>
                      <seq>05</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>6</max_len>
                    </element>
                    <element xid="CN106">
                      <data_ele>799</data_ele>
                      <name>Contract Version Identifier</name>
                      <usage>S</usage>
                      <seq>06</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                  </segment>
<!--End of CN1 segment-->
                  <segment xid="AMT">
                    <name>Credit/Debit Card Maximum Amount</name>
                    <usage>S</usage>
                    <pos>175</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>MA</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Credit or Debit Card Maximum Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Patient Amount Paid</name>
                    <usage>S</usage>
                    <pos>175</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>F5</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Patient Amount Paid</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="AMT">
                    <name>Total Purchased Service Amount</name>
                    <usage>S</usage>
                    <pos>175</pos>
                    <max_use>1</max_use>
                    <element xid="AMT01">
                      <data_ele>522</data_ele>
                      <name>Amount Qualifier Code</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>3</max_len>
                      <valid_codes>
                        <code>NE</code>
                      </valid_codes>
                    </element>
                    <element xid="AMT02">
                      <data_ele>782</data_ele>
                      <name>Total Purchased Service Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="AMT03">
                      <data_ele>478</data_ele>
                      <name>Credit/Debit Flag Code</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>1</max_len>
                    </element>
                  </segment>
<!--End of AMT segment-->
                  <segment xid="REF">
                    <name>Service Authorization Exception Code</name>
                    <usage>S</usage>
                    <pos>180</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>4N</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Service Authorization Exception Code</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                      <valid_codes>
                        <code>1</code>
                        <code>2</code>
                        <code>3</code>
                        <code>4</code>
                        <code>5</code>
                        <code>6</code>
                        <code>7</code>
                      </valid_codes>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Mandatory Medicare (Section 4081) Crossover Indicator</name>
                    <usage>S</usage>
                    <pos>180</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>F5</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Medicare Section 4081 Indicator</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                      <valid_codes>
                        <code>Y</code>
                        <code>N</code>
                      </valid_codes>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Mammography Certification Number</name>
                    <usage>S</usage>
                    <pos>180</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>EW</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Mammography Certification Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Prior Authorization or Referral Number</name>
                    <usage>S</usage>
                    <pos>180</pos>
                    <max_use>2</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>9F</code>
                        <code>G1</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Prior Authorization or Referral Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Original Reference Number (ICN/DCN)</name>
                    <usage>S</usage>
                    <pos>180</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>F8</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Claim Original Reference Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Clinical Laboratory Improvement Amendment (CLIA) Number</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>X4</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Clinical Laboratory Improvement Amendment Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Repriced Claim Number</name>
                    <usage>S</usage>
                    <pos>180</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>9A</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Repriced Claim Reference Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Adjusted Repriced Claim Number</name>
                    <usage>S</usage>
                    <pos>180</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>9C</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Adjusted Repriced Claim Reference Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
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                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
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                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Investigational Device Exemption Number</name>
                    <usage>S</usage>
                    <pos>180</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>LX</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Investigational Device Exemption Identifier</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Claim Identification Number for Clearing Houses and Other Transmission Intermediaries</name>
                    <usage>S</usage>
                    <pos>180</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>D9</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Clearinghouse 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="REF03">
                      <data_ele>352</data_ele>
                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Ambulatory Patient Group (APG)</name>
                    <usage>S</usage>
                    <pos>180</pos>
                    <max_use>4</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>1S</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Ambulatory Patient Group Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
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                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Medical Record Number</name>
                    <usage>S</usage>
                    <pos>180</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>EA</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Medical Record Number</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="REF03">
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                      <name>Description</name>
                      <usage>N</usage>
                      <seq>03</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <composite>
                      <data_ele>C040</data_ele>
                      <name>Reference Identifier</name>
                      <usage>N</usage>
                      <seq>04</seq>
                    </composite>
                  </segment>
<!--End of REF segment-->
                  <segment xid="REF">
                    <name>Demonstration Project Identifier</name>
                    <usage>S</usage>
                    <pos>180</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>P4</code>
                      </valid_codes>
                    </element>
                    <element xid="REF02">
                      <data_ele>127</data_ele>
                      <name>Demonstration Project 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">
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                      <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="K3">
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                    <usage>S</usage>
                    <pos>185</pos>
                    <max_use>10</max_use>
                    <element xid="K301">
                      <data_ele>449</data_ele>
                      <name>Fixed Format Information</name>
                      <usage>R</usage>
                      <seq>01</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                    <element xid="K302">
                      <data_ele>1333</data_ele>
                      <name>Record Format Code</name>
                      <usage>N</usage>
                      <seq>02</seq>
                      <data_type>ID</data_type>
                      <min_len>1</min_len>
                      <max_len>2</max_len>
                    </element>
                    <composite>
                      <data_ele>C001</data_ele>
                      <name>Composite Unit of Measure</name>
                      <usage>N</usage>
                      <seq>03</seq>
                    </composite>
                  </segment>
<!--End of K3 segment-->
                  <segment xid="NTE">
                    <name>Claim Note</name>
                    <usage>S</usage>
                    <pos>190</pos>
                    <max_use>1</max_use>
                    <element xid="NTE01">
                      <data_ele>363</data_ele>
                      <name>Note Reference 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>ADD</code>
                        <code>CER</code>
                        <code>DCP</code>
                        <code>DGN</code>
                        <code>PMT</code>
                        <code>TPO</code>
                      </valid_codes>
                    </element>
                    <element xid="NTE02">
                      <data_ele>352</data_ele>
                      <name>Claim Note Text</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>80</max_len>
                    </element>
                  </segment>
<!--End of NTE segment-->
                  <segment xid="CR1">
                    <name>Ambulance Transport Information</name>
                    <usage>S</usage>
                    <pos>195</pos>
                    <max_use>1</max_use>
                    <element xid="CR101">
                      <data_ele>355</data_ele>
                      <name>Unit or Basis for Measurement Code</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>LB</code>
                      </valid_codes>
                    </element>
                    <element xid="CR102">
                      <data_ele>81</data_ele>
                      <name>Patient Weight</name>
                      <usage>S</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>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>B</code>
                        <code>C</code>
                        <code>D</code>
                        <code>E</code>
                      </valid_codes>
                    </element>
                    <element xid="CR105">
                      <data_ele>355</data_ele>
                      <name>Unit or Basis for Measurement Code</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>DH</code>
                      </valid_codes>
                    </element>
                    <element xid="CR106">
                      <data_ele>380</data_ele>
                      <name>Transport Distance</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="CR107">
                      <data_ele>166</data_ele>
                      <name>Address Information</name>
                      <usage>N</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>Address Information</name>
                      <usage>N</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>Round Trip Purpose Description</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="CR110">
                      <data_ele>352</data_ele>
                      <name>Stretcher Purpose Description</name>
                      <usage>S</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>200</pos>
                    <max_use>1</max_use>
                    <element xid="CR201">
                      <data_ele>609</data_ele>
                      <name>Treatment Series Number</name>
                      <usage>R</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>R</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>R</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>R</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>R</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>Patient Condition 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>A</code>
                        <code>C</code>
                        <code>D</code>
                        <code>E</code>
                        <code>F</code>
                        <code>G</code>
                        <code>M</code>
                      </valid_codes>
                    </element>
                    <element xid="CR209">
                      <data_ele>1073</data_ele>
                      <name>Complication Indicator</name>
                      <usage>R</usage>
                      <seq>09</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="CR210">
                      <data_ele>352</data_ele>
                      <name>Patient Condition Description</name>
                      <usage>S</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>Patient Condition Description</name>
                      <usage>S</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>X-ray Availability Indicator</name>
                      <usage>R</usage>
                      <seq>12</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 CR2 segment-->
                  <segment xid="CRC">
                    <name>Ambulance Certification</name>
                    <usage>S</usage>
                    <pos>220</pos>
                    <max_use>3</max_use>
                    <element xid="CRC01">
                      <data_ele>1136</data_ele>
                      <name>Code Category</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>07</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC02">
                      <data_ele>1073</data_ele>
                      <name>Certification Condition Indicator</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>N</code>
                        <code>Y</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC03">
                      <data_ele>1321</data_ele>
                      <name>Condition 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>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>60</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC04">
                      <data_ele>1321</data_ele>
                      <name>Condition Code</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>60</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC05">
                      <data_ele>1321</data_ele>
                      <name>Condition Code</name>
                      <usage>S</usage>
                      <seq>05</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>60</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC06">
                      <data_ele>1321</data_ele>
                      <name>Condition 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>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>60</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC07">
                      <data_ele>1321</data_ele>
                      <name>Condition Code</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>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>06</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>60</code>
                      </valid_codes>
                    </element>
                  </segment>
<!--End of CRC segment-->
                  <segment xid="CRC">
                    <name>Patient Condition Information:  Vision</name>
                    <usage>S</usage>
                    <pos>220</pos>
                    <max_use>3</max_use>
                    <element xid="CRC01">
                      <data_ele>1136</data_ele>
                      <name>Code Category</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>E1</code>
                        <code>E2</code>
                        <code>E3</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC02">
                      <data_ele>1073</data_ele>
                      <name>Certification Condition Indicator</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>N</code>
                        <code>Y</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC03">
                      <data_ele>1321</data_ele>
                      <name>Condition 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>L1</code>
                        <code>L2</code>
                        <code>L3</code>
                        <code>L4</code>
                        <code>L5</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC04">
                      <data_ele>1321</data_ele>
                      <name>Condition Code</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>L1</code>
                        <code>L2</code>
                        <code>L3</code>
                        <code>L4</code>
                        <code>L5</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC05">
                      <data_ele>1321</data_ele>
                      <name>Condition 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>L1</code>
                        <code>L2</code>
                        <code>L3</code>
                        <code>L4</code>
                        <code>L5</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC06">
                      <data_ele>1321</data_ele>
                      <name>Condition 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>L1</code>
                        <code>L2</code>
                        <code>L3</code>
                        <code>L4</code>
                        <code>L5</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC07">
                      <data_ele>1321</data_ele>
                      <name>Condition Code</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>L1</code>
                        <code>L2</code>
                        <code>L3</code>
                        <code>L4</code>
                        <code>L5</code>
                      </valid_codes>
                    </element>
                  </segment>
<!--End of CRC segment-->
                  <segment xid="CRC">
                    <name>Homebound Indicator</name>
                    <usage>S</usage>
                    <pos>220</pos>
                    <max_use>1</max_use>
                    <element xid="CRC01">
                      <data_ele>1136</data_ele>
                      <name>Code Category</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>75</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC02">
                      <data_ele>1073</data_ele>
                      <name>Certification Condition Indicator</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>Y</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC03">
                      <data_ele>1321</data_ele>
                      <name>Homebound Indicator</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>IH</code>
                      </valid_codes>
                    </element>
                    <element xid="CRC04">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</name>
                      <usage>N</usage>
                      <seq>04</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="CRC05">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</name>
                      <usage>N</usage>
                      <seq>05</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="CRC06">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</name>
                      <usage>N</usage>
                      <seq>06</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="CRC07">
                      <data_ele>1321</data_ele>
                      <name>Condition Indicator</name>
                      <usage>N</usage>
                      <seq>07</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                  </segment>
<!--End of CRC segment-->
                  <segment xid="HI">
                    <name>Health Care Diagnosis Code</name>
                    <usage>S</usage>
                    <pos>231</pos>
                    <max_use>1</max_use>
                    <composite>
                      <data_ele>C022</data_ele>
                      <name>Principal Diagnosis</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>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>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                      <element xid="HI01-04">
                        <data_ele>1251</data_ele>
                        <name>Date Time Period</name>
                        <usage>N</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</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>
                        </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>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                      <element xid="HI02-04">
                        <data_ele>1251</data_ele>
                        <name>Date Time Period</name>
                        <usage>N</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</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>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                      <element xid="HI03-04">
                        <data_ele>1251</data_ele>
                        <name>Date Time Period</name>
                        <usage>N</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</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>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                      <element xid="HI04-04">
                        <data_ele>1251</data_ele>
                        <name>Date Time Period</name>
                        <usage>N</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</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>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                      <element xid="HI05-04">
                        <data_ele>1251</data_ele>
                        <name>Date Time Period</name>
                        <usage>N</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</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>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                      <element xid="HI06-04">
                        <data_ele>1251</data_ele>
                        <name>Date Time Period</name>
                        <usage>N</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</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>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                      <element xid="HI07-04">
                        <data_ele>1251</data_ele>
                        <name>Date Time Period</name>
                        <usage>N</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</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>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                      <element xid="HI08-04">
                        <data_ele>1251</data_ele>
                        <name>Date Time Period</name>
                        <usage>N</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>Health Care Code Information</name>
                      <usage>N</usage>
                      <seq>09</seq>
                    </composite>
                    <composite>
                      <data_ele>C022</data_ele>
                      <name>Health Care Code Information</name>
                      <usage>N</usage>
                      <seq>10</seq>
                    </composite>
                    <composite>
                      <data_ele>C022</data_ele>
                      <name>Health Care Code Information</name>
                      <usage>N</usage>
                      <seq>11</seq>
                    </composite>
                    <composite>
                      <data_ele>C022</data_ele>
                      <name>Health Care Code Information</name>
                      <usage>N</usage>
                      <seq>12</seq>
                    </composite>
                  </segment>
<!--End of HI segment-->
                  <segment xid="HCP">
                    <name>Claim Pricing/Repricing Information</name>
                    <usage>S</usage>
                    <pos>241</pos>
                    <max_use>1</max_use>
                    <element xid="HCP01">
                      <data_ele>1473</data_ele>
                      <name>Pricing/Repricing Methodology</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>01</code>
                        <code>02</code>
                        <code>03</code>
                        <code>04</code>
                        <code>05</code>
                        <code>07</code>
                        <code>08</code>
                        <code>09</code>
                        <code>10</code>
                        <code>11</code>
                        <code>12</code>
                        <code>13</code>
                        <code>14</code>
                      </valid_codes>
                    </element>
                    <element xid="HCP02">
                      <data_ele>782</data_ele>
                      <name>Repriced Allowed Amount</name>
                      <usage>R</usage>
                      <seq>02</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="HCP03">
                      <data_ele>782</data_ele>
