b.build("HC", "837", "",
d::TableDef.("Table 1 - Header",
b::Segment(50, s::ST, "Transaction Set Header",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Transaction Set Identifier Code", b::Values("837")),
b::Element(e::Required, "Transaction Set Control Number"),
b::Element(e::Required, "Version, Release or Industry Identifier")),
b::Segment(100, s::BHT, "Beginning of Hierarchical Transaction",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Hierarchical Structure Code", b::Values("0019")),
b::Element(e::Required, "Transaction Set Purpose Code", b::Values("00", "18")),
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, "Claim Identifier", b::Values("31", "CH", "RP"))),
d::LoopDef.build("1000A SUBMITTER NAME",
d::RepeatCount.bounded(1),
b::Segment(200, s::NM1, "Submitter 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, "Submitter Last or Organization Name"),
b::Element(e::Situational, "Submitter First Name"),
b::Element(e::Situational, "Submitter Middle Name or Initial"),
b::Element(e::NotUsed, "Name Prefix"),
b::Element(e::NotUsed, "Name Suffix"),
b::Element(e::Required, "Identification Qualifier Code", b::Values("46")),
b::Element(e::Required, "Submitter Identifier"),
b::Element(e::NotUsed, "Entity Relationship Code"),
b::Element(e::NotUsed, "Entity Identifier Code"),
b::Element(e::NotUsed, "Name Last or Organization Name")),
b::Segment(450, s::PER, "Submitter EDI Contact Information",
r::Required, d::RepeatCount.bounded(2),
b::Element(e::Required, "Contact Function Code", b::Values("IC")),
b::Element(e::Situational, "Submitter Contact Name"),
b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
b::Element(e::Required, "Communication Number"),
b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
b::Element(e::Situational, "Communication Number"),
b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
b::Element(e::Situational, "Communication Number"),
b::Element(e::NotUsed, "Contact Inquiry Reference"))),
d::LoopDef.build("1000B RECEIVER NAME",
d::RepeatCount.bounded(1),
b::Segment(200, s::NM1, "Receiver Name",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Entity Identifier Code", b::Values("40")),
b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
b::Element(e::Required, "Receiver Name"),
b::Element(e::NotUsed, "Name First"),
b::Element(e::NotUsed, "Name Last"),
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, "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::TableDef.detail("Table 2 - Billing Provider Detail",
d::LoopDef.build("2000A BILLING PROVIDER HIERARCHICAL LEVEL",
d::RepeatCount.bounded(1), b::Segment(10, s::HL, "Billing Provider Hierarchical 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"))),
b::Segment(30, s::PRV, "Billing Provider Specialty Information",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Provider Code", b::Values("BI")),
b::Element(e::Required, "Reference Identification Qualifier", b::Values("PXC")),
b::Element(e::Required, "Provider Taxonomy Code"),
b::Element(e::NotUsed, "State or Province Code"),
b::Element(e::NotUsed, "PROVIDER SPECIALTY INFORMATION"),
b::Element(e::NotUsed, "Provider Organization Code")),
b::Segment(100, s::CUR, "Foreign Currency Information",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Entity Identifier Code", b::Values("85")),
b::Element(e::Required, "Currency Code"),
b::Element(e::NotUsed, "Exchange Rate"),
b::Element(e::NotUsed, "Entity Identifier Code"),
b::Element(e::NotUsed, "Currency Code"),
b::Element(e::NotUsed, "Currency Market/Exchange Code"),
b::Element(e::NotUsed, "Date/Time Qualifier"),
b::Element(e::NotUsed, "Date"),
b::Element(e::NotUsed, "Time"),
b::Element(e::NotUsed, "Date/Time Qualifier"),
b::Element(e::NotUsed, "Date"),
b::Element(e::NotUsed, "Time"),
b::Element(e::NotUsed, "Date/Time Qualifier"),
b::Element(e::NotUsed, "Date"),
b::Element(e::NotUsed, "Time"),
b::Element(e::NotUsed, "Date/Time Qualifier"),
b::Element(e::NotUsed, "Date"),
b::Element(e::NotUsed, "Time"),
b::Element(e::NotUsed, "Date/Time Qualifier"),
b::Element(e::NotUsed, "Date"),
b::Element(e::NotUsed, "Time")),
d::LoopDef.build("2010AA BILLING PROVIDER NAME",
d::RepeatCount.bounded(1),
b::Segment(150, 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("2")),
b::Element(e::Required, "Billing Provider Organizational 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::Situational, "Identification Code Qualifier", b::Values("XX")),
b::Element(e::Situational, "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")),
