stupidedi 1.2.20 → 1.4.1

data/lib/stupidedi/transaction_sets/005010/implementations/X212-HR276.rb

@@ -0,0 +1,329 @@
+# frozen_string_literal: true
+module Stupidedi
+  module TransactionSets
+    module FiftyTen
+      module Implementations
+        module X212
+          b = Builder
+          d = Schema
+          r = SegmentReqs
+          e = ElementReqs
+          s = SegmentDefs
+
+          HR276 = b.build("HR", "276", "Health Care Claim Request",
+            d::TableDef.header("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("276")),
+                b::Element(e::Required,    "Transaction Set Control Number"),
+                b::Element(e::Required,    "Version, Release, or Industry Identifier", b::Values("005010X212"))),
+              b::Segment(200, s::BHT, "Beginning of Hierarchical Transaction", r::Required, d::RepeatCount.bounded(1),
+                b::Element(e::Required,    "Hierarchical Structure Code", b::Values("0010")),
+                b::Element(e::Required,    "Transaction Set Purpose Code", b::Values("13")),
+                b::Element(e::Required,    "Reference Identification"),
+                b::Element(e::Required,    "Transaction Set Creation Date"),
+                b::Element(e::Required,    "Transaction Set Creation Time"),
+                b::Element(e::NotUsed,     "Transaction Type Code"))),
+
+            d::TableDef.detail("2 - Information Source Detail",
+              d::LoopDef.build("2000A INFORMATION SOURCE LEVEL", d::RepeatCount.unbounded,
+                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 PAYER NAME", d::RepeatCount.bounded(1),
+                  b::Segment(500, 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"))))),
+
+            d::TableDef.detail("2 - Information Receiver Detail",
+              d::LoopDef.build("2000B INFORMATION RECEIVER LEVEL", d::RepeatCount.unbounded,
+                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("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::Situational, "Information Receiver Last or Organization Name"),
+                    b::Element(e::Situational, "Information Receiver First Name"),
+                    b::Element(e::Situational, "Information Receiver Middle Name"),
+                    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 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::TableDef.detail("2 - Service Provider Detail",
+              d::LoopDef.build("2000C SERVICE PROVIDER LEVEL", d::RepeatCount.unbounded,
+                b::Segment(100, s::HL, "Billing Provider of Service 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("19")),
+                  b::Element(e::Required,    "Hierachical Child Code", b::Values("1"))),
+
+                d::LoopDef.build("2100C PROVIDER NAME", d::RepeatCount.bounded(2),
+                  b::Segment(500, s::NM1, "Billing Provider Name", r::Required, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Entity Identifier Code", b::Values("1P")),
+                    b::Element(e::Required,    "Entity Type Qualifier", b::Values("1", "2")),
+                    b::Element(e::Situational, "Provider Last or Organization Name"),
+                    b::Element(e::Situational, "Provider First Name"),
+                    b::Element(e::Situational, "Provider Middle Name"),
+                    b::Element(e::NotUsed,     "Name Prefix"),
+                    b::Element(e::Situational, "Provider Name Suffix"),
+                    b::Element(e::Required,    "Identification Code Qualifier", b::Values("FI", "SV", "XX")),
+                    b::Element(e::Required,    "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::TableDef.detail("2 - Subscriber Detail",
+              d::LoopDef.build("2000D SUBSCRIBER LEVEL", d::RepeatCount.unbounded,
+                b::Segment(100, s::HL, "Subscriber 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(400, 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::Situational, "Subscriber Gender Code", b::Values("F", "M")),
+                  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")),
+
+                d::LoopDef.build("2100D SUBSCRIBER NAME", d::RepeatCount.bounded(1),
+                  b::Segment(500, 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::Required,    "Identification Code Qualifier", b::Values("24", "II", "MI")),
+                    b::Element(e::Required,    "Subscriber 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("2200D CLAIM STATUS TRACKING NUMBER", d::RepeatCount.unbounded,
+                  b::Segment( 900, s::TRN, "Claim Status Tracking Number", r::Situational, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Trace Type Code", b::Values("1")),
+                    b::Element(e::Required,    "Current Transaction Trace Number"),
+                    b::Element(e::NotUsed,     "Originating Company Identifier"),
+                    b::Element(e::NotUsed,     "Reference Identification")),
+                  b::Segment(1000, s::REF, "Payer Claim Control Number", r::Situational, d::RepeatCount.bounded(1),
