Module: Stupidedi::Guides::FiftyTen::X214
- Defined in:
- lib/stupidedi/guides/005010.rb,
lib/stupidedi/guides/005010/X214-HN277.rb
Constant Summary collapse
- HN277 =
Health Care Claim Acknowledgement
b.build(t::HN277, d::TableDef.header("Table 1 - Header", b::Segment(100, s::ST, "Transaction Set Header", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Transaction Set Identifier Code", b::Values("277")), b::Element(e::Required, "Transaction Set Control Number"), b::Element(e::Required, "Version, Release, or Industry Identifier", b::Values("005010X214"))), b::Segment(200, s::BHT, "Beginning of Hierarchical Transaction", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Hierarchical Structure Code", b::Values("0085")), b::Element(e::Required, "Transaction Set Purpose Code", b::Values("08")), b::Element(e::Required, "Originator Application Transaction Identifier", b::MaxLength(30)), b::Element(e::Required, "Transaction Set Creation Date"), b::Element(e::Required, "Transaction Set Creation Time"), b::Element(e::Required, "Transaction Type Code", b::Values("TH")))), d::TableDef.detail("Table 2 - Information Source Detail", d::LoopDef.build("2000A INFORMATION SOURCE LEVEL", d::RepeatCount.bounded(1), b::Segment(100, s::HL, "Information Source Level", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Hierarchical ID Number"), b::Element(e::NotUsed, "Hierarchical Parent ID Number"), b::Element(e::Required, "Hierarchical Level Code", b::Values("20")), b::Element(e::Required, "Hierachical Child Code", b::Values("1"))), d::LoopDef.build("2100A INFORMATION SOURCE NAME", d::RepeatCount.bounded(1), b::Segment(500, s::NM1, "Information Source Name", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("AY", "PR")), b::Element(e::Required, "Entity Type Qualifier", b::Values("2")), b::Element(e::Required, "Information Source Name"), b::Element(e::NotUsed, "Name First"), b::Element(e::NotUsed, "Name Middle"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::NotUsed, "Name Suffix"), b::Element(e::Required, "Identification Code Qualifier", b::Values("46", "FI", "PI")), b::Element(e::Required, "Information Source Identifier"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Name Last or Organization Name"))), d::LoopDef.build("2200A TRANSMISSION RECEIPT CONTROL IDENTIFIER", d::RepeatCount.bounded(1), b::Segment( 900, s::TRN, "Transmission Receipt Control Identifier", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Trace Type Code", b::Values("1")), b::Element(e::Required, "Information Source Application Trace Identifier"), b::Element(e::NotUsed, "Originating Company Identifier"), b::Element(e::NotUsed, "Reference Identification")), b::Segment(1200, s::DTP, "Information Source Receipt Date", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Date Time Qualifier", b::Values("050")), b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")), b::Element(e::Required, "Information Source Receipt Date")), b::Segment(1200, s::DTP, "Information Source Process Date", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Date Time Qualifier", b::Values("009")), b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")), b::Element(e::Required, "Information Source Process Date"))))), d::TableDef.detail("Table 2 - Information Receiver Detail", d::LoopDef.build("2000B INFORMATION RECEIVER LEVEL", d::RepeatCount.bounded(1), b::Segment(100, s::HL, "Information Receiver Level", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Hierarchical ID Number"), b::Element(e::Required, "Hierarchical Parent ID Number"), b::Element(e::Required, "Hierarchical Level Code", b::Values("21")), b::Element(e::Required, "Hierachical Child Code", b::Values("0", "1"))), d::LoopDef.build("2100B INFORMATION RECEIVER NAME", d::RepeatCount.bounded(1), b::Segment(500, s::NM1, "Information Receiver Name", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("41")), b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")), b::Element(e::Required, "Information Receiver Last or Organizational Name"), b::Element(e::Situational, "Information Receiver First Name"), b::Element(e::Situational, "Information Receiver Middle Name or Initial"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::NotUsed, "Name Suffix"), b::Element(e::Required, "Identification Code Qualifier", b::Values("46")), b::Element(e::Required, "Information Receiver Primary Identifier"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Name Last or Organization Name"))), d::LoopDef.build("2200B INFORMATION RECEIVER APPLICATION TRACE IDENTIFIER", d::RepeatCount.bounded(1), b::Segment( 