                      <name>Repriced Saving Amount</name>
                      <usage>S</usage>
                      <seq>03</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="HCP04">
                      <data_ele>127</data_ele>
                      <name>Repricing Organization Identifier</name>
                      <usage>S</usage>
                      <seq>04</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="HCP05">
                      <data_ele>118</data_ele>
                      <name>Repricing Per Diem or Flat Rate Amount</name>
                      <usage>S</usage>
                      <seq>05</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>9</max_len>
                    </element>
                    <element xid="HCP06">
                      <data_ele>127</data_ele>
                      <name>Repriced Approved Ambulatory Patient Group Code</name>
                      <usage>S</usage>
                      <seq>06</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>30</max_len>
                    </element>
                    <element xid="HCP7">
                      <data_ele>782</data_ele>
                      <name>Repriced Approved Ambulatory Patient Group Amount</name>
                      <usage>S</usage>
                      <seq>7</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>18</max_len>
                    </element>
                    <element xid="HCP08">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>08</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="HCP09">
                      <data_ele>235</data_ele>
                      <name>Product/Service ID Qualifier</name>
                      <usage>N</usage>
                      <seq>09</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="HCP10">
                      <data_ele>234</data_ele>
                      <name>Product/Service ID</name>
                      <usage>N</usage>
                      <seq>10</seq>
                      <data_type>AN</data_type>
                      <min_len>1</min_len>
                      <max_len>48</max_len>
                    </element>
                    <element xid="HCP11">
                      <data_ele>355</data_ele>
                      <name>Unit or Basis for Measurement Code</name>
                      <usage>N</usage>
                      <seq>11</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                    </element>
                    <element xid="HCP12">
                      <data_ele>380</data_ele>
                      <name>Quantity</name>
                      <usage>N</usage>
                      <seq>12</seq>
                      <data_type>R</data_type>
                      <min_len>1</min_len>
                      <max_len>15</max_len>
                    </element>
                    <element xid="HCP13">
                      <data_ele>901</data_ele>
                      <name>Reject Reason Code</name>
                      <usage>S</usage>
                      <seq>13</seq>
                      <data_type>ID</data_type>
                      <min_len>2</min_len>
                      <max_len>2</max_len>
                      <valid_codes>
                        <code>T1</code>
                        <code>T2</code>
                        <code>T3</code>
                        <code>T4</code>
                        <code>T5</code>
                        <code>T6</code>
                      </valid_codes>
                    </element>
                    <element xid="HCP14">
                      <data_ele>1526</data_ele>
                      <name>Policy Compliance Code</name>
                      <usage>S</usage>
                      <seq>14</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>
                      </valid_codes>
                    </element>
                    <element xid="HCP15">
                      <data_ele>1527</data_ele>
                      <name>Exception Code</name>
                      <usage>S</usage>
                      <seq>15</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>
                      </valid_codes>
                    </element>
                  </segment>
<!--End of HCP segment-->
                  <loop xid="2305">
                    <name>Home Health Care Plan Information</name>
                    <usage>S</usage>
                    <pos>242</pos>
                    <count>6</count>
                    <segment xid="CR7">
                      <name>Home Health Care Plan Information</name>
                      <usage>S</usage>
                      <pos>242</pos>
                      <max_use>1</max_use>
                      <element xid="CR701">
                        <data_ele>921</data_ele>
                        <name>Discipline Type 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>AI</code>
                          <code>MS</code>
                          <code>OT</code>
                          <code>PT</code>
                          <code>SN</code>
                          <code>ST</code>
                        </valid_codes>
                      </element>
                      <element xid="CR702">
                        <data_ele>1470</data_ele>
                        <name>Total Visits Rendered Count</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>N0</data_type>
                        <min_len>1</min_len>
                        <max_len>9</max_len>
                      </element>
                      <element xid="CR703">
                        <data_ele>1470</data_ele>
                        <name>Certification Period Projected Visit Count</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>N0</data_type>
                        <min_len>1</min_len>
                        <max_len>9</max_len>
                      </element>
                    </segment>
<!--End of CR7 segment-->
                    <segment xid="HSD">
                      <name>Health Care Services Delivery</name>
                      <usage>S</usage>
                      <pos>243</pos>
                      <max_use>3</max_use>
                      <element xid="HSD01">
                        <data_ele>673</data_ele>
                        <name>Visits</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>VS</code>
                        </valid_codes>
                      </element>
                      <element xid="HSD02">
                        <data_ele>380</data_ele>
                        <name>Number of Visits</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>Frequency Period</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>Q1</code>
                          <code>WK</code>
                        </valid_codes>
                      </element>
                      <element xid="HSD04">
                        <data_ele>1167</data_ele>
                        <name>Frequency Count</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>Duration of Visits Units</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>7</code>
                          <code>35</code>
                        </valid_codes>
                      </element>
                      <element xid="HSD06">
                        <data_ele>616</data_ele>
                        <name>Duration of Visits, Number of Units</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>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>N</code>
                          <code>O</code>
                          <code>S</code>
                          <code>W</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>
                        </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>D</code>
                          <code>E</code>
                          <code>F</code>
                        </valid_codes>
                      </element>
                    </segment>
<!--End of HSD segment-->
                  </loop>
<!--End of 2305 loop-->
                  <loop xid="2310A">
                    <name>Referring Provider Name</name>
                    <usage>S</usage>
                    <pos>250</pos>
                    <count>2</count>
                    <segment xid="NM1">
                      <name>Referring Provider Name</name>
                      <usage>S</usage>
                      <pos>250</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>DN</code>
                          <code>P3</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>Referring Provider Last Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Referring 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>Referring 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>Referring 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>XX</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Referring 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="PRV">
                      <name>Referring Provider Specialty Information</name>
                      <usage>S</usage>
                      <pos>255</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>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-->
                    <segment xid="N2">
                      <name>Additional Referring Provider Name Information</name>
                      <usage>S</usage>
                      <pos>260</pos>
                      <max_use>1</max_use>
                      <element xid="N201">
                        <data_ele>93</data_ele>
                        <name>Referring Provider Name Additional Text</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="N202">
                        <data_ele>93</data_ele>
                        <name>Name</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                    </segment>
<!--End of N2 segment-->
                    <segment xid="REF">
                      <name>Referring Provider Secondary Identification</name>
                      <usage>S</usage>
                      <pos>271</pos>
                      <max_use>5</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>0B</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>1G</code>
                          <code>1H</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                          <code>SY</code>
                          <code>X5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Referring Provider Secondary 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-->
                  </loop>
<!--End of 2310A loop-->
                  <loop xid="2310B">
                    <name>Rendering Provider Name</name>
                    <usage>S</usage>
                    <pos>250</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Rendering Provider Name</name>
                      <usage>S</usage>
                      <pos>250</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>82</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>Rendering Provider Last or Organization Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Rendering 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>Rendering 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>Rendering 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>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>XX</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Rendering Provider 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="PRV">
                      <name>Rendering Provider Specialty Information</name>
                      <usage>R</usage>
                      <pos>255</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>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-->
                    <segment xid="N2">
                      <name>Additional Rendering Provider Name Information</name>
                      <usage>S</usage>
                      <pos>260</pos>
                      <max_use>1</max_use>
                      <element xid="N201">
                        <data_ele>93</data_ele>
                        <name>Rendering Provider Name Additional Text</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="N202">
                        <data_ele>93</data_ele>
                        <name>Name</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                    </segment>
<!--End of N2 segment-->
                    <segment xid="REF">
                      <name>Rendering Provider Secondary Identification</name>
                      <usage>S</usage>
                      <pos>271</pos>
                      <max_use>5</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>0B</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>1G</code>
                          <code>1H</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                          <code>SY</code>
                          <code>X5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Rendering Provider Secondary 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-->
                  </loop>
<!--End of 2310B loop-->
                  <loop xid="2310C">
                    <name>Purchased Service Provider Name</name>
                    <usage>S</usage>
                    <pos>250</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Purchased Service Provider Name</name>
                      <usage>S</usage>
                      <pos>250</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>QB</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>Name Last or Organization Name</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>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>XX</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Purchased 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>Purchased Service Provider Secondary Identification</name>
                      <usage>S</usage>
                      <pos>271</pos>
                      <max_use>5</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>0B</code>
                          <code>1A</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>1G</code>
                          <code>1H</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                          <code>SY</code>
                          <code>U3</code>
                          <code>X5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Purchased Service Provider Secondary 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-->
                  </loop>
<!--End of 2310C loop-->
                  <loop xid="2310D">
                    <name>Service Facility Location</name>
                    <usage>S</usage>
                    <pos>250</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Service Facility Location</name>
                      <usage>S</usage>
                      <pos>250</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>77</code>
                          <code>FA</code>
                          <code>LI</code>
                          <code>TL</code>
                        </valid_codes>
                      </element>
                      <element xid="NM102">
                        <data_ele>1065</data_ele>
                        <name>Entity Type Qualifier</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>2</code>
                        </valid_codes>
                      </element>
                      <element xid="NM103">
                        <data_ele>1035</data_ele>
                        <name>Laboratory or Facility 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>Name First</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Name Middle</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM106">
                        <data_ele>1038</data_ele>
                        <name>Name Prefix</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM107">
                        <data_ele>1039</data_ele>
                        <name>Name Suffix</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="NM108">
                        <data_ele>66</data_ele>
                        <name>Identification Code Qualifier</name>
                        <usage>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>XX</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Laboratory or Facility 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="N2">
                      <name>Additional Service Facility Location Name Information</name>
                      <usage>S</usage>
                      <pos>260</pos>
                      <max_use>1</max_use>
                      <element xid="N201">
                        <data_ele>93</data_ele>
                        <name>Laboratory or Facility Name Additional Text</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="N202">
                        <data_ele>93</data_ele>
                        <name>Name</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                    </segment>
<!--End of N2 segment-->
                    <segment xid="N3">
                      <name>Service Facility Location Address</name>
                      <usage>R</usage>
                      <pos>265</pos>
                      <max_use>1</max_use>
                      <element xid="N301">
                        <data_ele>166</data_ele>
                        <name>Laboratory or Facility 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>Laboratory or Facility 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 Facility Location City/State/ZIP</name>
                      <usage>R</usage>
                      <pos>270</pos>
                      <max_use>1</max_use>
                      <element xid="N401">
                        <data_ele>19</data_ele>
                        <name>Laboratory or Facility City Name</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="N402">
                        <data_ele>156</data_ele>
                        <name>Laboratory or Facility State or Province Code</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes external="states"/>
                      </element>
                      <element xid="N403">
                        <data_ele>116</data_ele>
                        <name>Laboratory or Facility Postal Zone or ZIP Code</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>3</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="N404">
                        <data_ele>26</data_ele>
                        <name>Laboratory/Facility 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="REF">
                      <name>Service Facility Location Secondary Identification</name>
                      <usage>S</usage>
                      <pos>271</pos>
                      <max_use>5</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>0B</code>
                          <code>1A</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>1G</code>
                          <code>1H</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                          <code>TJ</code>
                          <code>X4</code>
                          <code>X5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Laboratory or Facility Secondary 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-->
                  </loop>
<!--End of 2310D loop-->
                  <loop xid="2310E">
                    <name>Supervising Provider Name</name>
                    <usage>S</usage>
                    <pos>250</pos>
                    <count>1</count>
                    <segment xid="NM1">
                      <name>Supervising Provider Name</name>
                      <usage>S</usage>
                      <pos>250</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>DQ</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>Supervising Provider Last Name</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="NM104">
                        <data_ele>1036</data_ele>
                        <name>Supervising Provider First Name</name>
                        <usage>R</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>25</max_len>
                      </element>
                      <element xid="NM105">
                        <data_ele>1037</data_ele>
                        <name>Supervising 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>Supervising 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>XX</code>
                        </valid_codes>
                      </element>
                      <element xid="NM109">
                        <data_ele>67</data_ele>
                        <name>Supervising 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="N2">
                      <name>Additional Supervising Provider Name Information</name>
                      <usage>S</usage>
                      <pos>260</pos>
                      <max_use>1</max_use>
                      <element xid="N201">
                        <data_ele>93</data_ele>
                        <name>Supervising Provider Name Additional Text</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="N202">
                        <data_ele>93</data_ele>
                        <name>Name</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                    </segment>
<!--End of N2 segment-->
                    <segment xid="REF">
                      <name>Supervising Provider Secondary Identification</name>
                      <usage>S</usage>
                      <pos>271</pos>
                      <max_use>5</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>0B</code>
                          <code>1B</code>
                          <code>1C</code>
                          <code>1D</code>
                          <code>1G</code>
                          <code>1H</code>
                          <code>EI</code>
                          <code>G2</code>
                          <code>LU</code>
                          <code>N5</code>
                          <code>SY</code>
                          <code>X5</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Supervising Provider Secondary 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-->
                  </loop>
<!--End of 2310E loop-->
                  <loop xid="2320">
                    <name>Other Subscriber Information</name>
                    <usage>S</usage>
                    <pos>290</pos>
                    <count>10</count>
                    <segment xid="SBR">
                      <name>Other Subscriber Information</name>
                      <usage>S</usage>
                      <pos>290</pos>
                      <max_use>1</max_use>
                      <element xid="SBR01">
                        <data_ele>1138</data_ele>
                        <name>Payer Responsibility Sequence Number Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>P</code>
                          <code>S</code>
                          <code>T</code>
                        </valid_codes>
                      </element>
                      <element xid="SBR02">
                        <data_ele>1069</data_ele>
                        <name>Individual Relationship Code</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>01</code>
                          <code>04</code>
                          <code>05</code>
                          <code>07</code>
                          <code>10</code>
                          <code>15</code>
                          <code>17</code>
                          <code>18</code>
                          <code>19</code>
                          <code>20</code>
                          <code>21</code>
                          <code>22</code>
                          <code>23</code>
                          <code>24</code>
                          <code>29</code>
                          <code>32</code>
                          <code>33</code>
                          <code>36</code>
                          <code>39</code>
                          <code>40</code>
                          <code>41</code>
                          <code>43</code>
                          <code>53</code>
                          <code>G8</code>
                        </valid_codes>
                      </element>
                      <element xid="SBR03">
                        <data_ele>127</data_ele>
                        <name>Insured Group or Policy Number</name>
                        <usage>S</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="SBR04">
                        <data_ele>93</data_ele>
                        <name>Other Insured Group Name</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>60</max_len>
                      </element>
                      <element xid="SBR05">
                        <data_ele>1336</data_ele>
                        <name>Insurance Type Code</name>
                        <usage>R</usage>
                        <seq>05</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>AP</code>
                          <code>C1</code>
                          <code>CP</code>
                          <code>GP</code>
                          <code>HM</code>
                          <code>IP</code>
                          <code>LD</code>
                          <code>LT</code>
                          <code>MB</code>
                          <code>MC</code>
                          <code>MI</code>
                          <code>MP</code>
                          <code>OT</code>
                          <code>PP</code>
                          <code>SP</code>
                        </valid_codes>
                      </element>
                      <element xid="SBR06">
                        <data_ele>1143</data_ele>
                        <name>Coordination of Benefits 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="SBR07">
                        <data_ele>1073</data_ele>
                        <name>Yes/No Condition or Response 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="SBR08">
