1+ let Rule5010270 = "FILE DATA\n" +
2+ "Version=005010X279A1\n" +
3+ "Description=270 Eligibility, Coverage or Benefit Inquiry\n" +
4+ "ELEMENT DEFINITIONS\n" +
5+ "19=AN,2,30,City Name\n" +
6+ "26=ID,2,3,Country Code\n" +
7+ "28=NO,1,9,Group Control Number\n" +
8+ "66=ID,1,2,Identification Code Qualifier\n" +
9+ "67=AN,2,80,Identification Code\n" +
10+ "93=AN,1,60,Name\n" +
11+ "96=NO,1,10,Number of Included Segments\n" +
12+ "97=NO,1,6,Number of Transaction Sets Included\n" +
13+ "98=ID,2,3,Entity Identifier Code\n" +
14+ "101=ID,2,2,Authorization Information Qualifier\n" +
15+ "102=AN,10,10,Authorization Information\n" +
16+ "103=ID,2,2,Security Information Qualifier\n" +
17+ "104=AN,10,10,Security Information\n" +
18+ "105=ID,2,2,Interchange ID Qualifier\n" +
19+ "106=AN,15,15,Interchange Sender ID\n" +
20+ "107=AN,15,15,Interchange Receiver ID\n" +
21+ "108=DT,6,6,Interchange Date\n" +
22+ "109=TM,4,4,Interchange Time\n" +
23+ "110=ID,1,1\n" +
24+ "111=ID,5,5,Interchange Control Version Number\n" +
25+ "112=NO,9,9,Interchange Control Number\n" +
26+ "113=ID,1,1,Acknowledgment Requested\n" +
27+ "114=ID,1,1,Interchange Usage Indicator\n" +
28+ "115=ID,1,1,Component Element Separator\n" +
29+ "116=ID,3,15,Postal Code\n" +
30+ "124=AN,2,15,Application Receiver Code\n" +
31+ "127=AN,1,50,Reference Identification\n" +
32+ "128=ID,2,3,Reference Identification Qualifier\n" +
33+ "142=AN,2,15,Application Sender Code\n" +
34+ "143=ID,3,3,Transaction Set Identifier Code\n" +
35+ "156=ID,2,2,State or Province Code\n" +
36+ "165=ID,1,1,Repetition Separator\n" +
37+ "166=AN,1,55,Address Information\n" +
38+ "234=AN,1,48,Product/Service ID\n" +
39+ "235=ID,2,2,Product/Service ID Qualifier\n" +
40+ "309=ID,1,2,Location Qualifier\n" +
41+ "310=AN,1,30,Location Identifier\n" +
42+ "329=AN,4,9,Transaction Set Control Number\n" +
43+ "337=TM,4,8,Time\n" +
44+ "352=AN,1,80,Description\n" +
45+ "353=ID,2,2,Transaction Set Purpose Code\n" +
46+ "364=AN,1,80,Communication Number\n" +
47+ "365=ID,2,2,Communication Number Qualifier\n" +
48+ "366=ID,2,2,Contact Function Code\n" +
49+ "373=DT,8,8,Date\n" +
50+ "374=ID,3,3,Date/Time Qualifier\n" +
51+ "380=R,1,15,Quantity\n" +
52+ "455=ID,1,2,Responsible Agency Code\n" +
53+ "478=ID,1,1,Credit/Debit Flag Code\n" +
54+ "479=ID,2,2,Functional Identifier Code\n" +
55+ "480=AN,1,12,Version / Release / Industry Identifier Code\n" +
56+ "481=ID,1,2,Trace Type Code\n" +
57+ "509=AN,10,10,Originating Company Identifier\n" +
58+ "522=ID,1,3,Amount Qualifier Code\n" +
59+ "584=ID,2,2,Employment Status Code\n" +
60+ "615=ID,1,2,Time Period Qualifier\n" +