900, s::TRN, "Information Receiver Application Trace Identifier", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Trace Type Code", b::Values("2")), b::Element(e::Required, "Claim Transaction Batch Number"), b::Element(e::NotUsed, "Originating Company Identifier"), b::Element(e::NotUsed, "Reference Identification")), b::Segment(1000, s::STC, "Information Receiver Status Information", r::Required, d::RepeatCount.unbounded, b::Element(e::Required, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("36", "40", "41", "AY", "PR")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::Required, "Status Information Effective Date"), b::Element(e::Required, "Action Code", b::Values("U", "WQ")), b::Element(e::Required, "Total Submitted Charges for Unit Work"), b::Element(e::NotUsed, "Monetary Amount"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Payment Method Code"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Check Number"), b::Element(e::Situational, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("36", "40", "41", "AY", "PR")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::Situational, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("36", "40", "41", "AY", "PR")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::NotUsed, "Free-form Message Text")), b::Segment(1210, s::QTY, "Total Accepted Quantity", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Quantity Qualifier", b::Values("90")), b::Element(e::Required, "Total Accepted Quantity"), b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"), b::Element(e::NotUsed, "Free-form Information")), b::Segment(1210, s::QTY, "Total Rejected Quantity", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Quantity Qualifier", b::Values("AA")), b::Element(e::Required, "Total Rejected Quantity"), b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"), b::Element(e::NotUsed, "Free-form Information")), b::Segment(1220, s::AMT, "Total Accepted Amount", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Amount Qualifier Code", b::Values("YU")), b::Element(e::Required, "Total Rejected Amount"), b::Element(e::NotUsed, "Credit/Debit Flag Code")), b::Segment(1220, s::AMT, "Total Accepted Amount", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Amount Qualifier Code", b::Values("YY")), b::Element(e::Required, "Total Accepted Amount"), b::Element(e::NotUsed, "Credit/Debit Flag Code"))))), d::TableDef.detail("Table 2 - Billing Provider of Service Detail", d::LoopDef.build("2000C BILLING PROVIDER OF SERVICE LEVEL", d::RepeatCount.bounded(1), b::Segment(100, s::HL, "Billing Provider of Service Level", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Hierarchical ID Number"), b::Element(e::Required, "Hierarchical Parent ID Number"), b::Element(e::Required, "Hierarchical Level Code", b::Values("19")), b::Element(e::Required, "Hierachical Child Code", b::Values("0", "1"))), d::LoopDef.build("2100C BILLING PROVIDER NAME", d::RepeatCount.unbounded, b::Segment(500, s::NM1, "Billing Provider Name", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("85")), b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")), b::Element(e::Required, "Billing Provider Last or Organizational Name"), b::Element(e::Situational, "Billing Provider First Name"), b::Element(e::Situational, "Billing Provider Middle Name or Initial"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::Situational, "Billing Provider Name Suffix"), b::Element(e::Required, "Identification Code Qualifier", b::Values("FI", "XX")), b::Element(e::Required, "Billing Provider Identifier"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Name Last or Organization Name"))), d::LoopDef.build("2200C PROVIDER OF SERVICE INFORMATION TRACE IDENTIFIER", d::RepeatCount.bounded(1), b::Segment( 900, s::TRN, "Provider of Service Information Trace Identifier", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Trace Type Code", b::Values("1")), b::Element(e::Required, "Provider of Service Information Trace Identifier"), b::Element(e::NotUsed, "Originating Company Identifier"), b::Element(e::NotUsed, "Reference Identification")), b::Segment(1000, s::STC, "Billing Provider Status Information", r::Situational, d::RepeatCount.unbounded, b::Element(e::Required, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("36", "40", "41", "77", "82", "85", "87", "AY", "PR")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::NotUsed, ""), b::Element(e::Required, "Action Code", b::Values("U", "WQ")), b::Element(e::Required, "Total Submitted Charges for Unit Work"), b::Element(e::NotUsed, "Monetary