Multiple interchanges in one payload

Scenario

This file contains two complete interchanges: the single-benefit example followed by the Medicare Advantage example. Each has its own ISA/IEA, functional group, and transaction set.

Complete response

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ISA*00*          *00*          *ZZ*CEDARVALLEYHP  *ZZ*OAKSTMEDGROUP  *990101*1201*^*00501*000000101*0*P*:~
GS*HB*CEDARVALLEYHP*OAKSTMEDGROUP*20990101*1201*101*X*005010X279A1~
ST*271*0101*005010X279A1~
BHT*0022*11*ELIG1010001*20990101*1201~
HL*1**20*1~
NM1*PR*2*CEDAR VALLEY HEALTH PLAN~
HL*2*1*21*1~
NM1*1P*2*OAK STREET MEDICAL GROUP~
HL*3*2*22*0~
NM1*IL*1*REED*JORDAN~
EB*1**30**SILVER PPO~
SE*10*0101~
GE*1*101~
IEA*1*000000101~
ISA*00*          *00*          *ZZ*PINECRESTMAP   *ZZ*WILLOWCREEKMG  *990104*1204*^*00501*000000404*0*P*:~
GS*HB*PINECRESTMAP*WILLOWCREEKMG*20990101*1204*404*X*005010X279A1~
ST*271*0404*005010X279A1~
BHT*0022*11*ELIG4040001*20990101*1204~
HL*1**20*1~
NM1*PR*2*PINECREST ADVANTAGE PLAN~
HL*2*1*21*1~
NM1*1P*2*WILLOW CREEK MEDICAL GROUP~
HL*3*2*22*0~
NM1*IL*1*BROOKS*TAYLOR~
EB*1**30**MEDICARE ADVANTAGE PLAN~
DTP*291*D8*20990101~
MSG*MEDICARE ADVANTAGE COVERAGE REPORTED~
SE*12*0404~
GE*1*404~
IEA*1*000000404~

Segment breakdown

The entries below follow the source order. Empty fields are shown as(empty); fields not present in a source segment are not added. Stedi links identify public field references; the licensed X279A1 implementation guide supplies the complete transaction rules.

Interchange 1

• 1. ISA
• 2. GS
• 3. ST
• 4. BHT
• 5. HL
• 6. NM1
• 7. HL
• 8. NM1
• 9. HL
• 10. NM1
• 11. EB
• 12. SE
• 13. GE
• 14. IEA

1. ISA

   Raw segment: ISA*00* *00* *ZZ*CEDARVALLEYHP *ZZ*OAKSTMEDGROUP *990101*1201*^*00501*000000101*0*P*:~

   Opens an interchange and establishes its fixed control and delimiter positions. Its control number is 000000101.

   ISA fields

   Position	Raw value	Field name	Explanation
   ISA01	00	Authorization Information Qualifier	Identifies the format of the authorization information. The value 00 means no authorization information is present.
   ISA02	(blank: 10 spaces)	Authorization Information	Carries the authorization value; this example leaves the fixed-width value blank.
   ISA03	00	Security Information Qualifier	Identifies the format of the security information. The value 00 means no security information is present.
   ISA04	(blank: 10 spaces)	Security Information	Carries the security value; this example leaves the fixed-width value blank.
   ISA05	ZZ	Interchange ID Qualifier	Identifies the type of sender identifier. The value ZZ identifies a mutually defined sender identifier.
   ISA06	CEDARVALLEYHP	Interchange Sender ID	Identifies the sender of this interchange.
   ISA07	ZZ	Interchange ID Qualifier	Identifies the type of receiver identifier. The value ZZ identifies a mutually defined receiver identifier.
   ISA08	OAKSTMEDGROUP	Interchange Receiver ID	Identifies the receiver of this interchange.
   ISA09	990101	Interchange Date	Records the interchange date in YYMMDD format.
   ISA10	1201	Interchange Time	Records the interchange time in HHMM format.
   ISA11	^	Repetition Separator	Separates repeated composite values in this interchange.
   ISA12	00501	Interchange Control Version Number	Identifies the interchange control version, 00501 here.
   ISA13	000000101	Interchange Control Number	Identifies this interchange and must match IEA02.
   ISA14	0	Acknowledgment Requested	Indicates whether an interchange acknowledgment is requested. The value 0 means no interchange acknowledgment is requested.
   ISA15	P	Interchange Usage Indicator	Indicates whether the interchange is for test, production, or information data. The value P is the code for production data.
   ISA16	:	Component Element Separator	Separates component values within a composite element.