61+ "628=AN,1,12,Hierarchical ID Number\n" +
62+ "640=ID,2,2,Transaction Type Code\n" +
63+ "659=ID,1,2,Basis of Verification Code\n" +
64+ "673=ID,2,2,Quantity Qualifier\n" +
65+ "734=AN,1,12,Hierarchical Parent ID Number\n" +
66+ "735=ID,1,12,Hierarchical Level Code\n" +
67+ "736=ID,1,1,Hierarchical Child Code\n" +
68+ "782=R,1,18,Monetary Amount\n" +
69+ "799=AN,1,30,Version Identifier\n" +
70+ "875=ID,3,3,Maintenance Type Code\n" +
71+ "933=AN,1,264,Free-form Message Text\n" +
72+ "934=ID,2,2,Printer Carriage Control Code\n" +
73+ "954=R,1,10,Percent\n" +
74+ "1005=ID,4,4,Hierarchical Structure Code\n" +
75+ "1035=AN,1,60,Name Last or Organization Name\n" +
76+ "1036=AN,1,25,Name First\n" +
77+ "1037=AN,1,25,Name Middle\n" +
78+ "1038=AN,1,10,Name Prefix\n" +
79+ "1039=AN,1,10,Name Suffix\n" +
80+ "1065=ID,1,1,Entity Type Qualifier\n" +
81+ "1066=ID,1,2,Citizenship Status Code\n" +
82+ "1067=ID,1,1,Marital Status Code\n" +
83+ "1068=ID,1,1,Gender Code\n" +
84+ "1069=ID,2,2,Individual Relationship Code\n" +
85+ "1073=ID,1,1,Yes/No Condition or Response Code\n" +
86+ "1109=ID,1,1\n" +
87+ "1136=ID,2,2,Code Category\n" +
88+ "1165=ID,1,1,Confidentiality Code\n" +
89+ "1203=ID,2,3,Maintenance Reason Code\n" +
90+ "1204=AN,1,50,Plan Coverage Description\n" +
91+ "1207=ID,3,3,Coverage Level Code\n" +
92+ "1216=ID,1,1,Benefit Status Code\n" +
93+ "1218=ID,1,1\n" +
94+ "1219=AN,1,2,COBRA\n" +
95+ "1220=ID,1,1,Student Status Code\n" +
96+ "1221=AN,1,3,Provider Code\n" +
97+ "1250=ID,2,3,DateTime Period Format Qualifier\n" +
98+ "1251=AN,1,35,Date Time Period\n" +
99+ "1270=ID,2,3,Code List Qual Code\n" +
100+ "1271=AN,1,30,Industry Code\n" +
101+ "1328=NO,1,2,Diagnosis Code Pointer\n" +
102+ "1336=ID,1,3,Insurance Type Code\n" +
103+ "1339=AN,2,2,Procedure Modifier\n" +
104+ "1365=ID,1,2,Service Type Code\n" +
105+ "1470=NO,1,9,Number\n" +
106+ "1705=AN,1,35,Implementation Convention Reference\n" +
107+ "1715=ID,1,3,Country Subdivision Code\n" +
108+ "11111112=NO,1,9,Interchange Control Number\n" +
109+ "11111116=NO,1,5,Number of Included Functional Groups\n" +
110+ "COMPOSITE ELEMENT DEFINITIONS\n" +
111+ "C003=[235,O][234,O][1339,O][1339,O][1339,O][1339,O][352,O],@@....#\n" +
112+ "C004=[1328,O][1328,O][1328,O][1328,O],@...\n" +
113+ "C022=[1270,O][1271,O][1250,O][1251,O][782,O][380,O][799,O][1271,O][1073,O],@@#######\n" +
114+ "SEGMENT DEFINITIONS\n" +
115+ "AMT=[522][782][478],@@#\n" +
116+ "BHT=[1005,M][353,M][127][373,M][337,M][640]\n" +
117+ "DMG=[1250][1251][1068][1067][1109][1066][26][659][380]+P0102,...######\n" +
118+ "DTP=[374,M][1250,M][1251,M]\n" +