                        <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="SBR09">
                        <data_ele>1032</data_ele>
                        <name>Claim Filing Indicator Code</name>
                        <usage>S</usage>
                        <seq>09</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>09</code>
                          <code>10</code>
                          <code>11</code>
                          <code>12</code>
                          <code>13</code>
                          <code>14</code>
                          <code>15</code>
                          <code>16</code>
                          <code>AM</code>
                          <code>BL</code>
                          <code>CH</code>
                          <code>CI</code>
                          <code>DS</code>
                          <code>HM</code>
                          <code>LI</code>
                          <code>LM</code>
                          <code>MB</code>
                          <code>MC</code>
                          <code>OF</code>
                          <code>TV</code>
                          <code>VA</code>
                          <code>WC</code>
                          <code>ZZ</code>
                        </valid_codes>
                      </element>
                    </segment>
<!--End of SBR segment-->
                    <segment xid="CAS">
                      <name>Claim Level Adjustments</name>
                      <usage>S</usage>
                      <pos>295</pos>
                      <max_use>5</max_use>
                      <element xid="CAS01">
                        <data_ele>1033</data_ele>
                        <name>Claim Adjustment Group 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>CO</code>
                          <code>CR</code>
                          <code>OA</code>
                          <code>PI</code>
                          <code>PR</code>
                        </valid_codes>
                      </element>
                      <element xid="CAS02">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS03">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS04">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="CAS05">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS06">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>S</usage>
                        <seq>06</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS07">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</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="CAS08">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>S</usage>
                        <seq>08</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS09">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>S</usage>
                        <seq>09</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS10">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</name>
                        <usage>S</usage>
                        <seq>10</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="CAS11">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>S</usage>
                        <seq>11</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS12">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>S</usage>
                        <seq>12</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS13">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</name>
                        <usage>S</usage>
                        <seq>13</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="CAS14">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>S</usage>
                        <seq>14</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS15">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>S</usage>
                        <seq>15</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS16">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</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="CAS17">
                        <data_ele>1034</data_ele>
                        <name>Adjustment Reason Code</name>
                        <usage>S</usage>
                        <seq>17</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>5</max_len>
                        <valid_codes external="adjustment_reason"/>
                      </element>
                      <element xid="CAS18">
                        <data_ele>782</data_ele>
                        <name>Adjustment Amount</name>
                        <usage>S</usage>
                        <seq>18</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CAS19">
                        <data_ele>380</data_ele>
                        <name>Adjustment Quantity</name>
                        <usage>S</usage>
                        <seq>19</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                    </segment>
<!--End of CAS segment-->
                    <segment xid="AMT">
                      <name>Coordination of Benefits (COB) Payer Paid Amount</name>
                      <usage>S</usage>
                      <pos>300</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>D</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Payer Paid Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="AMT">
                      <name>Coordination of Benefits (COB) Approved Amount</name>
                      <usage>S</usage>
                      <pos>300</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>AAE</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Approved Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="AMT">
                      <name>Coordination of Benefits (COB) Allowed Amount</name>
                      <usage>S</usage>
                      <pos>300</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>B6</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Allowed Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="AMT">
                      <name>Coordination of Benefits (COB) Patient Responsibility Amount</name>
                      <usage>S</usage>
                      <pos>300</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>F2</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Other Payer Patient Responsibility Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="AMT">
                      <name>Coordination of Benefits (COB) Covered Amount</name>
                      <usage>S</usage>
                      <pos>300</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>AU</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Other Payer Covered Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="AMT">
                      <name>Coordination of Benefits (COB) Discount Amount</name>
                      <usage>S</usage>
                      <pos>300</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>D8</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Other Payer Discount Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="AMT">
                      <name>Coordination of Benefits (COB) Per Day Limit Amount</name>
                      <usage>S</usage>
                      <pos>300</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>DY</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Other Payer Per Day Limit Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="AMT">
                      <name>Coordination of Benefits (COB) Patient Paid Amount</name>
                      <usage>S</usage>
                      <pos>300</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>F5</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Other Payer Patient Paid Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="AMT">
                      <name>Coordination of Benefits (COB) Tax Amount</name>
                      <usage>S</usage>
                      <pos>300</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>T</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Other Payer Tax Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="AMT">
                      <name>Coordination of Benefits (COB) Total Claim Before Taxes Amount</name>
                      <usage>S</usage>
                      <pos>300</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>T2</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Other Payer Pre-Tax Claim Total Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="DMG">
                      <name>Subscriber Demographic Information</name>
                      <usage>S</usage>
                      <pos>305</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>Other Insured Birth Date</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>35</max_len>
                      </element>
                      <element xid="DMG03">
                        <data_ele>1068</data_ele>
                        <name>Other Insured Gender Code</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>F</code>
                          <code>M</code>
                          <code>U</code>
                        </valid_codes>
                      </element>
                      <element xid="DMG04">
                        <data_ele>1067</data_ele>
                        <name>Marital Status Code</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                      <element xid="DMG05">
                        <data_ele>1109</data_ele>
                        <name>Race or Ethnicity Code</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                      <element xid="DMG6">
                        <data_ele>1066</data_ele>
                        <name>Citizenship Status Code</name>
                        <usage>N</usage>
                        <seq>6</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="OI">
                      <name>Other Insurance Coverage Information</name>
                      <usage>R</usage>
                      <pos>310</pos>
                      <max_use>1</max_use>
                      <element xid="OI01">
                        <data_ele>1032</data_ele>
                        <name>Claim Filing Indicator Code</name>
                        <usage>N</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="OI02">
                        <data_ele>1383</data_ele>
                        <name>Claim Submission Reason 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="OI03">
                        <data_ele>1073</data_ele>
                        <name>Benefits Assignment Certification Indicator</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>N</code>
                          <code>Y</code>
                        </valid_codes>
                      </element>
                      <element xid="OI04">
                        <data_ele>1351</data_ele>
                        <name>Patient Signature Source Code</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>B</code>
                          <code>C</code>
                          <code>M</code>
                          <code>P</code>
                          <code>S</code>
                        </valid_codes>
                      </element>
                      <element xid="OI05">
                        <data_ele>1360</data_ele>
                        <name>Provider Agreement 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="OI06">
                        <data_ele>1363</data_ele>
                        <name>Release of Information Code</name>
                        <usage>R</usage>
                        <seq>06</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>A</code>
                          <code>I</code>
                          <code>M</code>
                          <code>N</code>
                          <code>O</code>
                          <code>Y</code>
                        </valid_codes>
                      </element>
                    </segment>
<!--End of OI segment-->
                    <segment xid="MOA">
                      <name>Medicare Outpatient Adjudication Information</name>
                      <usage>S</usage>
                      <pos>320</pos>
                      <max_use>1</max_use>
                      <element xid="MOA01">
                        <data_ele>954</data_ele>
                        <name>Reimbursement Rate</name>
                        <usage>S</usage>
                        <seq>01</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>10</max_len>
                      </element>
                      <element xid="MOA02">
                        <data_ele>782</data_ele>
                        <name>HCPCS Payable Amount</name>
                        <usage>S</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="MOA03">
                        <data_ele>127</data_ele>
                        <name>Remark Code</name>
                        <usage>S</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                        <valid_codes external="remark_code"/>
                      </element>
                      <element xid="MOA04">
                        <data_ele>127</data_ele>
                        <name>Remark Code</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                        <valid_codes external="remark_code"/>
                      </element>
                      <element xid="MOA05">
                        <data_ele>127</data_ele>
                        <name>Remark Code</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                        <valid_codes external="remark_code"/>
                      </element>
                      <element xid="MOA06">
                        <data_ele>127</data_ele>
                        <name>Remark Code</name>
                        <usage>S</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                        <valid_codes external="remark_code"/>
                      </element>
                      <element xid="MOA07">
                        <data_ele>127</data_ele>
                        <name>Remark Code</name>
                        <usage>S</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                        <valid_codes external="remark_code"/>
                      </element>
                      <element xid="MOA08">
                        <data_ele>782</data_ele>
                        <name>End Stage Renal Disease Payment Amount</name>
                        <usage>S</usage>
                        <seq>08</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="MOA09">
                        <data_ele>782</data_ele>
                        <name>Non-Payable Professional Component Billed Amount</name>
                        <usage>S</usage>
                        <seq>09</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                    </segment>
<!--End of MOA segment-->
                    <loop xid="2330A">
                      <name>Other Subscriber Name</name>
                      <usage>R</usage>
                      <pos>325</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Other Subscriber Name</name>
                        <usage>R</usage>
                        <pos>325</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>
                            <code>2</code>
                          </valid_codes>
                        </element>
                        <element xid="NM103">
                          <data_ele>1035</data_ele>
                          <name>Other Insured Last Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Other Insured 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>Other Insured Middle Name</name>
                          <usage>S</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM106">
                          <data_ele>1038</data_ele>
                          <name>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>Other Insured Name Suffix</name>
                          <usage>S</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM108">
                          <data_ele>66</data_ele>
                          <name>Identification Code Qualifier</name>
                          <usage>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>Other Insured 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="N2">
                        <name>Additional Other Subscriber Name Information</name>
                        <usage>S</usage>
                        <pos>330</pos>
                        <max_use>1</max_use>
                        <element xid="N201">
                          <data_ele>93</data_ele>
                          <name>Other Insured Additional Name</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                        <element xid="N202">
                          <data_ele>93</data_ele>
                          <name>Name</name>
                          <usage>N</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                      </segment>
<!--End of N2 segment-->
                      <segment xid="N3">
                        <name>Other Subscriber Address</name>
                        <usage>S</usage>
                        <pos>332</pos>
                        <max_use>1</max_use>
                        <element xid="N301">
                          <data_ele>166</data_ele>
                          <name>Other Insured 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>Other Insured 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>Other Subscriber City/State/ZIP Code</name>
                        <usage>S</usage>
                        <pos>340</pos>
                        <max_use>1</max_use>
                        <element xid="N401">
                          <data_ele>19</data_ele>
                          <name>Other Insured 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>Other Insured State 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>Other Insured 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>Subscriber 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="REF">
                        <name>Other Subscriber Secondary Identification</name>
                        <usage>S</usage>
                        <pos>355</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>1W</code>
                            <code>23</code>
                            <code>IG</code>
                            <code>SY</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Other Insured Additional 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-->
                    </loop>
<!--End of 2330A loop-->
                    <loop xid="2330B">
                      <name>Other Payer Name</name>
                      <usage>R</usage>
                      <pos>325</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Other Payer Name</name>
                        <usage>R</usage>
                        <pos>325</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>PR</code>
                          </valid_codes>
                        </element>
                        <element xid="NM102">
                          <data_ele>1065</data_ele>
                          <name>Entity Type Qualifier</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>1</max_len>
                          <valid_codes>
                            <code>2</code>
                          </valid_codes>
                        </element>
                        <element xid="NM103">
                          <data_ele>1035</data_ele>
                          <name>Other Payer Last or Organization Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Name First</name>
                          <usage>N</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Name Middle</name>
                          <usage>N</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM106">
                          <data_ele>1038</data_ele>
                          <name>Name Prefix</name>
                          <usage>N</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM107">
                          <data_ele>1039</data_ele>
                          <name>Name Suffix</name>
                          <usage>N</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM108">
                          <data_ele>66</data_ele>
                          <name>Identification Code Qualifier</name>
                          <usage>R</usage>
                          <seq>08</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>PI</code>
                            <code>XV</code>
                          </valid_codes>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Other Payer 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="N2">
                        <name>Additional Other Payer Name Information</name>
                        <usage>S</usage>
                        <pos>330</pos>
                        <max_use>1</max_use>
                        <element xid="N201">
                          <data_ele>93</data_ele>
                          <name>Other Payer Additional Name Text</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                        <element xid="N202">
                          <data_ele>93</data_ele>
                          <name>Name</name>
                          <usage>N</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                      </segment>
<!--End of N2 segment-->
                      <segment xid="PER">
                        <name>Other Payer Contact Information</name>
                        <usage>S</usage>
                        <pos>345</pos>
                        <max_use>2</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>Other Payer Contact Name</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                        <element xid="PER03">
                          <data_ele>365</data_ele>
                          <name>Communication Number Qualifier</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>ED</code>
                            <code>EM</code>
                            <code>FX</code>
                            <code>TE</code>
                          </valid_codes>
                        </element>
                        <element xid="PER04">
                          <data_ele>364</data_ele>
                          <name>Communication Number</name>
                          <usage>R</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="PER05">
                          <data_ele>365</data_ele>
                          <name>Communication Number Qualifier</name>
                          <usage>S</usage>
                          <seq>05</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>ED</code>
                            <code>EM</code>
                            <code>EX</code>
                            <code>FX</code>
                            <code>TE</code>
                          </valid_codes>
                        </element>
                        <element xid="PER06">
                          <data_ele>364</data_ele>
                          <name>Communication Number</name>
                          <usage>S</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="PER07">
                          <data_ele>365</data_ele>
                          <name>Communication Number Qualifier</name>
                          <usage>S</usage>
                          <seq>07</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>ED</code>
                            <code>EM</code>
                            <code>EX</code>
                            <code>FX</code>
                            <code>TE</code>
                          </valid_codes>
                        </element>
                        <element xid="PER08">
                          <data_ele>364</data_ele>
                          <name>Communication Number</name>
                          <usage>S</usage>
                          <seq>08</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="PER09">
                          <data_ele>443</data_ele>
                          <name>Contact Inquiry Reference</name>
                          <usage>N</usage>
                          <seq>09</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>20</max_len>
                        </element>
                      </segment>
<!--End of PER segment-->
                      <segment xid="DTP">
                        <name>Claim Adjudication Date</name>
                        <usage>S</usage>
                        <pos>345</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>573</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>Adjudication or Payment 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="REF">
                        <name>Other Payer Secondary Identifier</name>
                        <usage>S</usage>
                        <pos>355</pos>
                        <max_use>2</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>2U</code>
                            <code>F8</code>
                            <code>FY</code>
                            <code>NF</code>
                            <code>TJ</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Other Payer Secondary Identifier</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>30</max_len>
                        </element>
                        <element xid="REF03">
                          <data_ele>352</data_ele>
                          <name>Description</name>
                          <usage>N</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>80</max_len>
                        </element>
                        <composite>
                          <data_ele>C040</data_ele>
                          <name>Reference Identifier</name>
                          <usage>N</usage>
                          <seq>04</seq>