   Field reference: Stedi ISA segment reference.

2. GS

   Raw segment: GS*HB*CEDARVALLEYHP*OAKSTMEDGROUP*20990101*1201*101*X*005010X279A1~

   Opens a functional group inside the interchange. Its group control number is 101.

   GS fields

   Position	Raw value	Field name	Explanation
   GS01	HB	Functional Identifier Code	Identifies a group of application-related transaction sets. The value HB means Eligibility, Coverage or Benefit Information.
   GS02	CEDARVALLEYHP	Application Sender's Code	Identifies the party sending the transmission.
   GS03	OAKSTMEDGROUP	Application Receiver's Code	Identifies the party receiving the transmission.
   GS04	20990101	Date	Records the functional group date.
   GS05	1201	Time	Records the functional group time.
   GS06	101	Group Control Number	Identifies this group and must match GE02.
   GS07	X	Responsible Agency Code	Identifies the agency responsible for the implementation convention. The value X identifies the responsible agency as X12.
   GS08	005010X279A1	Version / Release / Industry Identifier Code	Identifies the implementation convention used by the group.

   Field reference: Stedi GS segment reference.

3. ST

   Raw segment: ST*271*0101*005010X279A1~

   Opens a transaction set inside the functional group. This transaction is 271 with control number 0101.

   ST fields

   Position	Raw value	Field name	Explanation
   ST01	271	Transaction Set Identifier Code	Identifies this response as transaction set 271. The value 271 identifies an eligibility, coverage, or benefit response.
   ST02	0101	Transaction Set Control Number	Identifies this transaction and must match SE02.
   ST03	005010X279A1	Implementation Convention Reference	Identifies the implementation convention used by the transaction.

   Field reference: Stedi ST segment reference.

4. BHT

   Raw segment: BHT*0022*11*ELIG1010001*20990101*1201~

   Supplies beginning-of-hierarchical-transaction context.

   BHT fields

   Position	Raw value	Field name	Explanation
   BHT01	0022	Hierarchical Structure Code	Identifies the hierarchical structure used by the transaction. The value 0022 means Information Source, Information Receiver, Subscriber, Dependent.
   BHT02	11	Transaction Set Purpose Code	States the purpose of this transaction set. The value 11 means Response.
   BHT03	ELIG1010001	Reference Identification	Provides the transaction reference used in this response.
   BHT04	20990101	Date	Records the date the transaction was created in the business application.
   BHT05	1201	Time	Records the time the transaction was created in the business application.

   Field reference: Stedi BHT segment reference.

5. HL

   Raw segment: HL*1**20*1~

   Establishes one hierarchical level and its optional parent relationship. This level is 1 at the top of the hierarchy.

   HL fields

   Position	Raw value	Field name	Explanation
   HL01	1	Hierarchical ID Number	Identifies this hierarchy level.
   HL02	(empty)	Hierarchical Parent ID Number	Identifies the parent level; an empty value marks the top level.
   HL03	20	Hierarchical Level Code	Identifies the kind of entity represented by this level. The value 20 identifies an information-source hierarchy level.
   HL04	1	Hierarchical Child Code	Indicates whether this level has subordinate levels. The value 1 indicates that this level has child levels.

   Field reference: Stedi HL segment reference.

6. NM1

   Raw segment: NM1*PR*2*CEDAR VALLEY HEALTH PLAN~

   Identifies the party attached to the current hierarchy level.

   NM1 fields

   Position	Raw value	Field name	Explanation
   NM101	PR	Entity Identifier Code	Identifies the party role represented by this name loop. The value PR identifies the payer party.
   NM102	2	Entity Type Qualifier	Identifies whether the party is an individual or organization. The value 2 identifies an organization.
   NM103	CEDAR VALLEY HEALTH PLAN	Name Last or Organization Name	Supplies the party name used in this response.

   Field reference: Stedi NM1 segment reference.

7. HL

   Raw segment: HL*2*1*21*1~

   Establishes one hierarchical level and its optional parent relationship. This level is 2 under parent 1.