b::Segment(250, s::N3, "Billing Provider Address",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Billing Provider Address Line"),
b::Element(e::Situational, "Billing Provider Address Line")),
b::Segment(300, s::N4, "Billing Provider City, State, ZIP Code",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Billing Provider City Name"),
b::Element(e::Situational, "Billing Provider State or Province Code"),
b::Element(e::Situational, "Billing Provider Postal Zone or ZIP Code"),
b::Element(e::Situational, "Country Code"),
b::Element(e::NotUsed, "Location Qualifier"),
b::Element(e::NotUsed, "Location Identifier"),
b::Element(e::Situational, "Country Subdivision Code")),
b::Segment(350, s::REF, "Billing Provider Tax Identification",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI")),
b::Element(e::Required, "Billing Provider Tax Identification Number"),
b::Element(e::NotUsed, "Description"),
b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
b::Segment(400, s::PER, "Billing Provider Contact Information",
r::Situational, d::RepeatCount.bounded(2),
b::Element(e::Required, "Contact Function Code", b::Values("IC")),
b::Element(e::Situational, "Billing Provider Contact Name"),
b::Element(e::Required, "Communication Number Qualifier", b::Values("EM", "FX", "TE")),
b::Element(e::Required, "Communication Number"),
b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
b::Element(e::Situational, "Communication Number"),
b::Element(e::Situational, "Communication Number Qualifier", b::Values("EM", "EX", "FX", "TE")),
b::Element(e::Situational, "Communication Number"),
b::Element(e::NotUsed, "Contact Inquiry Reference"))),
d::LoopDef.build("2010AB PAY-TO ADDRESS NAME",
d::RepeatCount.bounded(1),
b::Segment(150, s::NM1, "Pay-to Address Name",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Entity Identifier Code", b::Values("87")),
b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
b::Element(e::NotUsed, "Name Last or Organizational 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::NotUsed, "Identification Code Qualifier"),
b::Element(e::NotUsed, "Identifier Code"),
b::Element(e::NotUsed, "Entity Relationship Code"),
b::Element(e::NotUsed, "Entity Identifier Code"),
b::Element(e::NotUsed, "Name Last or Organization Name")),
b::Segment(250, s::N3, "Pay-to Address - ADDRESS",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Pay-To Address Line"),
b::Element(e::Situational, "Pay-To Address Line")),
b::Segment(300, s::N4, "Pay-To Address City, State, ZIP Code",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Pay-to Address City Name"),
b::Element(e::Situational, "Pay-to Address State Code"),
b::Element(e::Situational, "Pay-to Address Postal Zone or ZIP Code"),
b::Element(e::Situational, "Country Code"),
b::Element(e::NotUsed, "Location Qualifier"),
b::Element(e::NotUsed, "Location Identifier"),
b::Element(e::Situational, "Country Subdivision Code"))),
d::LoopDef.build("2010AC PAY-TO PLAN NAME",
d::RepeatCount.bounded(1),
b::Segment(150, s::NM1, "Pay-To Plan Name",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Entity Identifier Code", b::Values("PE")),
b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
b::Element(e::Required, "Pay-To Plan Organizational 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("PI", "XV")),
b::Element(e::Required, "Pay-To Plan 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")),
b::Segment(250, s::N3, "Pay-to Plan Address",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Pay-To Plan Address Line"),
b::Element(e::Situational, "Pay-To Plan Address Line")),
b::Segment(300, s::N4, "Pay-To Plan City, State, ZIP Code",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Pay-to Plan City Name"),
b::Element(e::Situational, "Pay-to Plan State or Province Code"),
b::Element(e::Situational, "Pay-to Plan Postal Zone or ZIP Code"),
b::Element(e::Situational, "Country Code"),
b::Element(e::NotUsed, "Location Qualifier"),
b::Element(e::NotUsed, "Location Identifier"),
b::Element(e::Situational, "Country Subdivision Code")),
b::Segment(350, s::REF, "Pay-to Plan Secondary Identification",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "FY", "NF")),
b::Element(e::Required, "Pay-to Plan Secondary Identifier"),
b::Element(e::NotUsed, "Description"),
b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
b::Segment(350, s::REF, "Pay-to Plan Tax Identification Number",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Reference Identification Qualifier", b::Values("EI")),
b::Element(e::Required, "Pay-to Plan Tax Identification Number"),
b::Element(e::NotUsed, "Description"),