                        </composite>
                      </segment>
<!--End of REF segment-->
                      <segment xid="REF">
                        <name>Other Payer Prior Authorization or Referral Number</name>
                        <usage>S</usage>
                        <pos>355</pos>
                        <max_use>2</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>9F</code>
                            <code>G1</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Other Payer Prior Authorization or Referral Number</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>30</max_len>
                        </element>
                        <element xid="REF03">
                          <data_ele>352</data_ele>
                          <name>Description</name>
                          <usage>N</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>80</max_len>
                        </element>
                        <composite>
                          <data_ele>C040</data_ele>
                          <name>Reference Identifier</name>
                          <usage>N</usage>
                          <seq>04</seq>
                        </composite>
                      </segment>
<!--End of REF segment-->
                      <segment xid="REF">
                        <name>Other Payer Claim Adjustment Indicator</name>
                        <usage>S</usage>
                        <pos>355</pos>
                        <max_use>2</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>T4</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Other Payer Claim Adjustment Indicator</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>30</max_len>
                          <valid_codes>
                            <code>Y</code>
                          </valid_codes>
                        </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-->
                    </loop>
<!--End of 2330B loop-->
                    <loop xid="2330C">
                      <name>Other Payer Patient Information</name>
                      <usage>S</usage>
                      <pos>325</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Other Payer Patient Information</name>
                        <usage>S</usage>
                        <pos>325</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>Patient Last Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Name First</name>
                          <usage>N</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Name Middle</name>
                          <usage>N</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM106">
                          <data_ele>1038</data_ele>
                          <name>Name Prefix</name>
                          <usage>N</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM107">
                          <data_ele>1039</data_ele>
                          <name>Name Suffix</name>
                          <usage>N</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM108">
                          <data_ele>66</data_ele>
                          <name>Identification Code Qualifier</name>
                          <usage>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>
                          </valid_codes>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Other Payer Patient 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>Other Payer Patient Identification</name>
                        <usage>S</usage>
                        <pos>355</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>1W</code>
                            <code>23</code>
                            <code>IG</code>
                            <code>SY</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Other Payer Patient Secondary 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-->
                    </loop>
<!--End of 2330C loop-->
                    <loop xid="2330D">
                      <name>Other Payer Referring Provider</name>
                      <usage>S</usage>
                      <pos>325</pos>
                      <count>2</count>
                      <segment xid="NM1">
                        <name>Other Payer Referring Provider</name>
                        <usage>S</usage>
                        <pos>325</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>DN</code>
                            <code>P3</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>Referring Provider Last Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Name First</name>
                          <usage>N</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Name Middle</name>
                          <usage>N</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM106">
                          <data_ele>1038</data_ele>
                          <name>Name Prefix</name>
                          <usage>N</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM107">
                          <data_ele>1039</data_ele>
                          <name>Name Suffix</name>
                          <usage>N</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM108">
                          <data_ele>66</data_ele>
                          <name>Identification Code Qualifier</name>
                          <usage>N</usage>
                          <seq>08</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Identification Code</name>
                          <usage>N</usage>
                          <seq>09</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="NM110">
                          <data_ele>706</data_ele>
                          <name>Entity Relationship Code</name>
                          <usage>N</usage>
                          <seq>10</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="NM111">
                          <data_ele>98</data_ele>
                          <name>Entity Identifier Code</name>
                          <usage>N</usage>
                          <seq>11</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>3</max_len>
                        </element>
                      </segment>
<!--End of NM1 segment-->
                      <segment xid="REF">
                        <name>Other Payer Referring Provider Identification</name>
                        <usage>R</usage>
                        <pos>355</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>1B</code>
                            <code>1C</code>
                            <code>1D</code>
                            <code>EI</code>
                            <code>G2</code>
                            <code>LU</code>
                            <code>N5</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Other Payer Referring Provider 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-->
                    </loop>
<!--End of 2330D loop-->
                    <loop xid="2330E">
                      <name>Other Payer Rendering Provider</name>
                      <usage>S</usage>
                      <pos>325</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Other Payer Rendering Provider</name>
                        <usage>S</usage>
                        <pos>325</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>82</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>Rendering Provider Last or Organization Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Name First</name>
                          <usage>N</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Name Middle</name>
                          <usage>N</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM106">
                          <data_ele>1038</data_ele>
                          <name>Name Prefix</name>
                          <usage>N</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM107">
                          <data_ele>1039</data_ele>
                          <name>Name Suffix</name>
                          <usage>N</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM108">
                          <data_ele>66</data_ele>
                          <name>Identification Code Qualifier</name>
                          <usage>N</usage>
                          <seq>08</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Identification Code</name>
                          <usage>N</usage>
                          <seq>09</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="NM110">
                          <data_ele>706</data_ele>
                          <name>Entity Relationship Code</name>
                          <usage>N</usage>
                          <seq>10</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="NM111">
                          <data_ele>98</data_ele>
                          <name>Entity Identifier Code</name>
                          <usage>N</usage>
                          <seq>11</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>3</max_len>
                        </element>
                      </segment>
<!--End of NM1 segment-->
                      <segment xid="REF">
                        <name>Other Payer Rendering Provider Secondary Identification</name>
                        <usage>R</usage>
                        <pos>355</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>1B</code>
                            <code>1C</code>
                            <code>1D</code>
                            <code>EI</code>
                            <code>G2</code>
                            <code>LU</code>
                            <code>N5</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Other Payer Rendering Provider Secondary 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-->
                    </loop>
<!--End of 2330E loop-->
                    <loop xid="2330F">
                      <name>Other Payer Purchased Service Provider</name>
                      <usage>S</usage>
                      <pos>325</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Other Payer Purchased Service Provider</name>
                        <usage>S</usage>
                        <pos>325</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>QB</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>Purchased Service Provider Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Name First</name>
                          <usage>N</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Name Middle</name>
                          <usage>N</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM106">
                          <data_ele>1038</data_ele>
                          <name>Name Prefix</name>
                          <usage>N</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM107">
                          <data_ele>1039</data_ele>
                          <name>Name Suffix</name>
                          <usage>N</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM108">
                          <data_ele>66</data_ele>
                          <name>Identification Code Qualifier</name>
                          <usage>N</usage>
                          <seq>08</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Identification Code</name>
                          <usage>N</usage>
                          <seq>09</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="NM110">
                          <data_ele>706</data_ele>
                          <name>Entity Relationship Code</name>
                          <usage>N</usage>
                          <seq>10</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="NM111">
                          <data_ele>98</data_ele>
                          <name>Entity Identifier Code</name>
                          <usage>N</usage>
                          <seq>11</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>3</max_len>
                        </element>
                      </segment>
<!--End of NM1 segment-->
                      <segment xid="REF">
                        <name>Other Payer Purchased Service Provider Identification</name>
                        <usage>R</usage>
                        <pos>355</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>1A</code>
                            <code>1B</code>
                            <code>1C</code>
                            <code>1D</code>
                            <code>EI</code>
                            <code>G2</code>
                            <code>LU</code>
                            <code>N5</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Other Payer Purchased Service Provider 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-->
                    </loop>
<!--End of 2330F loop-->
                    <loop xid="2330G">
                      <name>Other Payer Service Facility Location</name>
                      <usage>S</usage>
                      <pos>325</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Other Payer Service Facility Location</name>
                        <usage>S</usage>
                        <pos>325</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>77</code>
                            <code>FA</code>
                            <code>LI</code>
                            <code>TL</code>
                          </valid_codes>
                        </element>
                        <element xid="NM102">
                          <data_ele>1065</data_ele>
                          <name>Entity Type Qualifier</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>1</max_len>
                          <valid_codes>
                            <code>2</code>
                          </valid_codes>
                        </element>
                        <element xid="NM103">
                          <data_ele>1035</data_ele>
                          <name>Service Facility Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Name First</name>
                          <usage>N</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Name Middle</name>
                          <usage>N</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM106">
                          <data_ele>1038</data_ele>
                          <name>Name Prefix</name>
                          <usage>N</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM107">
                          <data_ele>1039</data_ele>
                          <name>Name Suffix</name>
                          <usage>N</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM108">
                          <data_ele>66</data_ele>
                          <name>Identification Code Qualifier</name>
                          <usage>N</usage>
                          <seq>08</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Identification Code</name>
                          <usage>N</usage>
                          <seq>09</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="NM110">
                          <data_ele>706</data_ele>
                          <name>Entity Relationship Code</name>
                          <usage>N</usage>
                          <seq>10</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="NM111">
                          <data_ele>98</data_ele>
                          <name>Entity Identifier Code</name>
                          <usage>N</usage>
                          <seq>11</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>3</max_len>
                        </element>
                      </segment>
<!--End of NM1 segment-->
                      <segment xid="REF">
                        <name>Other Payer Service Facility Location Identification</name>
                        <usage>R</usage>
                        <pos>355</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>1A</code>
                            <code>1B</code>
                            <code>1C</code>
                            <code>1D</code>
                            <code>G2</code>
                            <code>LU</code>
                            <code>N5</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Other Payer Service Facility Location 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-->
                    </loop>
<!--End of 2330G loop-->
                    <loop xid="2330H">
                      <name>Other Payer Supervising Provider</name>
                      <usage>S</usage>
                      <pos>325</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Other Payer Supervising Provider</name>
                        <usage>S</usage>
                        <pos>325</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>DQ</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>Supervising Provider Last Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Name First</name>
                          <usage>N</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Name Middle</name>
                          <usage>N</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM106">
                          <data_ele>1038</data_ele>
                          <name>Name Prefix</name>
                          <usage>N</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM107">
                          <data_ele>1039</data_ele>
                          <name>Name Suffix</name>
                          <usage>N</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM108">
                          <data_ele>66</data_ele>
                          <name>Identification Code Qualifier</name>
                          <usage>N</usage>
                          <seq>08</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Identification Code</name>
                          <usage>N</usage>
                          <seq>09</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="NM110">
                          <data_ele>706</data_ele>
                          <name>Entity Relationship Code</name>
                          <usage>N</usage>
                          <seq>10</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="NM111">
                          <data_ele>98</data_ele>
                          <name>Entity Identifier Code</name>
                          <usage>N</usage>
                          <seq>11</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>3</max_len>
                        </element>
                      </segment>
<!--End of NM1 segment-->
                      <segment xid="REF">
                        <name>Other Payer Supervising Provider Identification</name>
                        <usage>R</usage>
                        <pos>355</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>1B</code>
                            <code>1C</code>
                            <code>1D</code>
                            <code>EI</code>
                            <code>G2</code>
                            <code>N5</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Other Payer Supervising Provider 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-->
                    </loop>
<!--End of 2330H loop-->
                  </loop>
<!--End of 2320 loop-->
                  <loop xid="2400">
                    <name>Service Line</name>
                    <usage>R</usage>
                    <pos>365</pos>
                    <count>50</count>
                    <segment xid="LX">
                      <name>Service Line</name>
                      <usage>R</usage>
                      <pos>365</pos>
                      <max_use>1</max_use>
                      <element xid="LX01">
                        <data_ele>554</data_ele>
                        <name>Line Counter</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>N0</data_type>
                        <min_len>1</min_len>
                        <max_len>6</max_len>
                      </element>
                    </segment>
<!--End of LX segment-->
                    <segment xid="SV1">
                      <name>Professional Service</name>
                      <usage>R</usage>
                      <pos>370</pos>
                      <max_use>1</max_use>
                      <composite>
                        <data_ele>C003</data_ele>
                        <name>Procedure Identifier</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <element xid="SV101-01">
                          <data_ele>235</data_ele>
                          <name>Product or Service ID 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>HC</code>
                            <code>IV</code>
                            <code>N1</code>
                            <code>N2</code>
                            <code>N3</code>
                            <code>N4</code>
                            <code>ZZ</code>
                          </valid_codes>
                        </element>
                        <element xid="SV101-02">
                          <data_ele>234</data_ele>
                          <name>Procedure Code</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>48</max_len>
                        </element>
                        <element xid="SV101-03">
                          <data_ele>1339</data_ele>
                          <name>Procedure Modifier 1</name>
                          <usage>S</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="SV101-04">
                          <data_ele>1339</data_ele>
                          <name>Procedure Modifier 2</name>
                          <usage>S</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="SV101-05">
                          <data_ele>1339</data_ele>
                          <name>Procedure Modifier 3</name>
                          <usage>S</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="SV101-06">
                          <data_ele>1339</data_ele>
                          <name>Procedure Modifier 4</name>
                          <usage>S</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                        </element>
                        <element xid="SV101-07">
                          <data_ele>352</data_ele>
                          <name>Description</name>
                          <usage>N</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>80</max_len>
                        </element>
                      </composite>
                      <element xid="SV102">
                        <data_ele>782</data_ele>
                        <name>Line Item Change Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="SV103">
                        <data_ele>355</data_ele>
                        <name>Unit or Basis for Measurement 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>F2</code>
                          <code>MJ</code>
                          <code>UN</code>
                        </valid_codes>
                      </element>
                      <element xid="SV104">
                        <data_ele>380</data_ele>
                        <name>Service Unit Count</name>
                        <usage>R</usage>
                        <seq>04</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="SV105">
                        <data_ele>1331</data_ele>
                        <name>Place of Service Code</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>11</code>
                          <code>12</code>
                          <code>21</code>
                          <code>22</code>
                          <code>23</code>
                          <code>24</code>
                          <code>25</code>
                          <code>26</code>
                          <code>31</code>
                          <code>32</code>
                          <code>33</code>
                          <code>34</code>
                          <code>41</code>
                          <code>42</code>
                          <code>50</code>
                          <code>51</code>
                          <code>52</code>
                          <code>53</code>
                          <code>54</code>
                          <code>55</code>
                          <code>56</code>
                          <code>60</code>
                          <code>61</code>
                          <code>62</code>
                          <code>65</code>
                          <code>71</code>
                          <code>72</code>
                          <code>81</code>
                          <code>99</code>
                        </valid_codes>
                      </element>
                      <element xid="SV106">
                        <data_ele>1365</data_ele>
                        <name>Service Type Code</name>
                        <usage>N</usage>
                        <seq>06</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>C004</data_ele>
                        <name>Diagnosis Code Pointer</name>
                        <usage>S</usage>
                        <seq>07</seq>
                        <element xid="SV107-01">
                          <data_ele>1328</data_ele>
                          <name>Diagnosis Code Pointer</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>N0</data_type>
                          <min_len>1</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>1</code>
                            <code>2</code>
                            <code>3</code>
                            <code>4</code>
                            <code>5</code>
                            <code>6</code>
                            <code>7</code>
                            <code>8</code>
                          </valid_codes>
                        </element>
                        <element xid="SV107-02">
                          <data_ele>1328</data_ele>
                          <name>Diagnosis Code Pointer</name>
                          <usage>S</usage>