119+ "EQ=[1365][C003][1207][1336][C004]+R0102,..*1.#.*1,..*1##.*1\n" +
120+ "GE=[97,M][28,M]\n" +
121+ "GS=[479,M][142,M][124,M][373,M][337,M][28,M][455,M][480,M]\n" +
122+ "HI=[C022][C022][C022][C022][C022][C022][C022][C022][C022][C022][C022][C022],@*1.*1.*1.*1.*1.*1.*1.*1#*1#*1#*1#*1\n" +
123+ "HL=[628][734][735][736],@#@@,@@@@\n" +
124+ "IEA=[11111116,M][11111112,M]\n" +
125+ "III=[1270,M][1271,M]\n" +
126+ "INS=[1073][1069][875][1203][1216][1218][1219][584][1220][1073][1250][1251][1165][19][156][26][1470],@@##############@,@@##############.\n" +
127+ "ISA=[101,M][102,M][103,M][104,M][105,M][106,M][105,M][107,M][108,M][109,M][165,M][111,M][112,M][113,M][114,M][115,M]\n" +
128+ "MSG=[933][934][1470],@##\n" +
129+ "N3=[166,M][166]\n" +
130+ "N4=[19][156][116][26][309][310][1715],@...##.,....##.,@...##.\n" +
131+ "NM1=[98,M][1065,M][1035][1036][1037][1038][1039][66][67]+P0809,@@...#.@@,@@...#...,@@...#.##,@@@..#.@@\n" +
132+ "PER=[366][93][365][364][365][364][365][364]+P0304P0506P0708,@.......\n" +
133+ "PRV=[1221][128][127],@..\n" +
134+ "REF=[128,M][127,M][352],@@#\n" +
135+ "SE=[96,M][329,M]\n" +
136+ "ST=[143,M][329,M][1705,M]\n" +
137+ "TRN=[481,M][127,M][509,M][127]\n" +
138+ "SEGMENT SELF RULES\n" +
139+ "NM1~2~[EQ]1~4~0\n" +
140+ "NM1~2~[EQ]2~2~4,5\n" +
141+ "COMPOSITE ELEMENT SELF RULES\n" +
142+ "CODELISTS\n" +
143+ "FORMATS\n" +
144+ "Date CCYYMMDD=^(((\\d{4}((0[13578]|1[02])(0[1-9]|[12]\\d|3[01])|(0[13456789]|1[012])(0[1-9]|[12]\\d|30)|02(0[1-9]|1\\d|2[0-8])))|((\\d{2}[02468][048]|\\d{2}[13579][26]))0229)){0,8}$\n" +
145+ "EDI FILE STRUCTURE\n" +
146+ "{INTERCHANGE HEADER:1[ISA,M]{FUNCTIONAL GROUP:1[GS,M]{ST HEADER:>1[ST,M][BHT,M]{2000A:>1[HL*1,M]{2100A:1[NM1*4,M]}{2000B:>1[HL*2,M]{2100B:1[NM1*4,M][REF,O,9][N3][N4*1][PRV*1]}{2000C:>1[HL*2,M][TRN,O,2]{2100C:1[NM1*2,M][REF*1,O,9][N3][N4*1][PRV*1][DMG*1][INS*1][HI*1][DTP,O,2]{2110C:99[EQ*1][AMT*1][AMT*1][III][REF*1][DTP]}{2000D:>1[HL*2,X][TRN,O,2]{2100D:1[NM1*3,M][REF*1,O,9][N3][N4*3][PRV*1][DMG*1][INS*2][HI*1][DTP,O,2]{2110D:99[EQ*2,M][III][REF*1][DTP]}}}}}}}{END ST HEADER LOOP:1[SE,M]}}{END GS LOOP:1[GE,M]}}{END ISA LOOP:1[IEA,M]}}\n" +
147+ "ELEMENT CODES\n" +
148+ "101=1:1,00,03\n" +
149+ "103=1:3,00,01\n" +
150+ "105=1:5,01,14,20,27,28,29,30,33,ZZ*1:7,01,14,20,27,28,29,30,33,ZZ\n" +
151+ "111=1:12,00501\n" +
152+ "113=1:14,0,1\n" +
153+ "114=1:15,P,T\n" +
154+ "479=2:1,HS\n" +
155+ "455=2:7,X\n" +
156+ "480=2:8,005010X279A1\n" +
157+ "143=3:1,270\n" +
158+ "1705=3:3,005010X279A1\n" +
159+ "1005=4:1,0022\n" +
160+ "353=4:2,01,13\n" +
161+ "640=4:6,RT\n" +
162+ "735=5:3,20*7:3,21*13:3,22*30:3,23\n" +
163+ "736=5:4,1*7:4,1*13:4,0,1*30:4,0\n" +
