id description section req max_loop max_usage pos BPR Beginning Segment For Payment Order/Remittance Advice H M 0 1 1 NTE Note/Special Instruction H O 0 999999 2 TRN Trace H O 0 1 3 CUR Currency H O 0 1 4 REF Reference Information H O 0 999999 5 DTM Date/Time Reference H O 0 999999 6 N1 Party Identification H O 200 1 7 N2 Additional Name Information H O 0 999999 8 N3 Party Location H O 0 999999 9 N4 Geographic Location H O 0 1 10 REF Reference Information H O 0 999999 11 PER Administrative Communications Contact H O 0 999999 12 RDM Remittance Delivery Method H O 0 1 13 DTM Date/Time Reference H O 0 1 14 LX Transaction Set Line Number D O 999999 1 15 TS3 Transaction Statistics D O 0 1 16 TS2 Transaction Supplemental Statistics D O 0 1 17 CLP Claim Level Data D M 999999 1 18 CAS Claims Adjustment D O 0 99 19 NM1 Individual Or Organizational Name D M 0 9 20 MIA Medicare Inpatient Adjudication D O 0 1 21 MOA Medicare Outpatient Adjudication D O 0 1 22 REF Reference Information D O 0 99 23 DTM Date/Time Reference D O 0 9 24 PER Administrative Communications Contact D O 0 3 25 AMT Monetary Amount Information D O 0 20 26 QTY Quantity Information D O 0 20 27 SVC Service Information D O 999 1 28 DTM Date/Time Reference D O 0 9 29 CAS Claims Adjustment D O 0 99 30 REF Reference Information D O 0 99 31 AMT Monetary Amount Information D O 0 20 32 QTY Quantity Information D O 0 20 33 LQ Industry Code Identification D O 0 99 34 PLB Provider Level Adjustment S O 0 999999 35