b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))))),
d::TableDef.detail("Table 2 - Subscriber Detail",
d::LoopDef.build("2000B SUBSCRIBER HIERARCHICAL LEVEL",
d::RepeatCount.bounded(1),
b::Segment(10, s::HL, "Subscriber Hierarchical 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("22")),
b::Element(e::Required, "Hierachical Child Code", b::Values("0", "1"))),
b::Segment(50, s::SBR, "Subscriber Information",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Payer Responsibility Sequence Number Code", b::Values("A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U")),
b::Element(e::Situational, "Individual Relationship Code", b::Values("18")),
b::Element(e::Situational, "Subscriber Group or Policy Number"),
b::Element(e::Situational, "Subscriber Group Name"),
b::Element(e::NotUsed, "Insurance Type Code"),
b::Element(e::NotUsed, "Coordination of Benefits Code"),
b::Element(e::NotUsed, "Yes/No Condition or Response Code"),
b::Element(e::NotUsed, "Employment Status Code"),
b::Element(e::Required, "Claim Filing Indicator Code", b::Values("11", "12", "13", "14", "15", "16", "17", "AM", "BL", "CH", "CI", "DS", "FI", "HM", "LM", "MA", "MB", "MC", "OF", "TV", "VA", "WC", "ZZ"))),
d::LoopDef.build("2010BA SUBSCRIBER NAME",
d::RepeatCount.bounded(1),
b::Segment(150, s::NM1, "Subscriber Name",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Entity Identifier Code", b::Values("IL")),
b::Element(e::Required, "Entity Type Qualifier", b::Values("1", "2")),
b::Element(e::Required, "Subscriber Last Name"),
b::Element(e::Situational, "Subscriber First Name"),
b::Element(e::Situational, "Subscriber Middle Name or Initial"),
b::Element(e::NotUsed, "Name Prefix"),
b::Element(e::Situational, "Subscriber Name Suffix"),
b::Element(e::Situational, "Identification Code Qualifier", b::Values("II", "MI")),
b::Element(e::Situational, "Subscriber 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")),
b::Segment(250, s::N3, "Subscriber Address",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Subscriber Address Line"),
b::Element(e::Situational, "Subscriber Address Line")),
b::Segment(300, s::N4, "Subscriber City, State, ZIP Code",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Subscriber City Name"),
b::Element(e::Situational, "Subscriber State Code"),
b::Element(e::Situational, "Subscriber Postal Zone or ZIP Code"),
b::Element(e::Situational, "Country Code"),
b::Element(e::NotUsed, "Location Qualifier"),
b::Element(e::NotUsed, "Location Identifier"),
b::Element(e::Situational, "Country Subdivision Code")),
b::Segment(320, s::DMG, "Subscriber Demographic Information",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
b::Element(e::Required, "Subscriber Birth Date"),
b::Element(e::Required, "Subscriber Gender Code", b::Values("F", "M", "U")),
b::Element(e::NotUsed, "Marital Status Code"),
b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
b::Element(e::NotUsed, "Citizenship Status Code"),
b::Element(e::NotUsed, "Country Code"),
b::Element(e::NotUsed, "Basis of Verification Code"),
b::Element(e::NotUsed, "Quantity"),
b::Element(e::NotUsed, "Code List Qualifier Code"),
b::Element(e::NotUsed, "Industry Code")),
b::Segment(350, s::REF, "Subscriber Secondary Identification",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Reference Identification Qualifier", b::Values("SY")),
b::Element(e::Required, "Subscriber Supplemental Identifier"),
b::Element(e::NotUsed, "Description"),
b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
b::Segment(350, s::REF, "Property and Casualty Claim Number",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Reference Identification Qualifier", b::Values("Y4")),
b::Element(e::Required, "Property Casualty Claim Number"),
b::Element(e::NotUsed, "Description"),
b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
d::LoopDef.build("2010BB PAYER NAME",
d::RepeatCount.bounded(1),
b::Segment(150, s::NM1, "Payer Name",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Entity Identifier Code", b::Values("PR")),
b::Element(e::Required, "Entity Type Qualifier", b::Values("2")),
b::Element(e::Required, "Payer 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("PI", "XV")),
b::Element(e::Required, "Payer Identifier"),
b::Element(e::NotUsed, "Entity Relationship Code"),
b::Element(e::NotUsed, "Entity Identifier Code"),
b::Element(e::NotUsed, "Name Last or Organization Name")),
b::Segment(250, s::N3, "Payer Address",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Payer Address Line"),
b::Element(e::Situational, "Payer Address Line")),