164+ "98=6:1,2B,36,GP,P5,PR*8:1,1P,2B,36,80,FA,GP,P5,PR*15:1,IL*32:1,03\n" +
165+ "1065=6:2,1,2*8:2,1,2*15:2,1,2*32:2,1\n" +
166+ "66=6:8,24,46,FI,NI,PI,XV,XX*8:8,24,34,FI,PI,PP,SV,XV,XX*15:8,II,MI\n" +
167+ "128=9:1,0B,1C,1D,1J,4A,CT,EL,EO,HPI,JD,N5,N7,Q4,SY,TJ*12:2,PXC*16:1,18,1L,1W,3H,6P,CT,EA,EJ,F6,GH,HJ,IG,N6,NQ,SY,Y4*19:2,9K,D3,EI,HPI,PXC,SY,TJ*28:1,9F,G1*33:1,18,1L,1W,6P,CT,EA,EJ,F6,GH,HJ,IF,IG,MRC,N6,SY,Y4*36:2,9K,D3,EI,HPI,PXC,SY,TJ*43:1,9F,G1\n" +
168+ "1221=12:1,AD,AT,BI,CO,CV,H,HH,LA,OT,P1,P2,PC,PE,R,RF,SB,SK,SU*19:1,AD,AT,BI,CO,CV,H,HH,LA,OT,P1,P2,PC,PE,R,RF,SK,SU*36:1,AD,AT,BI,CO,CV,H,HH,LA,OT,P1,P2,PC,PE,R,RF,SK,SU\n" +
169+ "481=14:1,1*31:1,1\n" +
170+ "1250=20:1,D8*23:2,D8,RD8*29:2,D8,RD8*37:1,D8*40:2,D8,RD8*44:2,D8,RD8\n" +
171+ "1068=20:3,F,M*37:3,F,M\n" +
172+ "1073=21:1,Y*38:1,N\n" +
173+ "1069=21:2,18*38:2,01,19,34\n" +
174+ "1270=22:1:1,ABK,BK*22:2:1,ABF,BF*22:3:1,ABF,BF*22:4:1,ABF,BF*22:5:1,ABF,BF*22:6:1,ABF,BF*22:7:1,ABF,BF*22:8:1,ABF,BF*27:1,ZZ*39:1:1,ABK,BK*39:2:1,ABF,BF*39:3:1,ABF,BF*39:4:1,ABF,BF*39:5:1,ABF,BF*39:6:1,ABF,BF*39:7:1,ABF,BF*39:8:1,ABF,BF*42:1,BF,BK,ZZ\n" +
175+ "374=23:1,102,291*29:1,291*40:1,102,291*44:1,291\n" +
176+ "1365=24:1,1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,30,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,A0,A1,A2,A3,A4,A5,A6,A7,A8,A9,AA,AB,AC,AD,AE,AF,AG,AH,AI,AJ,AK,AL,AM,AN,AO,AQ,AR,B1,B2,B3,BA,BB,BC,BD,BE,BF,BG,BH,BI,BJ,BK,BL,BM,BN,BP,BQ,BR,BS,BT,BU,BV,BW,BX,BY,BZ,C1,CA,CB,CC,CD,CE,CF,CG,CH,CI,CJ,CK,CL,CM,CN,CO,CP,CQ,DG,DM,DS,GF,GN,GY,IC,MH,NI,ON,PT,PU,RN,RT,TC,TN,UC*41:1,1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,30,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,A0,A1,A2,A3,A4,A5,A6,A7,A8,A9,AA,AB,AC,AD,AE,AF,AG,AH,AI,AJ,AK,AL,AM,AN,AO,AQ,AR,BA,BB,BC,BD,BE,BF,BG,BH,BI,BJ,BK,BL,BM,BN,BP,BQ,BR,BS\n" +
177+ "235=24:2:1,AD,CJ,HC,ID,IV,N4,ZZ*41:2:1,AD,CJ,HC,ID,IV,N4,ZZ\n" +
178+ "1207=24:3,FAM*41:3,CHD,DEP,ECH,EMP,ESP,FAM,IND,SPC,SPO\n" +
179+ "522=25:1,R*26:1,PB\n" +
180+ "1336=41:4,AP,C1,CO,HM,IP,OT,PR,PS,SP,WC\n" +
181+ "ELEMENT FORMATS\n" +
182+ "1251=20:2,0,,Date CCYYMMDD\n" +
183+ "SUMMARY\n" +
184+ "ELEMENT EQUALITY\n" +
185+ "1:13=47:2\n" +
186+ "3:2=45:2\n" +
187+ "RULES\n" +
188+ "24=13:4'EQ'0!USAGE!2!1\n" +
189+ "30=13:4'EQ'1!USAGE!2!1\n" +
190+ "ELEMENT COUNTERS\n" +
191+ "ELEMENT CODE DESCRIPTION\n" +
192+ "LOOP DESCRIPTIONS\n" +
193+ "INTERCHANGE HEADER=START OF INTERCHANGE HEADER\n" +
194+ "FUNCTIONAL GROUP=START OF FUNCTIONAL GROUP\n" +
195+ "ST HEADER=START OF ST HEADER\n" +
196+ "2000A=INFORMATION SOURCE LEVEL\n" +
197+ "2100A=INFORMATION SOURCE NAME\n" +