   HL fields

   Position	Raw value	Field name	Explanation
   HL01	2	Hierarchical ID Number	Identifies this hierarchy level.
   HL02	1	Hierarchical Parent ID Number	Identifies the parent level; an empty value marks the top level.
   HL03	21	Hierarchical Level Code	Identifies the kind of entity represented by this level. The value 21 identifies an information-receiver hierarchy level.
   HL04	1	Hierarchical Child Code	Indicates whether this level has subordinate levels. The value 1 indicates that this level has child levels.

   Field reference: Stedi HL segment reference.

8. NM1

   Raw segment: NM1*1P*2*OAK STREET MEDICAL GROUP~

   Identifies the party attached to the current hierarchy level.

   NM1 fields

   Position	Raw value	Field name	Explanation
   NM101	1P	Entity Identifier Code	Identifies the party role represented by this name loop. The value 1P identifies the provider party.
   NM102	2	Entity Type Qualifier	Identifies whether the party is an individual or organization. The value 2 identifies an organization.
   NM103	OAK STREET MEDICAL GROUP	Name Last or Organization Name	Supplies the party name used in this response.

   Field reference: Stedi NM1 segment reference.

9. HL

   Raw segment: HL*3*2*22*0~

   Establishes one hierarchical level and its optional parent relationship. This level is 3 under parent 2.

   HL fields

   Position	Raw value	Field name	Explanation
   HL01	3	Hierarchical ID Number	Identifies this hierarchy level.
   HL02	2	Hierarchical Parent ID Number	Identifies the parent level; an empty value marks the top level.
   HL03	22	Hierarchical Level Code	Identifies the kind of entity represented by this level. The value 22 identifies a subscriber hierarchy level.
   HL04	0	Hierarchical Child Code	Indicates whether this level has subordinate levels. The value 0 indicates that this level has no child levels.

   Field reference: Stedi HL segment reference.

10. NM1

    Raw segment: NM1*IL*1*REED*JORDAN~

    Identifies the party attached to the current hierarchy level.

    NM1 fields

    Position	Raw value	Field name	Explanation
    NM101	IL	Entity Identifier Code	Identifies the party role represented by this name loop. The value IL identifies the insured or subscriber party.
    NM102	1	Entity Type Qualifier	Identifies whether the party is an individual or organization. The value 1 identifies an individual person.
    NM103	REED	Name Last or Organization Name	Supplies the party name used in this response.
    NM104	JORDAN	Name First	Supplies the person’s first name when present.

    Field reference: Stedi NM1 segment reference.

11. EB

    Raw segment: EB*1**30**SILVER PPO~

    Reports one qualified eligibility or benefit statement in the current subscriber context. Its status is 1 and its service type is 30.

    EB fields

    Position	Raw value	Field name	Explanation
    EB01	1	Eligibility or Benefit Information Code	States the eligibility or benefit status represented by this statement. The value 1 means Active Coverage.
    EB02	(empty)	Coverage Level Code	Identifies the coverage level when supplied.
    EB03	30	Service Type Code	Identifies the service type covered by this statement. The value 30 identifies health benefit plan coverage as the service type.
    EB04	(empty)	Insurance Type Code	Identifies the insurance type when supplied.
    EB05	SILVER PPO	Plan Coverage Description	Provides the plan or coverage description used in this response.

    Field reference: Stedi EB segment reference.

12. SE

    Raw segment: SE*10*0101~

    Closes a transaction set and declares its segment count. It closes transaction 0101.

    SE fields

    Position	Raw value	Field name	Explanation
    SE01	10	Number of Included Segments	Counts segments from ST through SE.
    SE02	0101	Transaction Set Control Number	Matches ST02 for this transaction.

    Field reference: Stedi SE segment reference.

13. GE

    Raw segment: GE*1*101~

    Closes a functional group and declares its transaction count. It closes group 101.

    GE fields

    Position	Raw value	Field name	Explanation
    GE01	1	Number of Transaction Sets Included	Counts transaction sets in this functional group.
    GE02	101	Group Control Number	Matches GS06 for this functional group.

    Field reference: Stedi GE segment reference.