b::Segment(300, s::N4, "Payer City, State, ZIP Code",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Payer City Name"),
b::Element(e::Situational, "Payer State Code"),
b::Element(e::Situational, "Payer Postal Zone or ZIP Code"),
b::Element(e::Situational, "Country Code"),
b::Element(e::NotUsed, "Location Qualifier"),
b::Element(e::NotUsed, "Location Identifier"),
b::Element(e::Situational, "Country Subdivision Code")),
b::Segment(350, s::REF, "Payer Secondary Identification",
r::Situational, d::RepeatCount.bounded(3),
b::Element(e::Required, "Reference Identification Qualifier", b::Values("2U", "EI", "FY", "NF")),
b::Element(e::Required, "Payer Additional Identifier"),
b::Element(e::NotUsed, "Description"),
b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
b::Segment(350, s::REF, "Billing Provider Secondary Identification",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Reference Identification Qualifier", b::Values("G2", "LU")),
b::Element(e::Required, "Billing Provider Secondary Identifier"),
b::Element(e::NotUsed, "Description"),
b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
loop2300)),
d::TableDef.detail("Table 2 - Patient Detail",
d::LoopDef.build("2000C PATIENT HIERARCHICAL LEVEL",
d::RepeatCount.bounded(1),
b::Segment(10, s::HL, "Patient Hierachical 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("23")),
b::Element(e::Required, "Hierarchical Child Code", b::Values("0"))),
b::Segment(70, s::PAT, "Patient Information",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Individual Relationship Code", b::Values("01", "19", "20", "21", "39", "40", "53", "G8")),
b::Element(e::NotUsed, "Patient Location Code"),
b::Element(e::NotUsed, "Employment Status Code"),
b::Element(e::NotUsed, "Student Status Code"),
b::Element(e::NotUsed, "Date Time Period Format Qualifier"),
b::Element(e::NotUsed, "Date Time Period"),
b::Element(e::NotUsed, "Unit Basis for Measurement Code"),
b::Element(e::NotUsed, "Weight"),
b::Element(e::NotUsed, "Yes/No Condition or Response Code")),
d::LoopDef.build("2010CA PATIENT NAME",
d::RepeatCount.bounded(1),
b::Segment(150, 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 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::NotUsed, "Identification Code Qualifier"),
b::Element(e::NotUsed, "Identification Code"),
b::Element(e::NotUsed, "Entity Relationship Code"),
b::Element(e::NotUsed, "Entity Identifier Code"),
b::Element(e::NotUsed, "Name Last or Organization Name")),
b::Segment(250, s::N3, "Patient Address",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Patient Address Line"),
b::Element(e::Situational, "Patient Address Line")),
b::Segment(300, s::N4, "Patient City, State, ZIP Code",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Patient City Name"),
b::Element(e::Situational, "Patient State Code"),
b::Element(e::Situational, "Patient Postal Zone or ZIP Code"),
b::Element(e::Situational, "Country Code"),
b::Element(e::NotUsed, "Location Qualifier"),
b::Element(e::NotUsed, "Location Identifier"),
b::Element(e::Situational, "Country Subdivision Code")),
b::Segment(320, s::DMG, "Patient Demographic Information",
r::Required, d::RepeatCount.bounded(1),
b::Element(e::Required, "Date Time Period Format Qualifier", b::Values("D8")),
b::Element(e::Required, "Patient Birth Date"),
b::Element(e::Required, "Patient Gender Code", b::Values("F", "M", "U")),
b::Element(e::NotUsed, "Marital Status Code"),
b::Element(e::NotUsed, "COMPOSITE RACE OR ETHNICITY INFORMATION"),
b::Element(e::NotUsed, "Citizenship Status Code"),
b::Element(e::NotUsed, "Country Code"),
b::Element(e::NotUsed, "Basis of Verification Code"),
b::Element(e::NotUsed, "Quantity"),
b::Element(e::NotUsed, "Code List Qualifier Code"),
b::Element(e::NotUsed, "Industry Code")),
b::Segment(350, s::REF, "Property and Casualty Claim Number",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Reference Identifier Qualifier", b::Values("Y4")),
b::Element(e::Required, "Property Casualty Claim Number"),
b::Element(e::NotUsed, "Description"),
b::Element(e::NotUsed, "REFERENCE IDENTIFIER")),
b::Segment(350, s::REF, "Property and Casualty Patient Identifier",
r::Situational, d::RepeatCount.bounded(1),
b::Element(e::Required, "Reference Identification Qualifier", b::Values("1W", "SY")),
b::Element(e::Required, "Property and Casualty Patient Identifier"),
b::Element(e::NotUsed, "Description"),
b::Element(e::NotUsed, "REFERENCE IDENTIFIER"))),
loop2300)),
d::TableDef.summary("Table 3 - Summary",
b::Segment(5550, 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"))))