198+ "2000B=INFORMATION RECEIVER LEVEL\n" +
199+ "2100B=INFORMATION RECEIVER NAME\n" +
200+ "2000C=SUBSCRIBER LEVEL\n" +
201+ "2100C=SUBSCRIBER NAME\n" +
202+ "2110C=SUBSCRIBER ELIGIBILITY OR BENEFIT INQUIRY\n" +
203+ "2000D=DEPENDENT LEVEL\n" +
204+ "2100D=DEPENDENT NAME\n" +
205+ "2110D=DEPENDENT ELIGIBILITY OR BENEFIT INQUIRY\n" +
206+ "END ST HEADER LOOP=END ST HEADER LOOP\n" +
207+ "END GS LOOP=END OF FUNCTIONAL HEADER\n" +
208+ "END ISA LOOP=END OF INTERCHANGE HEADER\n" +
209+ "SEGMENT DESCRIPTIONS\n" +
210+ "ISA=1,Interchange Header\n" +
211+ "GS=2,Functional Group\n" +
212+ "ST=3,Transaction Set Header\n" +
213+ "BHT=4,Beginning of Hierarchical Transaction\n" +
214+ "HL=5,Information Source Level\n" +
215+ "NM1=6,Information Source Name\n" +
216+ "HL=7,Information Receiver Level\n" +
217+ "NM1=8,Information Receiver Name\n" +
218+ "REF=9,Information Receiver Additional Identification\n" +
219+ "N3=10,Information Receiver Address\n" +
220+ "N4=11,Information Receiver City\n" +
221+ "PRV=12,Information Receiver Provider Information\n" +
222+ "HL=13,Subscriber Level\n" +
223+ "TRN=14,Subscriber Trace Number\n" +
224+ "NM1=15,Subscriber Name\n" +
225+ "REF=16,Subscriber Additional Identification\n" +
226+ "N3=17,Subscriber Address\n" +
227+ "N4=18,Subscriber City\n" +
228+ "PRV=19,Provider Information\n" +
229+ "DMG=20,Subscriber Demographic Information\n" +
230+ "INS=21,Multiple Birth Sequence Number\n" +
231+ "HI=22,Subscriber Health Care Diagnosis Code\n" +
232+ "DTP=23,Subscriber Date\n" +
233+ "EQ=24,Subscriber Eligibility or Benefit Inquiry\n" +
234+ "AMT=25,Subscriber Spend Down Amount\n" +
235+ "AMT=26,Subscriber Spend Down Total Billed Amount\n" +
236+ "III=27,Subscriber Eligibility or Benefit Additional Inquiry Information\n" +
237+ "REF=28,Subscriber Additional Information\n" +
238+ "DTP=29,Subscriber Eligibility/Benefit Date\n" +
239+ "HL=30,Dependent Level\n" +
240+ "TRN=31,Dependent Trace Number\n" +
241+ "NM1=32,Dependent Name\n" +
242+ "REF=33,Dependent Additional Identification\n" +
243+ "N3=34,Dependent Address\n" +
244+ "N4=35,Dependent City\n" +
245+ "PRV=36,Provider Information\n" +
246+ "DMG=37,Dependent Demographic Information\n" +
247+ "INS=38,Dependent Relationship\n" +
248+ "HI=39,Dependent Health Care Diagnosis Code\n" +
249+ "DTP=40,Dependent Date\n" +
250+ "EQ=41,Dependent Eligibility or Benefit Inquiry\n" +
251+ "III=42,Dependent Eligibility or Benefit Additional Inquiry Information\n" +
252+ "REF=43,Dependent Additional Information\n" +
253+ "DTP=44,Dependent Eligibility/Benefit Date\n" +
254+ "SAMPLE DATA" ;
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