14. IEA

    Raw segment: IEA*1*000000101~

    Closes an interchange and declares its group count. It closes the interchange with control number 000000101.

    IEA fields

    Position	Raw value	Field name	Explanation
    IEA01	1	Number of Included Functional Groups	Counts functional groups in this interchange.
    IEA02	000000101	Interchange Control Number	Matches ISA13 for this interchange.

    Field reference: Stedi IEA segment reference.

Interchange 2

• 1. ISA
• 2. GS
• 3. ST
• 4. BHT
• 5. HL
• 6. NM1
• 7. HL
• 8. NM1
• 9. HL
• 10. NM1
• 11. EB
• 12. DTP
• 13. MSG
• 14. SE
• 15. GE
• 16. IEA

1. ISA

   Raw segment: ISA*00* *00* *ZZ*PINECRESTMAP *ZZ*WILLOWCREEKMG *990104*1204*^*00501*000000404*0*P*:~

   Opens an interchange and establishes its fixed control and delimiter positions. Its control number is 000000404.

   ISA fields

   Position	Raw value	Field name	Explanation
   ISA01	00	Authorization Information Qualifier	Identifies the format of the authorization information. The value 00 means no authorization information is present.
   ISA02	(blank: 10 spaces)	Authorization Information	Carries the authorization value; this example leaves the fixed-width value blank.
   ISA03	00	Security Information Qualifier	Identifies the format of the security information. The value 00 means no security information is present.
   ISA04	(blank: 10 spaces)	Security Information	Carries the security value; this example leaves the fixed-width value blank.
   ISA05	ZZ	Interchange ID Qualifier	Identifies the type of sender identifier. The value ZZ identifies a mutually defined sender identifier.
   ISA06	PINECRESTMAP	Interchange Sender ID	Identifies the sender of this interchange.
   ISA07	ZZ	Interchange ID Qualifier	Identifies the type of receiver identifier. The value ZZ identifies a mutually defined receiver identifier.
   ISA08	WILLOWCREEKMG	Interchange Receiver ID	Identifies the receiver of this interchange.
   ISA09	990104	Interchange Date	Records the interchange date in YYMMDD format.
   ISA10	1204	Interchange Time	Records the interchange time in HHMM format.
   ISA11	^	Repetition Separator	Separates repeated composite values in this interchange.
   ISA12	00501	Interchange Control Version Number	Identifies the interchange control version, 00501 here.
   ISA13	000000404	Interchange Control Number	Identifies this interchange and must match IEA02.
   ISA14	0	Acknowledgment Requested	Indicates whether an interchange acknowledgment is requested. The value 0 means no interchange acknowledgment is requested.
   ISA15	P	Interchange Usage Indicator	Indicates whether the interchange is for test, production, or information data. The value P is the code for production data.
   ISA16	:	Component Element Separator	Separates component values within a composite element.

   Field reference: Stedi ISA segment reference.

2. GS

   Raw segment: GS*HB*PINECRESTMAP*WILLOWCREEKMG*20990101*1204*404*X*005010X279A1~

   Opens a functional group inside the interchange. Its group control number is 404.

   GS fields

   Position	Raw value	Field name	Explanation
   GS01	HB	Functional Identifier Code	Identifies a group of application-related transaction sets. The value HB means Eligibility, Coverage or Benefit Information.
   GS02	PINECRESTMAP	Application Sender's Code	Identifies the party sending the transmission.
   GS03	WILLOWCREEKMG	Application Receiver's Code	Identifies the party receiving the transmission.
   GS04	20990101	Date	Records the functional group date.
   GS05	1204	Time	Records the functional group time.
   GS06	404	Group Control Number	Identifies this group and must match GE02.
   GS07	X	Responsible Agency Code	Identifies the agency responsible for the implementation convention. The value X identifies the responsible agency as X12.
   GS08	005010X279A1	Version / Release / Industry Identifier Code	Identifies the implementation convention used by the group.

   Field reference: Stedi GS segment reference.

3. ST

   Raw segment: ST*271*0404*005010X279A1~

   Opens a transaction set inside the functional group. This transaction is 271 with control number 0404.