                          <seq>02</seq>
                          <data_type>N0</data_type>
                          <min_len>1</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>1</code>
                            <code>2</code>
                            <code>3</code>
                            <code>4</code>
                            <code>5</code>
                            <code>6</code>
                            <code>7</code>
                            <code>8</code>
                          </valid_codes>
                        </element>
                        <element xid="SV107-03">
                          <data_ele>1328</data_ele>
                          <name>Diagnosis Code Pointer</name>
                          <usage>S</usage>
                          <seq>03</seq>
                          <data_type>N0</data_type>
                          <min_len>1</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>1</code>
                            <code>2</code>
                            <code>3</code>
                            <code>4</code>
                            <code>5</code>
                            <code>6</code>
                            <code>7</code>
                            <code>8</code>
                          </valid_codes>
                        </element>
                        <element xid="SV107-04">
                          <data_ele>1328</data_ele>
                          <name>Diagnosis Code Pointer</name>
                          <usage>S</usage>
                          <seq>04</seq>
                          <data_type>N0</data_type>
                          <min_len>1</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>1</code>
                            <code>2</code>
                            <code>3</code>
                            <code>4</code>
                            <code>5</code>
                            <code>6</code>
                            <code>7</code>
                            <code>8</code>
                          </valid_codes>
                        </element>
                      </composite>
                      <element xid="SV108">
                        <data_ele>782</data_ele>
                        <name>Monetary Amount</name>
                        <usage>N</usage>
                        <seq>08</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="SV109">
                        <data_ele>1073</data_ele>
                        <name>Emergency Indicator</name>
                        <usage>R</usage>
                        <seq>09</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="SV110">
                        <data_ele>1340</data_ele>
                        <name>Multiple Procedure Code</name>
                        <usage>N</usage>
                        <seq>10</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SV111">
                        <data_ele>1073</data_ele>
                        <name>EPSDT Indicator</name>
                        <usage>S</usage>
                        <seq>11</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>Y</code>
                        </valid_codes>
                      </element>
                      <element xid="SV112">
                        <data_ele>1073</data_ele>
                        <name>Family Planning Indicator</name>
                        <usage>S</usage>
                        <seq>12</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>Y</code>
                        </valid_codes>
                      </element>
                      <element xid="SV113">
                        <data_ele>1364</data_ele>
                        <name>Review Code</name>
                        <usage>N</usage>
                        <seq>13</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SV114">
                        <data_ele>1341</data_ele>
                        <name>National or Local Assigned Review Value</name>
                        <usage>N</usage>
                        <seq>14</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SV115">
                        <data_ele>1327</data_ele>
                        <name>Co-Pay Status Code</name>
                        <usage>S</usage>
                        <seq>15</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>0</code>
                        </valid_codes>
                      </element>
                      <element xid="SV116">
                        <data_ele>1334</data_ele>
                        <name>Health Care Professional Shortage Area Code</name>
                        <usage>N</usage>
                        <seq>16</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                      <element xid="SV117">
                        <data_ele>127</data_ele>
                        <name>Reference Identification</name>
                        <usage>N</usage>
                        <seq>17</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="SV118">
                        <data_ele>116</data_ele>
                        <name>Postal Code</name>
                        <usage>N</usage>
                        <seq>18</seq>
                        <data_type>ID</data_type>
                        <min_len>3</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="SV119">
                        <data_ele>782</data_ele>
                        <name>Monetary Amount</name>
                        <usage>N</usage>
                        <seq>19</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="SV120">
                        <data_ele>1337</data_ele>
                        <name>Level of Care Code</name>
                        <usage>N</usage>
                        <seq>20</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                      <element xid="SV121">
                        <data_ele>1360</data_ele>
                        <name>Provider Agreement Code</name>
                        <usage>N</usage>
                        <seq>21</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of SV1 segment-->
                    <segment xid="SV4">
                      <name>Prescription Number</name>
                      <usage>S</usage>
                      <pos>385</pos>
                      <max_use>1</max_use>
                      <element xid="SV401">
                        <data_ele>127</data_ele>
                        <name>Prescription Number</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <composite>
                        <data_ele>C003</data_ele>
                        <name>Composite Medical Procedure Identifier</name>
                        <usage>N</usage>
                        <seq>02</seq>
                      </composite>
                      <element xid="SV403">
                        <data_ele>127</data_ele>
                        <name>Reference Identification</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="SV404">
                        <data_ele>1073</data_ele>
                        <name>Yes/No Condition or Response 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="SV405">
                        <data_ele>1329</data_ele>
                        <name>Dispense as Written 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="SV406">
                        <data_ele>1338</data_ele>
                        <name>Level of Service Code</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                      </element>
                      <element xid="SV407">
                        <data_ele>1356</data_ele>
                        <name>Prescription Origin 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="SV408">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>08</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="SV409">
                        <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="SV410">
                        <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="SV411">
                        <data_ele>1370</data_ele>
                        <name>Unit Dose Code</name>
                        <usage>N</usage>
                        <seq>11</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                      <element xid="SV412">
                        <data_ele>1319</data_ele>
                        <name>Basis of Cost Determination Code</name>
                        <usage>N</usage>
                        <seq>12</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SV413">
                        <data_ele>1320</data_ele>
                        <name>Basis of Days Supply Determination 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="SV414">
                        <data_ele>1330</data_ele>
                        <name>Dosage Form Code</name>
                        <usage>N</usage>
                        <seq>14</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="SV415">
                        <data_ele>1327</data_ele>
                        <name>Copay Status 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="SV416">
                        <data_ele>1384</data_ele>
                        <name>Patient Location Code</name>
                        <usage>N</usage>
                        <seq>16</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                      <element xid="SV417">
                        <data_ele>1337</data_ele>
                        <name>Level of Care 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="SV418">
                        <data_ele>1357</data_ele>
                        <name>Prior Authorization Type Code</name>
                        <usage>N</usage>
                        <seq>18</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of SV4 segment-->
                    <segment xid="PWK">
                      <name>DMERC CMN Indicator</name>
                      <usage>S</usage>
                      <pos>420</pos>
                      <max_use>1</max_use>
                      <element xid="PWK01">
                        <data_ele>755</data_ele>
                        <name>Attachment Report Type 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>CT</code>
                        </valid_codes>
                      </element>
                      <element xid="PWK02">
                        <data_ele>756</data_ele>
                        <name>Attachment Transmission Code</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>AB</code>
                          <code>AD</code>
                          <code>AF</code>
                          <code>AG</code>
                          <code>NS</code>
                        </valid_codes>
                      </element>
                      <element xid="PWK03">
                        <data_ele>757</data_ele>
                        <name>Report Copies Needed</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>N0</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="PWK04">
                        <data_ele>98</data_ele>
                        <name>Entity Identifier Code</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>3</max_len>
                      </element>
                      <element xid="PWK05">
                        <data_ele>66</data_ele>
                        <name>Identification Code 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="PWK06">
                        <data_ele>67</data_ele>
                        <name>Identification Code</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>2</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="PWK07">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C002</data_ele>
                        <name>Actions Indicated</name>
                        <usage>N</usage>
                        <seq>08</seq>
                      </composite>
                      <element xid="PWK09">
                        <data_ele>1525</data_ele>
                        <name>Request Category Code</name>
                        <usage>N</usage>
                        <seq>09</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                    </segment>
<!--End of PWK segment-->
                    <segment xid="CR1">
                      <name>Ambulance Transport Information</name>
                      <usage>S</usage>
                      <pos>425</pos>
                      <max_use>1</max_use>
                      <element xid="CR101">
                        <data_ele>355</data_ele>
                        <name>Unit or Basis for Measurement Code</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>LB</code>
                        </valid_codes>
                      </element>
                      <element xid="CR102">
                        <data_ele>81</data_ele>
                        <name>Patient Weight</name>
                        <usage>S</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>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>B</code>
                          <code>C</code>
                          <code>D</code>
                          <code>E</code>
                        </valid_codes>
                      </element>
                      <element xid="CR105">
                        <data_ele>355</data_ele>
                        <name>Unit or Basis for Measurement Code</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>DH</code>
                        </valid_codes>
                      </element>
                      <element xid="CR106">
                        <data_ele>380</data_ele>
                        <name>Transport Distance</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="CR107">
                        <data_ele>166</data_ele>
                        <name>Address Information</name>
                        <usage>N</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>Address Information</name>
                        <usage>N</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>Round Trip Purpose Description</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="CR110">
                        <data_ele>352</data_ele>
                        <name>Stretcher Purpose Description</name>
                        <usage>S</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>430</pos>
                      <max_use>5</max_use>
                      <element xid="CR201">
                        <data_ele>609</data_ele>
                        <name>Treatment Series Number</name>
                        <usage>R</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>R</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>R</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>R</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>R</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>Patient Condition 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>A</code>
                          <code>C</code>
                          <code>D</code>
                          <code>E</code>
                          <code>F</code>
                          <code>G</code>
                          <code>M</code>
                        </valid_codes>
                      </element>
                      <element xid="CR209">
                        <data_ele>1073</data_ele>
                        <name>Complication Indicator</name>
                        <usage>R</usage>
                        <seq>09</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="CR210">
                        <data_ele>352</data_ele>
                        <name>Patient Condition Description</name>
                        <usage>S</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>Patient Condition Description</name>
                        <usage>S</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>X-ray Availability Indicator</name>
                        <usage>R</usage>
                        <seq>12</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 CR2 segment-->
                    <segment xid="CR3">
                      <name>Durable Medical Equipment Certification</name>
                      <usage>S</usage>
                      <pos>435</pos>
                      <max_use>1</max_use>
                      <element xid="CR301">
                        <data_ele>1322</data_ele>
                        <name>Certification Type Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>I</code>
                          <code>R</code>
                          <code>S</code>
                        </valid_codes>
                      </element>
                      <element xid="CR302">
                        <data_ele>355</data_ele>
                        <name>Unit or Basis for Measurement 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>MO</code>
                        </valid_codes>
                      </element>
                      <element xid="CR303">
                        <data_ele>380</data_ele>
                        <name>Durable Medical Equipment Duration</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="CR304">
                        <data_ele>1335</data_ele>
                        <name>Insulin Dependent 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="CR305">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                    </segment>
<!--End of CR3 segment-->
                    <segment xid="CR5">
                      <name>Home Oxygen Therapy Information</name>
                      <usage>S</usage>
                      <pos>445</pos>
                      <max_use>1</max_use>
                      <element xid="CR501">
                        <data_ele>1322</data_ele>
                        <name>Certification Type Code.Oxygen Therapy</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>I</code>
                          <code>R</code>
                          <code>S</code>
                        </valid_codes>
                      </element>
                      <element xid="CR502">
                        <data_ele>380</data_ele>
                        <name>Treatment Period Count</name>
                        <usage>R</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>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                      <element xid="CR504">
                        <data_ele>1348</data_ele>
                        <name>Oxygen Equipment Type 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="CR505">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="CR506">
                        <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="CR507">
                        <data_ele>380</data_ele>
                        <name>Quantity</name>
                        <usage>N</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>Quantity</name>
                        <usage>N</usage>
                        <seq>08</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="CR509">
                        <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="CR510">
                        <data_ele>380</data_ele>
                        <name>Arterial Blood Gas Quantity</name>
                        <usage>S</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>Oxygen Saturation Quantity</name>
                        <usage>S</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>R</usage>
                        <seq>12</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>E</code>
                          <code>R</code>
                          <code>S</code>
                        </valid_codes>
                      </element>
                      <element xid="CR513">
                        <data_ele>1350</data_ele>
                        <name>Oxygen Test Finding Code</name>
                        <usage>S</usage>
                        <seq>13</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="CR514">
                        <data_ele>1350</data_ele>
                        <name>Oxygen Test Finding Code</name>
                        <usage>S</usage>
                        <seq>14</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>2</code>
                        </valid_codes>
                      </element>
                      <element xid="CR515">
                        <data_ele>1350</data_ele>
                        <name>Oxygen Test Finding Code</name>
                        <usage>S</usage>
                        <seq>15</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                        <valid_codes>
                          <code>3</code>
                        </valid_codes>
                      </element>
                      <element xid="CR516">
                        <data_ele>380</data_ele>
                        <name>Quantity</name>
                        <usage>N</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>N</usage>
                        <seq>17</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                      <element xid="CR518">
                        <data_ele>1348</data_ele>
                        <name>Oxygen Equipment Type Code</name>
                        <usage>N</usage>
                        <seq>18</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of CR5 segment-->
                    <segment xid="CRC">
                      <name>Ambulance Certification</name>
                      <usage>S</usage>
                      <pos>450</pos>
                      <max_use>3</max_use>
                      <element xid="CRC01">
                        <data_ele>1136</data_ele>
                        <name>Code Category</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>07</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC02">
                        <data_ele>1073</data_ele>
                        <name>Certification Condition Indicator</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>N</code>
                          <code>Y</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC03">
                        <data_ele>1321</data_ele>
                        <name>Condition 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>01</code>
                          <code>02</code>
                          <code>03</code>
                          <code>04</code>
                          <code>05</code>
                          <code>06</code>
                          <code>07</code>
                          <code>08</code>
                          <code>09</code>
                          <code>60</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC04">
                        <data_ele>1321</data_ele>
                        <name>Condition Code</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>01</code>
                          <code>02</code>
                          <code>03</code>
                          <code>04</code>
                          <code>05</code>
                          <code>06</code>
                          <code>07</code>
                          <code>08</code>
                          <code>09</code>
                          <code>60</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC05">
                        <data_ele>1321</data_ele>
                        <name>Condition Code</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>01</code>
                          <code>02</code>
                          <code>03</code>
                          <code>04</code>
                          <code>05</code>
                          <code>06</code>
                          <code>07</code>
                          <code>08</code>
                          <code>09</code>
                          <code>60</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC06">
                        <data_ele>1321</data_ele>
                        <name>Condition 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>01</code>
                          <code>02</code>
                          <code>03</code>
                          <code>04</code>
                          <code>05</code>
                          <code>06</code>
                          <code>07</code>
                          <code>08</code>
                          <code>09</code>
                          <code>60</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC07">
                        <data_ele>1321</data_ele>
                        <name>Condition Code</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>01</code>
                          <code>02</code>
                          <code>03</code>
                          <code>04</code>
                          <code>05</code>
                          <code>06</code>
                          <code>07</code>
                          <code>08</code>
                          <code>09</code>
                          <code>60</code>
                        </valid_codes>
                      </element>
                    </segment>
<!--End of CRC segment-->
                    <segment xid="CRC">
                      <name>Hospice Employee Indicator</name>
                      <usage>S</usage>
                      <pos>450</pos>
                      <max_use>1</max_use>
                      <element xid="CRC01">
                        <data_ele>1136</data_ele>
                        <name>Code Category</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>70</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC02">
                        <data_ele>1073</data_ele>
                        <name>Hospice Employed Provider Indicator</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>N</code>
                          <code>Y</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC03">
                        <data_ele>1321</data_ele>
                        <name>Condition Indicator</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>65</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC04">
