id	description	section	req	max_loop	max_usage	pos
BHT	Beginning Of Hierarchical Transaction	H	M	0	1	1
REF	Reference Information	H	O	0	3	2
NM1	Individual Or Organizational Name	H	O	10	1	3
N2	Additional Name Information	H	O	0	2	4
N3	Party Location	H	O	0	2	5
N4	Geographic Location	H	O	0	1	6
REF	Reference Information	H	O	0	2	7
PER	Administrative Communications Contact	H	O	0	2	8
HL	Hierarchical Level	D	M	999999	1	9
PRV	Provider Information	D	O	0	1	10
SBR	Subscriber Information	D	O	0	1	11
PAT	Patient Information	D	O	0	1	12
DTP	Date Or Time Or Period	D	O	0	5	13
CUR	Currency	D	O	0	1	14
NM1	Individual Or Organizational Name	D	O	10	1	15
N2	Additional Name Information	D	O	0	2	16
N3	Party Location	D	O	0	2	17
N4	Geographic Location	D	O	0	1	18
DMG	Demographic Information	D	O	0	1	19
REF	Reference Information	D	O	0	20	20
PER	Administrative Communications Contact	D	O	0	2	21
CLM	Health Claim	D	O	100	1	22
DTP	Date Or Time Or Period	D	O	0	150	23
CL1	Claim Codes	D	O	0	1	24
DN1	Orthodontic Information	D	O	0	1	25
DN2	Tooth Summary	D	O	0	35	26
PWK	Paperwork	D	O	0	10	27
CN1	Contract Information	D	O	0	1	28
DSB	Disability Information	D	O	0	1	29
UR	Peer Review Organization Or Utilization Review	D	O	0	1	30
AMT	Monetary Amount Information	D	O	0	40	31
REF	Reference Information	D	O	0	30	32
K3	File Information	D	O	0	10	33
NTE	Note/Special Instruction	D	O	0	20	34
CR1	Ambulance Certification	D	O	0	1	35
CR2	Chiropractic Certification	D	O	0	1	36
CR3	Durable Medical Equipment Certification	D	O	0	1	37
CR4	Enteral Or Parenteral Therapy Certification	D	O	0	3	38
CR5	Oxygen Therapy Certification	D	O	0	1	39
CR6	Home Health Care Certification	D	O	0	1	40
CR8	Pacemaker Certification	D	O	0	9	41
CRC	Conditions Indicator	D	O	0	100	42
HI	Health Care Information Codes	D	O	0	25	43
QTY	Quantity Information	D	O	0	10	44
HCP	Health Care Pricing	D	O	0	1	45
CR7	Home Health Treatment Plan Certification	D	O	6	1	46
HSD	Health Care Services Delivery	D	O	0	12	47
NM1	Individual Or Organizational Name	D	O	9	1	48
PRV	Provider Information	D	O	0	1	49
N2	Additional Name Information	D	O	0	2	50
N3	Party Location	D	O	0	2	51
N4	Geographic Location	D	O	0	1	52
REF	Reference Information	D	O	0	20	53
PER	Administrative Communications Contact	D	O	0	2	54
SBR	Subscriber Information	D	O	10	1	55
CAS	Claims Adjustment	D	O	0	99	56
AMT	Monetary Amount Information	D	O	0	15	57
DMG	Demographic Information	D	O	0	1	58
OI	Other Health Insurance Information	D	O	0	1	59
MIA	Medicare Inpatient Adjudication	D	O	0	1	60
MOA	Medicare Outpatient Adjudication	D	O	0	1	61
NM1	Individual Or Organizational Name	D	O	10	1	62
N2	Additional Name Information	D	O	0	2	63
N3	Party Location	D	O	0	2	64
N4	Geographic Location	D	O	0	1	65
PER	Administrative Communications Contact	D	O	0	2	66
DTP	Date Or Time Or Period	D	O	0	9	67
REF	Reference Information	D	O	0	999999	68
LX	Transaction Set Line Number	D	O	999999	1	69
SV1	Professional Service	D	O	0	1	70
SV2	Institutional Service	D	O	0	1	71
SV3	Dental Service	D	O	0	1	72
TOO	Tooth Identification	D	O	0	32	73
SV4	Drug Service	D	O	0	1	74
SV5	Durable Medical Equipment Service	D	O	0	1	75
SV6	Anesthesia Service	D	O	0	1	76
SV7	Drug Adjudication	D	O	0	1	77
HI	Health Care Information Codes	D	O	0	25	78
PWK	Paperwork	D	O	0	10	79
CR1	Ambulance Certification	D	O	0	1	80
CR2	Chiropractic Certification	D	O	0	5	81
CR3	Durable Medical Equipment Certification	D	O	0	1	82
CR4	Enteral Or Parenteral Therapy Certification	D	O	0	3	83
CR5	Oxygen Therapy Certification	D	O	0	1	84
CRC	Conditions Indicator	D	O	0	3	85
DTP	Date Or Time Or Period	D	O	0	15	86
QTY	Quantity Information	D	O	0	5	87
MEA	Measurements	D	O	0	20	88
CN1	Contract Information	D	O	0	1	89
REF	Reference Information	D	O	0	30	90
AMT	Monetary Amount Information	D	O	0	15	91
K3	File Information	D	O	0	10	92
NTE	Note/Special Instruction	D	O	0	10	93
PS1	Purchase Service	D	O	0	1	94
IMM	Immunization Status	D	O	0	999999	95
HSD	Health Care Services Delivery	D	O	0	1	96
HCP	Health Care Pricing	D	O	0	1	97
LIN	Item Identification	D	O	999999	1	98
CTP	Pricing Information	D	O	0	1	99
REF	Reference Information	D	O	0	1	100
NM1	Individual Or Organizational Name	D	O	10	1	101
PRV	Provider Information	D	O	0	1	102
N2	Additional Name Information	D	O	0	2	103
N3	Party Location	D	O	0	2	104
N4	Geographic Location	D	O	0	1	105
REF	Reference Information	D	O	0	20	106
PER	Administrative Communications Contact	D	O	0	2	107
SVD	Service Line Adjudication	D	O	999999	1	108
CAS	Claims Adjustment	D	O	0	99	109
DTP	Date Or Time Or Period	D	O	0	9	110
AMT	Monetary Amount Information	D	O	0	20	111
LQ	Industry Code Identification	D	O	999999	1	112
FRM	Supporting Documentation	D	M	0	99	113