Amount"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Payment Method Code"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Check Number"), b::Element(e::Situational, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("36", "40", "41", "AY", "PR")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::Situational, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("36", "40", "41", "AY", "PR")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::NotUsed, "Free-form Message Text")), b::Segment(1100, s::REF, "Provider Secondary Identifier", r::Situational, d::RepeatCount.bounded(3), b::Element(e::Required, "Reference Identification Qualifier", b::Values("0B", "1G", "G2", "LU", "SY", "TJ")), b::Element(e::Required, "Billing Provider Additional Identifier"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(1210, s::QTY, "Total Accepted Quantity", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Quantity Qualifier", b::Values("QA")), b::Element(e::Required, "Total Accepted Quantity"), b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"), b::Element(e::NotUsed, "Free-form Information")), b::Segment(1210, s::QTY, "Total Rejected Quantity", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Quantity Qualifier", b::Values("QC")), b::Element(e::Required, "Total Rejected Quantity"), b::Element(e::NotUsed, "COMPOSITE UNIT OF MEASURE"), b::Element(e::NotUsed, "Free-form Information")), b::Segment(1220, s::AMT, "Total Accepted Amount", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Amount Qualifier Code", b::Values("YU")), b::Element(e::Required, "Total Rejected Amount"), b::Element(e::NotUsed, "Credit/Debit Flag Code")), b::Segment(1220, s::AMT, "Total Accepted Amount", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Amount Qualifier Code", b::Values("YY")), b::Element(e::Required, "Total Accepted Amount"), b::Element(e::NotUsed, "Credit/Debit Flag Code"))))), d::TableDef.detail("Table 2 - Patient Detail", d::LoopDef.build("2000D PATIENT LEVEL", d::RepeatCount.bounded(1), b::Segment(100, s::HL, "Patient Level", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Hierarchical ID Number"), b::Element(e::Required, "Hierarchical Parent ID Number"), b::Element(e::Required, "Hierarchical Level Code", b::Values("PT")), b::Element(e::NotUsed, "Hierachical Child Code")), d::LoopDef.build("2100D PATIENT NAME", d::RepeatCount.bounded(1), b::Segment(500, s::NM1, "Patient Name", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Entity Identifier Code", b::Values("QC")), b::Element(e::Required, "Entity Type Qualifier", b::Values("1")), b::Element(e::Required, "Patient Last or Organizational Name"), b::Element(e::Situational, "Patient First Name"), b::Element(e::Situational, "Patient Middle Name or Initial"), b::Element(e::NotUsed, "Name Prefix"), b::Element(e::Situational, "Patient Name Suffix"), b::Element(e::Required, "Identification Code Qualifier", b::Values("II", "MI")), b::Element(e::Required, "Patient Identification Number"), b::Element(e::NotUsed, "Entity Relationship Code"), b::Element(e::NotUsed, "Entity Identifier Code"), b::Element(e::NotUsed, "Name Last or Organization Name"))), d::LoopDef.build("2200D CLAIM STATUS TRACKING NUMBER", d::RepeatCount.unbounded, b::Segment( 900, s::TRN, "Claim Status Tracking Number", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Trace Type Code", b::Values("2")), b::Element(e::Required, "Patient Control Number"), b::Element(e::NotUsed, "Originating Company Identifier"), b::Element(e::NotUsed, "Reference Identification")), b::Segment(1000, s::STC, "Claim Level Status Information", r::Required, d::RepeatCount.unbounded, b::Element(e::Required, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("03", "1P", "1Z", "40", "41", "71", "72", "73", "77", "82", "85", "87", "DK", "DN", "DQ", "FA", "GB", "HK", "IL", "LI", "MSC", "PR", "PRP", "QB", "QC", "QD", "SEP", "TL", "TTP", "TU")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::Required, "Status Information Effective Date"), b::Element(e::Required, "Action Code", b::Values("U", "WQ")), b::Element(e::Required, "Total Claim Charge Amount"), b::Element(e::NotUsed, "Monetary Amount"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Payment Method Code"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Check Number"), b::Element(e::Situational, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("36", "40", "41", "AY", "PR")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::Situational, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("36", "40", "41", "AY", "PR")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::Situational, "Free