                        <data_ele>1321</data_ele>
                        <name>Condition Indicator</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="CRC05">
                        <data_ele>1321</data_ele>
                        <name>Condition Indicator</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="CRC06">
                        <data_ele>1321</data_ele>
                        <name>Condition Indicator</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="CRC07">
                        <data_ele>1321</data_ele>
                        <name>Condition Indicator</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                    </segment>
<!--End of CRC segment-->
                    <segment xid="CRC">
                      <name>DMERC Condition Indicator</name>
                      <usage>S</usage>
                      <pos>450</pos>
                      <max_use>2</max_use>
                      <element xid="CRC01">
                        <data_ele>1136</data_ele>
                        <name>Code Category</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>09</code>
                          <code>11</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC02">
                        <data_ele>1073</data_ele>
                        <name>Certification Condition Indicator</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>N</code>
                          <code>Y</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC03">
                        <data_ele>1321</data_ele>
                        <name>Condition Indicator</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>37</code>
                          <code>38</code>
                          <code>AL</code>
                          <code>P1</code>
                          <code>ZV</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC04">
                        <data_ele>1321</data_ele>
                        <name>Condition Indicator</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>37</code>
                          <code>38</code>
                          <code>AL</code>
                          <code>P1</code>
                          <code>ZV</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC05">
                        <data_ele>1321</data_ele>
                        <name>Condition Indicator</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>37</code>
                          <code>38</code>
                          <code>AL</code>
                          <code>P1</code>
                          <code>ZV</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC06">
                        <data_ele>1321</data_ele>
                        <name>Condition Indicator</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>37</code>
                          <code>38</code>
                          <code>AL</code>
                          <code>P1</code>
                          <code>ZV</code>
                        </valid_codes>
                      </element>
                      <element xid="CRC07">
                        <data_ele>1321</data_ele>
                        <name>Condition Indicator</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>37</code>
                          <code>38</code>
                          <code>AL</code>
                          <code>P1</code>
                          <code>ZV</code>
                        </valid_codes>
                      </element>
                    </segment>
<!--End of CRC segment-->
                    <segment xid="DTP">
                      <name>Date - Service Date</name>
                      <usage>R</usage>
                      <pos>455</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>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>Date - Certification Revision Date</name>
                      <usage>S</usage>
                      <pos>455</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>607</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 Revision 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>Date - Referral Date</name>
                      <usage>S</usage>
                      <pos>455</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>330</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>Referral 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>Date - Begin Therapy Date</name>
                      <usage>S</usage>
                      <pos>455</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>463</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>Begin Therapy 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>Date - Last Certification Date</name>
                      <usage>S</usage>
                      <pos>455</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>461</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 Certification 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>Date - Order Date</name>
                      <usage>S</usage>
                      <pos>455</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>938</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>Order 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>Date - Date Last Seen</name>
                      <usage>S</usage>
                      <pos>455</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>304</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 Seen 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>Date - Test</name>
                      <usage>S</usage>
                      <pos>455</pos>
                      <max_use>2</max_use>
                      <element xid="DTP01">
                        <data_ele>374</data_ele>
                        <name>Date Time Qualifier</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>3</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>738</code>
                          <code>739</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>Test Performed 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>Date - Oxygen Saturation/Arterial Blood Gas Test</name>
                      <usage>S</usage>
                      <pos>455</pos>
                      <max_use>3</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>119</code>
                          <code>480</code>
                          <code>481</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>Oxygen Saturation Test 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>Date - Shipped</name>
                      <usage>S</usage>
                      <pos>455</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>011</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>Shipped 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>Date - Onset of Current Symptom/Illness</name>
                      <usage>S</usage>
                      <pos>455</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 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>Date - Last X-ray</name>
                      <usage>S</usage>
                      <pos>455</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>455</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 X-Ray 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>Date - Acute Manifestation</name>
                      <usage>S</usage>
                      <pos>455</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>453</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>Acute Manifestation 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>Date - Initial Treatment</name>
                      <usage>S</usage>
                      <pos>455</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>454</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>Initial Treatment 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>Date - Similar Illness/Symptom Onset</name>
                      <usage>S</usage>
                      <pos>455</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>438</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>Similar Illness or Symptom 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="QTY">
                      <name>Anesthesia Modifying Units</name>
                      <usage>S</usage>
                      <pos>460</pos>
                      <max_use>5</max_use>
                      <element xid="QTY01">
                        <data_ele>673</data_ele>
                        <name>Quantity 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>BF</code>
                          <code>EC</code>
                          <code>EM</code>
                          <code>HM</code>
                          <code>HO</code>
                          <code>HP</code>
                          <code>P3</code>
                          <code>P4</code>
                          <code>P5</code>
                          <code>SG</code>
                        </valid_codes>
                      </element>
                      <element xid="QTY02">
                        <data_ele>380</data_ele>
                        <name>Anesthesia Modifying Units</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <composite>
                        <data_ele>C001</data_ele>
                        <name>Composite Unit of Measure</name>
                        <usage>N</usage>
                        <seq>03</seq>
                      </composite>
                      <element xid="QTY04">
                        <data_ele>61</data_ele>
                        <name>Free-Form Message</name>
                        <usage>N</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                    </segment>
<!--End of QTY segment-->
                    <segment xid="MEA">
                      <name>Test Result</name>
                      <usage>S</usage>
                      <pos>462</pos>
                      <max_use>20</max_use>
                      <element xid="MEA01">
                        <data_ele>737</data_ele>
                        <name>Measurement Reference Identification 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>OG</code>
                          <code>TR</code>
                        </valid_codes>
                      </element>
                      <element xid="MEA02">
                        <data_ele>738</data_ele>
                        <name>Measurement Qualifier</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>CON</code>
                          <code>GRA</code>
                          <code>HT</code>
                          <code>R1</code>
                          <code>R2</code>
                          <code>R3</code>
                          <code>R4</code>
                          <code>ZO</code>
                        </valid_codes>
                      </element>
                      <element xid="MEA03">
                        <data_ele>739</data_ele>
                        <name>Test Results</name>
                        <usage>R</usage>
                        <seq>03</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>20</max_len>
                      </element>
                      <composite>
                        <data_ele>C001</data_ele>
                        <name>Composite Unit of Measure</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                      <element xid="MEA05">
                        <data_ele>740</data_ele>
                        <name>Range Minimum</name>
                        <usage>N</usage>
                        <seq>05</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>20</max_len>
                      </element>
                      <element xid="MEA06">
                        <data_ele>741</data_ele>
                        <name>Range Maximum</name>
                        <usage>N</usage>
                        <seq>06</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>20</max_len>
                      </element>
                      <element xid="MEA07">
                        <data_ele>935</data_ele>
                        <name>Measurement Significance Code</name>
                        <usage>N</usage>
                        <seq>07</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="MEA08">
                        <data_ele>936</data_ele>
                        <name>Measurement Attribute 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="MEA09">
                        <data_ele>752</data_ele>
                        <name>Surface/Layer/Position Code</name>
                        <usage>N</usage>
                        <seq>09</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                      <element xid="MEA10">
                        <data_ele>1373</data_ele>
                        <name>Measurement Method or Device</name>
                        <usage>N</usage>
                        <seq>10</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>4</max_len>
                      </element>
                    </segment>
<!--End of MEA segment-->
                    <segment xid="CN1">
                      <name>Contract Information</name>
                      <usage>S</usage>
                      <pos>465</pos>
                      <max_use>1</max_use>
                      <element xid="CN101">
                        <data_ele>1166</data_ele>
                        <name>Contract Type 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>01</code>
                          <code>02</code>
                          <code>03</code>
                          <code>04</code>
                          <code>05</code>
                          <code>06</code>
                          <code>09</code>
                        </valid_codes>
                      </element>
                      <element xid="CN102">
                        <data_ele>782</data_ele>
                        <name>Contract Amount</name>
                        <usage>S</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="CN103">
                        <data_ele>332</data_ele>
                        <name>Contract Percentage</name>
                        <usage>S</usage>
                        <seq>03</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>6</max_len>
                      </element>
                      <element xid="CN104">
                        <data_ele>127</data_ele>
                        <name>Contract Code</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="CN105">
                        <data_ele>338</data_ele>
                        <name>Terms Discount Percentage</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>6</max_len>
                      </element>
                      <element xid="CN106">
                        <data_ele>799</data_ele>
                        <name>Contract Version Identifier</name>
                        <usage>S</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                    </segment>
<!--End of CN1 segment-->
                    <segment xid="REF">
                      <name>Repriced Line Item Reference Number</name>
                      <usage>S</usage>
                      <pos>470</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>9B</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Repriced Line Item Reference Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Adjusted Repriced Line Item Reference Number</name>
                      <usage>S</usage>
                      <pos>470</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>9D</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Adjusted Repriced Line Item Reference Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Prior Authorization or Referral Number</name>
                      <usage>S</usage>
                      <pos>470</pos>
                      <max_use>2</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>9F</code>
                          <code>G1</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Prior Authorization or Referral Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>4</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Line Item Control Number</name>
                      <usage>S</usage>
                      <pos>470</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>6R</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Line Item Control Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Mammography Certification Number</name>
                      <usage>S</usage>
                      <pos>470</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>EW</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Mammography Certification Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Clinical Laboratory Improvement Amendment (CLIA) Identification</name>
                      <usage>S</usage>
                      <pos>470</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>X4</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Clinical Laboratory Improvement Amendment Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Referring Clinical Laboratory Improvement Amendment (CLIA) Facility Identification</name>
                      <usage>S</usage>
                      <pos>470</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>F4</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Referring CLIA Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Immunization Batch Number</name>
                      <usage>S</usage>
                      <pos>470</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>BT</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Immunization Batch Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Ambulatory Patient Group (APG)</name>
                      <usage>S</usage>
                      <pos>470</pos>
                      <max_use>4</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>1S</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Ambulatory Patient Group Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Oxygen Flow Rate</name>
                      <usage>S</usage>
                      <pos>470</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>TP</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Oxygen Flow Rate</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="REF">
                      <name>Universal Product Number (UPN)</name>
                      <usage>S</usage>
                      <pos>470</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>OZ</code>
                          <code>VP</code>
                        </valid_codes>
                      </element>
                      <element xid="REF02">
                        <data_ele>127</data_ele>
                        <name>Universal Product Number</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="REF03">
                        <data_ele>352</data_ele>
                        <name>Description</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <composite>
                        <data_ele>C040</data_ele>
                        <name>Reference Identifier</name>
                        <usage>N</usage>
                        <seq>04</seq>
                      </composite>
                    </segment>
<!--End of REF segment-->
                    <segment xid="AMT">
                      <name>Sales Tax Amount</name>
                      <usage>S</usage>
                      <pos>475</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>T</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Sales Tax Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="AMT">
                      <name>Approved Amount</name>
                      <usage>S</usage>
                      <pos>475</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>AAE</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Approved Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="AMT">
                      <name>Postage Claimed Amount</name>
                      <usage>S</usage>
                      <pos>475</pos>
                      <max_use>1</max_use>
                      <element xid="AMT01">
                        <data_ele>522</data_ele>
                        <name>Amount Qualifier Code</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>3</max_len>
                        <valid_codes>
                          <code>F4</code>
                        </valid_codes>
                      </element>
                      <element xid="AMT02">
                        <data_ele>782</data_ele>
                        <name>Postage Claimed Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="AMT03">
                        <data_ele>478</data_ele>
                        <name>Credit/Debit Flag Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>1</max_len>
                      </element>
                    </segment>
<!--End of AMT segment-->
                    <segment xid="K3">
                      <name>File Information</name>
                      <usage>S</usage>
                      <pos>480</pos>
                      <max_use>10</max_use>
                      <element xid="K301">
                        <data_ele>449</data_ele>
                        <name>Fixed Format Information</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                      <element xid="K302">
                        <data_ele>1333</data_ele>
                        <name>Record Format Code</name>
                        <usage>N</usage>
                        <seq>02</seq>
                        <data_type>ID</data_type>
                        <min_len>1</min_len>
                        <max_len>2</max_len>
                      </element>
                      <composite>
                        <data_ele>C001</data_ele>
                        <name>Composite Unit of Measure</name>
                        <usage>N</usage>
                        <seq>03</seq>
                      </composite>
                    </segment>
<!--End of K3 segment-->
                    <segment xid="NTE">
                      <name>Line Note</name>
                      <usage>S</usage>
                      <pos>485</pos>
                      <max_use>1</max_use>
                      <element xid="NTE01">
                        <data_ele>363</data_ele>
                        <name>Note Reference 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>ADD</code>
                          <code>DCP</code>
                          <code>PMT</code>
                          <code>TPO</code>
                        </valid_codes>
                      </element>
                      <element xid="NTE02">
                        <data_ele>352</data_ele>
                        <name>Line Note Text</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>80</max_len>
                      </element>
                    </segment>
<!--End of NTE segment-->
                    <segment xid="PS1">
                      <name>Purchased Service Information</name>
                      <usage>S</usage>
                      <pos>488</pos>
                      <max_use>1</max_use>
                      <element xid="PS101">
                        <data_ele>127</data_ele>
                        <name>Purchased Service Provider Identifier</name>
                        <usage>R</usage>
                        <seq>01</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="PS102">
                        <data_ele>782</data_ele>
                        <name>Purchased Service Charge Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="PS103">
                        <data_ele>156</data_ele>
                        <name>State or Province Code</name>
                        <usage>N</usage>
                        <seq>03</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                      </element>
                    </segment>
<!--End of PS1 segment-->
                    <segment xid="HSD">
                      <name>Health Care Services Delivery</name>
                      <usage>S</usage>
                      <pos>491</pos>
                      <max_use>1</max_use>
                      <element xid="HSD01">
                        <data_ele>673</data_ele>
                        <name>Visits</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>VS</code>
                        </valid_codes>
                      </element>
                      <element xid="HSD02">
                        <data_ele>380</data_ele>
                        <name>Number of Visits</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>Frequency Period</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>Q1</code>
                          <code>WK</code>
                        </valid_codes>
                      </element>
                      <element xid="HSD04">
                        <data_ele>1167</data_ele>
                        <name>Frequency Count</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>Duration of Visits Units</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>7</code>
                          <code>34</code>
                          <code>35</code>
                        </valid_codes>
                      </element>
                      <element xid="HSD06">
                        <data_ele>616</data_ele>
                        <name>Duration of Visits, Number of Units</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>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>N</code>
                          <code>O</code>
                          <code>W</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>
                        </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>D</code>
                          <code>E</code>
                          <code>F</code>
                        </valid_codes>
                      </element>