   ST fields

   Position	Raw value	Field name	Explanation
   ST01	271	Transaction Set Identifier Code	Identifies this response as transaction set 271. The value 271 identifies an eligibility, coverage, or benefit response.
   ST02	0404	Transaction Set Control Number	Identifies this transaction and must match SE02.
   ST03	005010X279A1	Implementation Convention Reference	Identifies the implementation convention used by the transaction.

   Field reference: Stedi ST segment reference.

4. BHT

   Raw segment: BHT*0022*11*ELIG4040001*20990101*1204~

   Supplies beginning-of-hierarchical-transaction context.

   BHT fields

   Position	Raw value	Field name	Explanation
   BHT01	0022	Hierarchical Structure Code	Identifies the hierarchical structure used by the transaction. The value 0022 means Information Source, Information Receiver, Subscriber, Dependent.
   BHT02	11	Transaction Set Purpose Code	States the purpose of this transaction set. The value 11 means Response.
   BHT03	ELIG4040001	Reference Identification	Provides the transaction reference used in this response.
   BHT04	20990101	Date	Records the date the transaction was created in the business application.
   BHT05	1204	Time	Records the time the transaction was created in the business application.

   Field reference: Stedi BHT segment reference.

5. HL

   Raw segment: HL*1**20*1~

   Establishes one hierarchical level and its optional parent relationship. This level is 1 at the top of the hierarchy.

   HL fields

   Position	Raw value	Field name	Explanation
   HL01	1	Hierarchical ID Number	Identifies this hierarchy level.
   HL02	(empty)	Hierarchical Parent ID Number	Identifies the parent level; an empty value marks the top level.
   HL03	20	Hierarchical Level Code	Identifies the kind of entity represented by this level. The value 20 identifies an information-source hierarchy level.
   HL04	1	Hierarchical Child Code	Indicates whether this level has subordinate levels. The value 1 indicates that this level has child levels.

   Field reference: Stedi HL segment reference.

6. NM1

   Raw segment: NM1*PR*2*PINECREST ADVANTAGE PLAN~

   Identifies the party attached to the current hierarchy level.

   NM1 fields

   Position	Raw value	Field name	Explanation
   NM101	PR	Entity Identifier Code	Identifies the party role represented by this name loop. The value PR identifies the payer party.
   NM102	2	Entity Type Qualifier	Identifies whether the party is an individual or organization. The value 2 identifies an organization.
   NM103	PINECREST ADVANTAGE PLAN	Name Last or Organization Name	Supplies the party name used in this response.

   Field reference: Stedi NM1 segment reference.

7. HL

   Raw segment: HL*2*1*21*1~

   Establishes one hierarchical level and its optional parent relationship. This level is 2 under parent 1.

   HL fields

   Position	Raw value	Field name	Explanation
   HL01	2	Hierarchical ID Number	Identifies this hierarchy level.
   HL02	1	Hierarchical Parent ID Number	Identifies the parent level; an empty value marks the top level.
   HL03	21	Hierarchical Level Code	Identifies the kind of entity represented by this level. The value 21 identifies an information-receiver hierarchy level.
   HL04	1	Hierarchical Child Code	Indicates whether this level has subordinate levels. The value 1 indicates that this level has child levels.

   Field reference: Stedi HL segment reference.

8. NM1

   Raw segment: NM1*1P*2*WILLOW CREEK MEDICAL GROUP~

   Identifies the party attached to the current hierarchy level.

   NM1 fields

   Position	Raw value	Field name	Explanation
   NM101	1P	Entity Identifier Code	Identifies the party role represented by this name loop. The value 1P identifies the provider party.
   NM102	2	Entity Type Qualifier	Identifies whether the party is an individual or organization. The value 2 identifies an organization.
   NM103	WILLOW CREEK MEDICAL GROUP	Name Last or Organization Name	Supplies the party name used in this response.

   Field reference: Stedi NM1 segment reference.

9. HL

   Raw segment: HL*3*2*22*0~

   Establishes one hierarchical level and its optional parent relationship. This level is 3 under parent 2.

   HL fields

   Position	Raw value	Field name	Explanation
   HL01	3	Hierarchical ID Number	Identifies this hierarchy level.
   HL02	2	Hierarchical Parent ID Number	Identifies the parent level; an empty value marks the top level.
   HL03	22	Hierarchical Level Code	Identifies the kind of entity represented by this level. The value 22 identifies a subscriber hierarchy level.
   HL04	0	Hierarchical Child Code	Indicates whether this level has subordinate levels. The value 0 indicates that this level has no child levels.