Form Message Text")), b::Segment(1100, s::REF, "Payer Claim Control Number", r::Situational, d::RepeatCount.bounded(3), b::Element(e::Required, "Reference Identification Qualifier", b::Values("1K")), b::Element(e::Required, "Payer Claim Control Number"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(1100, s::REF, "Claim Identifier Number for Clearinghous and Other Transmission Intermediaries", r::Situational, d::RepeatCount.bounded(3), b::Element(e::Required, "Reference Identification Qualifier", b::Values("D9")), b::Element(e::Required, "Clearinghouse Trace Number"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(1100, s::REF, "Institutional Bill Type Identification", r::Situational, d::RepeatCount.bounded(3), b::Element(e::Required, "Reference Identification Qualifier", b::Values("BLT")), b::Element(e::Required, "Institutional Bill Type Identification"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(1200, s::DTP, "Claim Level Service Date", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Date Time Qualifier", b::Values("472")), b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8", "RD8")), b::Element(e::Required, "Claim Service Period")), d::LoopDef.build("2220D SERVICE LINE INFORMATION", d::RepeatCount.unbounded, b::Segment(1800, s::SVC, "Service Line Information", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER", b::Element(e::Required, "Procedure Code", b::Values("AD", "ER", "HC", "HP", "IV", "NU", "WK")), b::Element(e::Required, "Procedure Code"), b::Element(e::Situational, "Procedure Modifier"), b::Element(e::Situational, "Procedure Modifier"), b::Element(e::Situational, "Procedure Modifier"), b::Element(e::Situational, "Procedure Modifier"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "Product/Service ID")), b::Element(e::Required, "Line Item Charge Amount"), b::Element(e::NotUsed, "Monetary Amount"), b::Element(e::Situational, "Revenue Code"), b::Element(e::NotUsed, "Quantity"), b::Element(e::NotUsed, "COMPOSITE MEDICAL PROCEDURE IDENTIFIER"), b::Element(e::Situational, "Original Units of Service Count")), b::Segment(1900, s::STC, "Service Line Level Status Information", r::Required, d::RepeatCount.unbounded, b::Element(e::Required, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("03", "1P", "1Z", "40", "41", "71", "72", "73", "77", "82", "85", "87", "DK", "DN", "DQ", "FA", "GB", "HK", "IL", "LI", "MSC", "PR", "PRP", "QB", "QC", "QD", "SEP", "TL", "TTP", "TU")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::NotUsed, "Date"), b::Element(e::Required, "Action Code", b::Values("U")), b::Element(e::NotUsed, "Monetary Amount"), b::Element(e::NotUsed, "Monetary Amount"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Payment Method Code"), b::Element(e::NotUsed, "Date"), b::Element(e::NotUsed, "Check Number"), b::Element(e::Situational, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("36", "40", "41", "AY", "PR")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::Situational, "HEALTH CARE CLAIM STATUS", b::Element(e::Required, "Health Care Claim Status Category Code"), # @todo: CodeSource.external("507") b::Element(e::Required, "Health Care Claim Status Code"), # @todo: CodeSource.external("508") b::Element(e::Situational, "Entity Identifier Qualifier", b::Values("36", "40", "41", "AY", "PR")), b::Element(e::NotUsed, "Code List Qualifier Code")), b::Element(e::Situational, "Free Form Message Text")), b::Segment(2000, s::REF, "Service Line Item Identification", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Reference Identification Qualifier", b::Values("FJ")), b::Element(e::Required, "Line Item Control Number"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(2000, s::REF, "Pharmacy Prescription Number", r::Situational, d::RepeatCount.bounded(1), b::Element(e::Required, "Reference Identification Qualifier", b::Values("XZ")), b::Element(e::Required, "Pharmacy Prescription Number"), b::Element(e::NotUsed, "Description"), b::Element(e::NotUsed, "REFERENCE IDENTIFIER")), b::Segment(2100, s::DTP, "Service Line Date", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Date Time Qualifier", b::Values("472")), b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8", "RD8")), b::Element(e::Required, "Service Line Date")))))), d::TableDef.detail("Table 3 - Summary", b::Segment(2700, s::SE, "Transaction Set Trailer", r::Required, d::RepeatCount.bounded(1), b::Element(e::Required, "Transaction Segment Count"), b::Element(e::Required, "Transaction Set Control Number"))))