                    </segment>
<!--End of HSD segment-->
                    <segment xid="HCP">
                      <name>Line Pricing/Repricing Information</name>
                      <usage>S</usage>
                      <pos>492</pos>
                      <max_use>1</max_use>
                      <element xid="HCP01">
                        <data_ele>1473</data_ele>
                        <name>Pricing/Repricing Methodology</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>01</code>
                          <code>02</code>
                          <code>03</code>
                          <code>04</code>
                          <code>05</code>
                          <code>06</code>
                          <code>07</code>
                          <code>08</code>
                          <code>09</code>
                          <code>10</code>
                          <code>11</code>
                          <code>12</code>
                          <code>13</code>
                          <code>14</code>
                        </valid_codes>
                      </element>
                      <element xid="HCP02">
                        <data_ele>782</data_ele>
                        <name>Repriced Allowed Amount</name>
                        <usage>R</usage>
                        <seq>02</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="HCP03">
                        <data_ele>782</data_ele>
                        <name>Repriced Saving Amount</name>
                        <usage>S</usage>
                        <seq>03</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="HCP04">
                        <data_ele>127</data_ele>
                        <name>Repricing Organization Identifier</name>
                        <usage>S</usage>
                        <seq>04</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="HCP05">
                        <data_ele>118</data_ele>
                        <name>Repricing Per Diem or Flat Rate Amount</name>
                        <usage>S</usage>
                        <seq>05</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>9</max_len>
                      </element>
                      <element xid="HCP06">
                        <data_ele>127</data_ele>
                        <name>Repriced Approved Ambulatory Patient Group Code</name>
                        <usage>S</usage>
                        <seq>06</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>30</max_len>
                      </element>
                      <element xid="HCP7">
                        <data_ele>782</data_ele>
                        <name>Repriced Approved Ambulatory Patient Group Amount</name>
                        <usage>S</usage>
                        <seq>7</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>18</max_len>
                      </element>
                      <element xid="HCP08">
                        <data_ele>234</data_ele>
                        <name>Product/Service ID</name>
                        <usage>N</usage>
                        <seq>08</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>48</max_len>
                      </element>
                      <element xid="HCP09">
                        <data_ele>235</data_ele>
                        <name>Product or Service ID Qualifier</name>
                        <usage>S</usage>
                        <seq>09</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>HC</code>
                          <code>IV</code>
                          <code>ZZ</code>
                        </valid_codes>
                      </element>
                      <element xid="HCP10">
                        <data_ele>234</data_ele>
                        <name>Producedure Code</name>
                        <usage>S</usage>
                        <seq>10</seq>
                        <data_type>AN</data_type>
                        <min_len>1</min_len>
                        <max_len>48</max_len>
                      </element>
                      <element xid="HCP11">
                        <data_ele>355</data_ele>
                        <name>Unit or Basis for Measurement Code</name>
                        <usage>S</usage>
                        <seq>11</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>DA</code>
                          <code>UN</code>
                        </valid_codes>
                      </element>
                      <element xid="HCP12">
                        <data_ele>380</data_ele>
                        <name>Repriced Approved Service Unit Count</name>
                        <usage>S</usage>
                        <seq>12</seq>
                        <data_type>R</data_type>
                        <min_len>1</min_len>
                        <max_len>15</max_len>
                      </element>
                      <element xid="HCP13">
                        <data_ele>901</data_ele>
                        <name>Reject Reason Code</name>
                        <usage>S</usage>
                        <seq>13</seq>
                        <data_type>ID</data_type>
                        <min_len>2</min_len>
                        <max_len>2</max_len>
                        <valid_codes>
                          <code>T1</code>
                          <code>T2</code>
                          <code>T3</code>
                          <code>T4</code>
                          <code>T5</code>
                          <code>T6</code>
                        </valid_codes>
                      </element>
                      <element xid="HCP14">
                        <data_ele>1526</data_ele>
                        <name>Policy Compliance Code</name>
                        <usage>S</usage>
                        <seq>14</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>
                        </valid_codes>
                      </element>
                      <element xid="HCP15">
                        <data_ele>1527</data_ele>
                        <name>Exception Code</name>
                        <usage>S</usage>
                        <seq>15</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>
                        </valid_codes>
                      </element>
                    </segment>
<!--End of HCP segment-->
                    <loop xid="2420A">
                      <name>Rendering Provider Name</name>
                      <usage>S</usage>
                      <pos>500</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Rendering Provider Name</name>
                        <usage>S</usage>
                        <pos>500</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>82</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>Rendering Provider Last or Organization Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Rendering 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>Rendering 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>Rendering 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>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>XX</code>
                          </valid_codes>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Rendering Provider 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="PRV">
                        <name>Rendering Provider Specialty Information</name>
                        <usage>R</usage>
                        <pos>505</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>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>5</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-->
                      <segment xid="N2">
                        <name>Additional Rendering Provider Name Information</name>
                        <usage>S</usage>
                        <pos>510</pos>
                        <max_use>1</max_use>
                        <element xid="N201">
                          <data_ele>93</data_ele>
                          <name>Rendering Provider Name Additional Text</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                        <element xid="N202">
                          <data_ele>93</data_ele>
                          <name>Name</name>
                          <usage>N</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                      </segment>
<!--End of N2 segment-->
                      <segment xid="REF">
                        <name>Rendering Provider Secondary Identification</name>
                        <usage>S</usage>
                        <pos>525</pos>
                        <max_use>5</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>0B</code>
                            <code>1B</code>
                            <code>1C</code>
                            <code>1D</code>
                            <code>1G</code>
                            <code>1H</code>
                            <code>EI</code>
                            <code>G2</code>
                            <code>LU</code>
                            <code>N5</code>
                            <code>SY</code>
                            <code>X5</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Rendering Provider Secondary 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-->
                    </loop>
<!--End of 2420A loop-->
                    <loop xid="2420B">
                      <name>Purchased Service Provider Name</name>
                      <usage>S</usage>
                      <pos>500</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Purchased Service Provider Name</name>
                        <usage>S</usage>
                        <pos>500</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>QB</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>Name Last or Organization Name</name>
                          <usage>N</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Name First</name>
                          <usage>N</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Name Middle</name>
                          <usage>N</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM106">
                          <data_ele>1038</data_ele>
                          <name>Name Prefix</name>
                          <usage>N</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM107">
                          <data_ele>1039</data_ele>
                          <name>Name Suffix</name>
                          <usage>N</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM108">
                          <data_ele>66</data_ele>
                          <name>Identification Code Qualifier</name>
                          <usage>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>XX</code>
                          </valid_codes>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Purchased 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>Purchased Service Provider Secondary Identification</name>
                        <usage>S</usage>
                        <pos>525</pos>
                        <max_use>5</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>0B</code>
                            <code>1A</code>
                            <code>1B</code>
                            <code>1C</code>
                            <code>1D</code>
                            <code>1G</code>
                            <code>1H</code>
                            <code>EI</code>
                            <code>G2</code>
                            <code>LU</code>
                            <code>N5</code>
                            <code>SY</code>
                            <code>U3</code>
                            <code>X5</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Purchased Service Provider Secondary 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-->
                    </loop>
<!--End of 2420B loop-->
                    <loop xid="2420C">
                      <name>Service Facility Location</name>
                      <usage>S</usage>
                      <pos>500</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Service Facility Location</name>
                        <usage>S</usage>
                        <pos>500</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>77</code>
                            <code>FA</code>
                            <code>LI</code>
                            <code>TL</code>
                          </valid_codes>
                        </element>
                        <element xid="NM102">
                          <data_ele>1065</data_ele>
                          <name>Entity Type Qualifier</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>1</max_len>
                          <valid_codes>
                            <code>2</code>
                          </valid_codes>
                        </element>
                        <element xid="NM103">
                          <data_ele>1035</data_ele>
                          <name>Laboratory or Facility 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>Name First</name>
                          <usage>N</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Name Middle</name>
                          <usage>N</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM106">
                          <data_ele>1038</data_ele>
                          <name>Name Prefix</name>
                          <usage>N</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM107">
                          <data_ele>1039</data_ele>
                          <name>Name Suffix</name>
                          <usage>N</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM108">
                          <data_ele>66</data_ele>
                          <name>Identification Code Qualifier</name>
                          <usage>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>XX</code>
                          </valid_codes>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Laboratory or Facility 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="N2">
                        <name>Additional Service Facility Location Name Information</name>
                        <usage>S</usage>
                        <pos>510</pos>
                        <max_use>1</max_use>
                        <element xid="N201">
                          <data_ele>93</data_ele>
                          <name>Laboratory or Facility Name Additional Text</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                        <element xid="N202">
                          <data_ele>93</data_ele>
                          <name>Name</name>
                          <usage>N</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                      </segment>
<!--End of N2 segment-->
                      <segment xid="N3">
                        <name>Service Facility Location Address</name>
                        <usage>R</usage>
                        <pos>514</pos>
                        <max_use>1</max_use>
                        <element xid="N301">
                          <data_ele>166</data_ele>
                          <name>Laboratory or Facility 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>Laboratory or Facility 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 Facility Location City/State/ZIP</name>
                        <usage>R</usage>
                        <pos>520</pos>
                        <max_use>1</max_use>
                        <element xid="N401">
                          <data_ele>19</data_ele>
                          <name>Laboratory or Facility City Name</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>30</max_len>
                        </element>
                        <element xid="N402">
                          <data_ele>156</data_ele>
                          <name>Laboratory or Facility State or Province Code</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                          <valid_codes external="states"/>
                        </element>
                        <element xid="N403">
                          <data_ele>116</data_ele>
                          <name>Laboratory or Facility Postal Zone or ZIP Code</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>ID</data_type>
                          <min_len>3</min_len>
                          <max_len>15</max_len>
                        </element>
                        <element xid="N404">
                          <data_ele>26</data_ele>
                          <name>Service Facility Location 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="REF">
                        <name>Service Facility Location Secondary Identification</name>
                        <usage>S</usage>
                        <pos>525</pos>
                        <max_use>5</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>0B</code>
                            <code>1A</code>
                            <code>1B</code>
                            <code>1C</code>
                            <code>1D</code>
                            <code>1G</code>
                            <code>1H</code>
                            <code>G2</code>
                            <code>LU</code>
                            <code>N5</code>
                            <code>TJ</code>
                            <code>X4</code>
                            <code>X5</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Service Facility Location Secondary 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-->
                    </loop>
<!--End of 2420C loop-->
                    <loop xid="2420D">
                      <name>Supervising Provider Name</name>
                      <usage>S</usage>
                      <pos>500</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Supervising Provider Name</name>
                        <usage>S</usage>
                        <pos>500</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>DQ</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>Supervising Provider Last Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Supervising Provider First Name</name>
                          <usage>R</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Supervising 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>Supervising 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>XX</code>
                          </valid_codes>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Supervising 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="N2">
                        <name>Additional Supervising Provider Name Information</name>
                        <usage>S</usage>
                        <pos>510</pos>
                        <max_use>1</max_use>
                        <element xid="N201">
                          <data_ele>93</data_ele>
                          <name>Supervising Provider Name Additional Text</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                        <element xid="N202">
                          <data_ele>93</data_ele>
                          <name>Name</name>
                          <usage>N</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                      </segment>
<!--End of N2 segment-->
                      <segment xid="REF">
                        <name>Supervising Provider Secondary Identification</name>
                        <usage>S</usage>
                        <pos>525</pos>
                        <max_use>5</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>0B</code>
                            <code>1B</code>
                            <code>1C</code>
                            <code>1D</code>
                            <code>1G</code>
                            <code>1H</code>
                            <code>EI</code>
                            <code>G2</code>
                            <code>LU</code>
                            <code>N5</code>
                            <code>SY</code>
                            <code>X5</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Supervising Provider Secondary 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-->
                    </loop>
<!--End of 2420D loop-->
                    <loop xid="2420E">
                      <name>Ordering Provider Name</name>
                      <usage>S</usage>
                      <pos>500</pos>
                      <count>1</count>
                      <segment xid="NM1">
                        <name>Ordering Provider Name</name>
                        <usage>S</usage>
                        <pos>500</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>DK</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>Ordering Provider Last Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Ordering Provider First Name</name>
                          <usage>R</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Ordering 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>Ordering 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>XX</code>
                          </valid_codes>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Ordering 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="N2">
                        <name>Additional Ordering Provider Name Information</name>
                        <usage>S</usage>
                        <pos>510</pos>
                        <max_use>1</max_use>
                        <element xid="N201">
                          <data_ele>93</data_ele>
                          <name>Ordering Provider Name Additional Text</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                        <element xid="N202">
                          <data_ele>93</data_ele>
                          <name>Name</name>
                          <usage>N</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                      </segment>
<!--End of N2 segment-->
                      <segment xid="N3">
                        <name>Ordering Provider Address</name>
                        <usage>S</usage>
                        <pos>514</pos>
                        <max_use>1</max_use>
                        <element xid="N301">
                          <data_ele>166</data_ele>
                          <name>Ordering 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>Ordering 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>Ordering Provider City/State/ZIP Code</name>
                        <usage>S</usage>
                        <pos>520</pos>
                        <max_use>1</max_use>
                        <element xid="N401">
                          <data_ele>19</data_ele>
                          <name>Ordering Provider City Name</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>30</max_len>
                        </element>
                        <element xid="N402">
                          <data_ele>156</data_ele>
                          <name>Ordering Provider State Code</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                          <valid_codes external="states"/>
                        </element>
                        <element xid="N403">
                          <data_ele>116</data_ele>
                          <name>Ordering Provider Postal Zone or ZIP Code</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>ID</data_type>
                          <min_len>3</min_len>
                          <max_len>15</max_len>
                        </element>
                        <element xid="N404">
                          <data_ele>26</data_ele>
                          <name>Ordering 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="REF">
                        <name>Ordering Provider Secondary Identification</name>
                        <usage>S</usage>
                        <pos>525</pos>
                        <max_use>5</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>0B</code>
                            <code>1B</code>
                            <code>1C</code>
                            <code>1D</code>
                            <code>1G</code>
                            <code>1H</code>
                            <code>EI</code>
                            <code>G2</code>
                            <code>LU</code>
                            <code>N5</code>
                            <code>SY</code>
                            <code>X5</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Ordering Provider Secondary 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="PER">
                        <name>Ordering Provider Contact Information</name>
                        <usage>S</usage>
                        <pos>530</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>Ordering Provider Contact Name</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                        <element xid="PER03">
                          <data_ele>365</data_ele>
                          <name>Communication Number Qualifier</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>EM</code>
                            <code>FX</code>
                            <code>TE</code>
                          </valid_codes>
                        </element>
                        <element xid="PER04">
                          <data_ele>364</data_ele>
                          <name>Communication Number</name>
                          <usage>R</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="PER05">
                          <data_ele>365</data_ele>
                          <name>Communication Number Qualifier</name>
                          <usage>S</usage>
                          <seq>05</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>EM</code>
                            <code>EX</code>