   Field reference: Stedi HL segment reference.

10. NM1

    Raw segment: NM1*IL*1*BROOKS*TAYLOR~

    Identifies the party attached to the current hierarchy level.

    NM1 fields

    Position	Raw value	Field name	Explanation
    NM101	IL	Entity Identifier Code	Identifies the party role represented by this name loop. The value IL identifies the insured or subscriber party.
    NM102	1	Entity Type Qualifier	Identifies whether the party is an individual or organization. The value 1 identifies an individual person.
    NM103	BROOKS	Name Last or Organization Name	Supplies the party name used in this response.
    NM104	TAYLOR	Name First	Supplies the person’s first name when present.

    Field reference: Stedi NM1 segment reference.

11. EB

    Raw segment: EB*1**30**MEDICARE ADVANTAGE PLAN~

    Reports one qualified eligibility or benefit statement in the current subscriber context. Its status is 1 and its service type is 30.

    EB fields

    Position	Raw value	Field name	Explanation
    EB01	1	Eligibility or Benefit Information Code	States the eligibility or benefit status represented by this statement. The value 1 means Active Coverage.
    EB02	(empty)	Coverage Level Code	Identifies the coverage level when supplied.
    EB03	30	Service Type Code	Identifies the service type covered by this statement. The value 30 identifies health benefit plan coverage as the service type.
    EB04	(empty)	Insurance Type Code	Identifies the insurance type when supplied.
    EB05	MEDICARE ADVANTAGE PLAN	Plan Coverage Description	Provides the plan or coverage description used in this response.

    Field reference: Stedi EB segment reference.

12. DTP

    Raw segment: DTP*291*D8*20990101~

    Supplies a date or date period related to the current benefit context.

    DTP fields

    Position	Raw value	Field name	Explanation
    DTP01	291	Date/Time Qualifier	Identifies what the date represents. The value 291 means Plan (date/range for which plan is in effect).
    DTP02	D8	Date Time Period Format Qualifier	Identifies the format of the date value. The value D8 identifies a single date in CCYYMMDD format.
    DTP03	20990101	Date Time Period	Supplies the date or date period.

    Field reference: Stedi DTP segment reference.

13. MSG

    Raw segment: MSG*MEDICARE ADVANTAGE COVERAGE REPORTED~

    Carries explanatory text associated with the surrounding response context.

    MSG fields

    Position	Raw value	Field name	Explanation
    MSG01	MEDICARE ADVANTAGE COVERAGE REPORTED	Free-Form Message Text	Provides the explanatory text carried by this response.

    Field reference: Stedi MSG segment reference.

14. SE

    Raw segment: SE*12*0404~

    Closes a transaction set and declares its segment count. It closes transaction 0404.

    SE fields

    Position	Raw value	Field name	Explanation
    SE01	12	Number of Included Segments	Counts segments from ST through SE.
    SE02	0404	Transaction Set Control Number	Matches ST02 for this transaction.

    Field reference: Stedi SE segment reference.

15. GE

    Raw segment: GE*1*404~

    Closes a functional group and declares its transaction count. It closes group 404.

    GE fields

    Position	Raw value	Field name	Explanation
    GE01	1	Number of Transaction Sets Included	Counts transaction sets in this functional group.
    GE02	404	Group Control Number	Matches GS06 for this functional group.

    Field reference: Stedi GE segment reference.

16. IEA

    Raw segment: IEA*1*000000404~

    Closes an interchange and declares its group count. It closes the interchange with control number 000000404.

    IEA fields

    Position	Raw value	Field name	Explanation
    IEA01	1	Number of Included Functional Groups	Counts functional groups in this interchange.
    IEA02	000000404	Interchange Control Number	Matches ISA13 for this interchange.

    Field reference: Stedi IEA segment reference.

Sources

• X12-RFI-1585 supports multiple interchanges in one physical file.
• X12-EXAMPLES-005010X279 supports the public 271 interchange and hierarchy pattern.
• STEDI-ISA, STEDI-IEA, STEDI-GS, STEDI-GE, STEDI-ST, STEDI-SE, and STEDI-EB provide public field cross-references.