                            <code>FX</code>
                            <code>TE</code>
                          </valid_codes>
                        </element>
                        <element xid="PER06">
                          <data_ele>364</data_ele>
                          <name>Communication Number</name>
                          <usage>S</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="PER07">
                          <data_ele>365</data_ele>
                          <name>Communication Number Qualifier</name>
                          <usage>S</usage>
                          <seq>07</seq>
                          <data_type>ID</data_type>
                          <min_len>2</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>EM</code>
                            <code>EX</code>
                            <code>FX</code>
                            <code>TE</code>
                          </valid_codes>
                        </element>
                        <element xid="PER08">
                          <data_ele>364</data_ele>
                          <name>Communication Number</name>
                          <usage>S</usage>
                          <seq>08</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="PER09">
                          <data_ele>443</data_ele>
                          <name>Contact Inquiry Reference</name>
                          <usage>N</usage>
                          <seq>09</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>20</max_len>
                        </element>
                      </segment>
<!--End of PER segment-->
                    </loop>
<!--End of 2420E loop-->
                    <loop xid="2420F">
                      <name>Referring Provider Name</name>
                      <usage>S</usage>
                      <pos>500</pos>
                      <count>2</count>
                      <segment xid="NM1">
                        <name>Referring Provider Name</name>
                        <usage>S</usage>
                        <pos>500</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>DN</code>
                            <code>P3</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>Referring Provider Last Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Referring Provider First Name</name>
                          <usage>R</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Referring 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>Referring 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>XX</code>
                          </valid_codes>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Referring 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="PRV">
                        <name>Referring Provider Specialty Information</name>
                        <usage>S</usage>
                        <pos>505</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>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-->
                      <segment xid="N2">
                        <name>Additional Referring Provider Name Information</name>
                        <usage>S</usage>
                        <pos>510</pos>
                        <max_use>1</max_use>
                        <element xid="N201">
                          <data_ele>93</data_ele>
                          <name>Referring Provider Name Additional Text</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                        <element xid="N202">
                          <data_ele>93</data_ele>
                          <name>Name</name>
                          <usage>N</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>60</max_len>
                        </element>
                      </segment>
<!--End of N2 segment-->
                      <segment xid="REF">
                        <name>Referring Provider Secondary Identification</name>
                        <usage>S</usage>
                        <pos>525</pos>
                        <max_use>5</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>0B</code>
                            <code>1B</code>
                            <code>1C</code>
                            <code>1D</code>
                            <code>1G</code>
                            <code>1H</code>
                            <code>EI</code>
                            <code>G2</code>
                            <code>LU</code>
                            <code>N5</code>
                            <code>SY</code>
                            <code>X5</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Referring Provider Secondary 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-->
                    </loop>
<!--End of 2420F loop-->
                    <loop xid="2420G">
                      <name>Other Payer Prior Authorization or Referral Number</name>
                      <usage>S</usage>
                      <pos>500</pos>
                      <count>4</count>
                      <segment xid="NM1">
                        <name>Other Payer Prior Authorization or Referral Number</name>
                        <usage>S</usage>
                        <pos>500</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>PR</code>
                          </valid_codes>
                        </element>
                        <element xid="NM102">
                          <data_ele>1065</data_ele>
                          <name>Entity Type Qualifier</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>1</max_len>
                          <valid_codes>
                            <code>2</code>
                          </valid_codes>
                        </element>
                        <element xid="NM103">
                          <data_ele>1035</data_ele>
                          <name>Payer Name</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                        <element xid="NM104">
                          <data_ele>1036</data_ele>
                          <name>Name First</name>
                          <usage>N</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM105">
                          <data_ele>1037</data_ele>
                          <name>Name Middle</name>
                          <usage>N</usage>
                          <seq>05</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>25</max_len>
                        </element>
                        <element xid="NM106">
                          <data_ele>1038</data_ele>
                          <name>Name Prefix</name>
                          <usage>N</usage>
                          <seq>06</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM107">
                          <data_ele>1039</data_ele>
                          <name>Name Suffix</name>
                          <usage>N</usage>
                          <seq>07</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>10</max_len>
                        </element>
                        <element xid="NM108">
                          <data_ele>66</data_ele>
                          <name>Identification Code Qualifier</name>
                          <usage>R</usage>
                          <seq>08</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>2</max_len>
                          <valid_codes>
                            <code>PI</code>
                            <code>XV</code>
                          </valid_codes>
                        </element>
                        <element xid="NM109">
                          <data_ele>67</data_ele>
                          <name>Other Payer Identification Number</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>Other Payer Prior Authorization or Referral Number</name>
                        <usage>R</usage>
                        <pos>525</pos>
                        <max_use>2</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>9F</code>
                            <code>G1</code>
                          </valid_codes>
                        </element>
                        <element xid="REF02">
                          <data_ele>127</data_ele>
                          <name>Other Payer Prior Authorization or Referral Number</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>30</max_len>
                        </element>
                        <element xid="REF03">
                          <data_ele>352</data_ele>
                          <name>Description</name>
                          <usage>N</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>80</max_len>
                        </element>
                        <composite>
                          <data_ele>C040</data_ele>
                          <name>Reference Identifier</name>
                          <usage>N</usage>
                          <seq>04</seq>
                        </composite>
                      </segment>
<!--End of REF segment-->
                    </loop>
<!--End of 2420G loop-->
                    <loop xid="2430">
                      <name>Line Adjudication Information</name>
                      <usage>S</usage>
                      <pos>540</pos>
                      <count>25</count>
                      <segment xid="SVD">
                        <name>Line Adjudication Information</name>
                        <usage>S</usage>
                        <pos>540</pos>
                        <max_use>1</max_use>
                        <element xid="SVD01">
                          <data_ele>67</data_ele>
                          <name>Other Payer Primary Identifier</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>AN</data_type>
                          <min_len>2</min_len>
                          <max_len>80</max_len>
                        </element>
                        <element xid="SVD02">
                          <data_ele>782</data_ele>
                          <name>Service Line Paid Amount</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>18</max_len>
                        </element>
                        <composite>
                          <data_ele>C003</data_ele>
                          <name>Procedure Identifier</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <element xid="SVD03-01">
                            <data_ele>235</data_ele>
                            <name>Product or Service ID 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>HC</code>
                              <code>IV</code>
                              <code>N1</code>
                              <code>N2</code>
                              <code>N3</code>
                              <code>N4</code>
                              <code>ZZ</code>
                            </valid_codes>
                          </element>
                          <element xid="SVD03-02">
                            <data_ele>234</data_ele>
                            <name>Procedure Code</name>
                            <usage>R</usage>
                            <seq>02</seq>
                            <data_type>AN</data_type>
                            <min_len>1</min_len>
                            <max_len>48</max_len>
                          </element>
                          <element xid="SVD03-03">
                            <data_ele>1339</data_ele>
                            <name>Procedure Modifier 1</name>
                            <usage>S</usage>
                            <seq>03</seq>
                            <data_type>AN</data_type>
                            <min_len>2</min_len>
                            <max_len>2</max_len>
                          </element>
                          <element xid="SVD03-04">
                            <data_ele>1339</data_ele>
                            <name>Procedure Modifier 2</name>
                            <usage>S</usage>
                            <seq>04</seq>
                            <data_type>AN</data_type>
                            <min_len>2</min_len>
                            <max_len>2</max_len>
                          </element>
                          <element xid="SVD03-05">
                            <data_ele>1339</data_ele>
                            <name>Procedure Modifier 3</name>
                            <usage>S</usage>
                            <seq>05</seq>
                            <data_type>AN</data_type>
                            <min_len>2</min_len>
                            <max_len>2</max_len>
                          </element>
                          <element xid="SVD03-06">
                            <data_ele>1339</data_ele>
                            <name>Procedure Modifier 4</name>
                            <usage>S</usage>
                            <seq>06</seq>
                            <data_type>AN</data_type>
                            <min_len>2</min_len>
                            <max_len>2</max_len>
                          </element>
                          <element xid="SVD03-07">
                            <data_ele>352</data_ele>
                            <name>Procedure Code Description</name>
                            <usage>S</usage>
                            <seq>07</seq>
                            <data_type>AN</data_type>
                            <min_len>1</min_len>
                            <max_len>80</max_len>
                          </element>
                        </composite>
                        <element xid="SVD04">
                          <data_ele>234</data_ele>
                          <name>Product/Service ID</name>
                          <usage>N</usage>
                          <seq>04</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>48</max_len>
                        </element>
                        <element xid="SVD05">
                          <data_ele>380</data_ele>
                          <name>Paid Service Unit Count</name>
                          <usage>R</usage>
                          <seq>05</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>15</max_len>
                        </element>
                        <element xid="SVD06">
                          <data_ele>554</data_ele>
                          <name>Bundled or Unbundled Line Number</name>
                          <usage>S</usage>
                          <seq>06</seq>
                          <data_type>N0</data_type>
                          <min_len>1</min_len>
                          <max_len>6</max_len>
                        </element>
                      </segment>
<!--End of SVD segment-->
                      <segment xid="CAS">
                        <name>Line Adjustment</name>
                        <usage>S</usage>
                        <pos>545</pos>
                        <max_use>99</max_use>
                        <element xid="CAS01">
                          <data_ele>1033</data_ele>
                          <name>Adjustment Group 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>CO</code>
                            <code>CR</code>
                            <code>OA</code>
                            <code>PI</code>
                            <code>PR</code>
                          </valid_codes>
                        </element>
                        <element xid="CAS02">
                          <data_ele>1034</data_ele>
                          <name>Adjustment Reason Code</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>5</max_len>
                          <valid_codes external="adjustment_reason"/>
                        </element>
                        <element xid="CAS03">
                          <data_ele>782</data_ele>
                          <name>Adjustment Amount</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>18</max_len>
                        </element>
                        <element xid="CAS04">
                          <data_ele>380</data_ele>
                          <name>Adjustment Quantity</name>
                          <usage>S</usage>
                          <seq>04</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>15</max_len>
                        </element>
                        <element xid="CAS05">
                          <data_ele>1034</data_ele>
                          <name>Adjustment Reason Code</name>
                          <usage>S</usage>
                          <seq>05</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>5</max_len>
                          <valid_codes external="adjustment_reason"/>
                        </element>
                        <element xid="CAS06">
                          <data_ele>782</data_ele>
                          <name>Adjustment Amount</name>
                          <usage>S</usage>
                          <seq>06</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>18</max_len>
                        </element>
                        <element xid="CAS07">
                          <data_ele>380</data_ele>
                          <name>Adjustment Quantity</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="CAS08">
                          <data_ele>1034</data_ele>
                          <name>Adjustment Reason Code</name>
                          <usage>S</usage>
                          <seq>08</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>5</max_len>
                          <valid_codes external="adjustment_reason"/>
                        </element>
                        <element xid="CAS09">
                          <data_ele>782</data_ele>
                          <name>Adjustment Amount</name>
                          <usage>S</usage>
                          <seq>09</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>18</max_len>
                        </element>
                        <element xid="CAS10">
                          <data_ele>380</data_ele>
                          <name>Adjustment Quantity</name>
                          <usage>S</usage>
                          <seq>10</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>15</max_len>
                        </element>
                        <element xid="CAS11">
                          <data_ele>1034</data_ele>
                          <name>Adjustment Reason Code</name>
                          <usage>S</usage>
                          <seq>11</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>5</max_len>
                          <valid_codes external="adjustment_reason"/>
                        </element>
                        <element xid="CAS12">
                          <data_ele>782</data_ele>
                          <name>Adjustment Amount</name>
                          <usage>S</usage>
                          <seq>12</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>18</max_len>
                        </element>
                        <element xid="CAS13">
                          <data_ele>380</data_ele>
                          <name>Adjustment Quantity</name>
                          <usage>S</usage>
                          <seq>13</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>15</max_len>
                        </element>
                        <element xid="CAS14">
                          <data_ele>1034</data_ele>
                          <name>Adjustment Reason Code</name>
                          <usage>S</usage>
                          <seq>14</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>5</max_len>
                          <valid_codes external="adjustment_reason"/>
                        </element>
                        <element xid="CAS15">
                          <data_ele>782</data_ele>
                          <name>Adjustment Amount</name>
                          <usage>S</usage>
                          <seq>15</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>18</max_len>
                        </element>
                        <element xid="CAS16">
                          <data_ele>380</data_ele>
                          <name>Adjustment Quantity</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="CAS17">
                          <data_ele>1034</data_ele>
                          <name>Adjustment Reason Code</name>
                          <usage>S</usage>
                          <seq>17</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>5</max_len>
                          <valid_codes external="adjustment_reason"/>
                        </element>
                        <element xid="CAS18">
                          <data_ele>782</data_ele>
                          <name>Adjustment Amount</name>
                          <usage>S</usage>
                          <seq>18</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>18</max_len>
                        </element>
                        <element xid="CAS19">
                          <data_ele>380</data_ele>
                          <name>Adjustment Quantity</name>
                          <usage>S</usage>
                          <seq>19</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>15</max_len>
                        </element>
                      </segment>
<!--End of CAS segment-->
                      <segment xid="DTP">
                        <name>Line Adjudication Date</name>
                        <usage>R</usage>
                        <pos>550</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>573</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>Adjudication or Payment Date</name>
                          <usage>R</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>35</max_len>
                        </element>
                      </segment>
<!--End of DTP segment-->
                    </loop>
<!--End of 2430 loop-->
                    <loop xid="2440">
                      <name>Form Identification Code</name>
                      <usage>S</usage>
                      <pos>551</pos>
                      <count>5</count>
                      <segment xid="LQ">
                        <name>Form Identification Code</name>
                        <usage>S</usage>
                        <pos>551</pos>
                        <max_use>1</max_use>
                        <element xid="LQ01">
                          <data_ele>1270</data_ele>
                          <name>Form Identification 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>AS</code>
                            <code>UT</code>
                          </valid_codes>
                        </element>
                        <element xid="LQ02">
                          <data_ele>1271</data_ele>
                          <name>Form Identifier</name>
                          <usage>R</usage>
                          <seq>02</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>30</max_len>
                        </element>
                      </segment>
<!--End of LQ segment-->
                      <segment xid="FRM">
                        <name>Supporting Documentation</name>
                        <usage>R</usage>
                        <pos>552</pos>
                        <max_use>99</max_use>
                        <element xid="FRM01">
                          <data_ele>350</data_ele>
                          <name>Question Number/Letter</name>
                          <usage>R</usage>
                          <seq>01</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>20</max_len>
                        </element>
                        <element xid="FRM02">
                          <data_ele>1073</data_ele>
                          <name>Question Response</name>
                          <usage>S</usage>
                          <seq>02</seq>
                          <data_type>ID</data_type>
                          <min_len>1</min_len>
                          <max_len>1</max_len>
                          <valid_codes>
                            <code>N</code>
                            <code>W</code>
                            <code>Y</code>
                          </valid_codes>
                        </element>
                        <element xid="FRM03">
                          <data_ele>127</data_ele>
                          <name>Question Response</name>
                          <usage>S</usage>
                          <seq>03</seq>
                          <data_type>AN</data_type>
                          <min_len>1</min_len>
                          <max_len>30</max_len>
                        </element>
                        <element xid="FRM04">
                          <data_ele>373</data_ele>
                          <name>Question Response</name>
                          <usage>S</usage>
                          <seq>04</seq>
                          <data_type>DT</data_type>
                          <min_len>8</min_len>
                          <max_len>8</max_len>
                        </element>
                        <element xid="FRM05">
                          <data_ele>332</data_ele>
                          <name>Question Response</name>
                          <usage>S</usage>
                          <seq>05</seq>
                          <data_type>R</data_type>
                          <min_len>1</min_len>
                          <max_len>6</max_len>
                        </element>
                      </segment>
<!--End of FRM segment-->
                    </loop>
<!--End of 2440 loop-->
                  </loop>
<!--End of 2400 loop-->
                </loop>
<!--End of 2300 loop-->
              </loop>
<!--End of 2000C loop-->
            </loop>
<!--End of 2000B loop-->
          </loop>
<!--End of 2000A 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>555</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>