+                    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(1000, s::REF, "Institutional Bill Type Identification", r::Situational, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Reference Identification Qualifier", b::Values("BLT")),
+                    b::Element(e::Required,    "Bill Type Identifier"),
+                    b::Element(e::NotUsed,     "Description"),
+                    b::Element(e::NotUsed,     "REFERENCE IDENTIFIER")),
+                  b::Segment(1000, s::REF, "Application or Location System Identifier", r::Situational, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Reference Identification Qualifier", b::Values("LU")),
+                    b::Element(e::Required,    "Application or Location System Identifier"),
+                    b::Element(e::NotUsed,     "Description"),
+                    b::Element(e::NotUsed,     "REFERENCE IDENTIFIER")),
+                  b::Segment(1000, s::REF, "Group Number", r::Situational, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Reference Identification Qualifier", b::Values("6P")),
+                    b::Element(e::Required,    "Group Number"),
+                    b::Element(e::NotUsed,     "Description"),
+                    b::Element(e::NotUsed,     "REFERENCE IDENTIFIER")),
+                  b::Segment(1000, s::REF, "Patient Control Number", r::Situational, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Reference Identification Qualifier", b::Values("EJ")),
+                    b::Element(e::Required,    "Patient Control Number"),
+                    b::Element(e::NotUsed,     "Description"),
+                    b::Element(e::NotUsed,     "REFERENCE IDENTIFIER")),
+                  b::Segment(1000, 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(1000, s::REF, "Claim Identification Number for Clearinghouses and Other Transmission Intermediaries", r::Situational, d::RepeatCount.bounded(1),
+                    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::AMT, "Institutional Bill Type Identification", r::Situational, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Amount Qualifier Code", b::Values("T3")),
+                    b::Element(e::Required,    "Total Claim Charge Amount"),
+                    b::Element(e::NotUsed,     "Credit/Debit Flag Code")),
+                  b::Segment(1200, s::DTP, "Claim Level Service Date", r::Situational, 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("2210D SERVICE LINE INFORMATION", d::RepeatCount.unbounded,
+                    b::Segment(1300, s::SVC, "Service Line Information", r::Situational, d::RepeatCount.bounded(1),
+                      b::Element(e::Required,    "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
+                        b::Element(e::Required,    "Product or Service ID Qualifier", b::Values("AD", "ER", "HC", "HP", "IV", "N4", "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, "Units of Service Count")),
+                    b::Segment(1400, s::REF, "Service Line Item Identification", r::Situational, 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(1500, 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("2 - Dependent Detail",
+              d::LoopDef.build("2000E DEPENDENT LEVEL", d::RepeatCount.unbounded,
+                b::Segment(100, s::HL, "Dependent 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::NotUsed,     "Hierachical Child Code")),
+                b::Segment(400, s::DMG, "Dependent 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::Situational, "Patient Gender Code", b::Values("F", "M")),
+                  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")),
+
+                d::LoopDef.build("2100E DEPENDENT NAME", d::RepeatCount.bounded(1),
+                  b::Segment(500, s::NM1, "Dependent 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"))),
+
+                d::LoopDef.build("2200E 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("1")),
+                    b::Element(e::Required,    "Current Transaction Trace Number"),
+                    b::Element(e::NotUsed,     "Originating Company Identifier"),
+                    b::Element(e::NotUsed,     "Reference Identification")),
+                  b::Segment(1000, s::REF, "Payer Claim Control Number", r::Situational, d::RepeatCount.bounded(1),
+                    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(1000, s::REF, "Institutional Bill Type Identification", r::Situational, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Reference Identification Qualifier", b::Values("BLT")),
+                    b::Element(e::Required,    "Bill Type Identifier"),
+                    b::Element(e::NotUsed,     "Description"),
+                    b::Element(e::NotUsed,     "REFERENCE IDENTIFIER")),
+                  b::Segment(1000, s::REF, "Application or Location System Identifier", r::Situational, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Reference Identification Qualifier", b::Values("LU")),
+                    b::Element(e::Required,    "Application or Location System Identifier"),
+                    b::Element(e::NotUsed,     "Description"),
+                    b::Element(e::NotUsed,     "REFERENCE IDENTIFIER")),
+                  b::Segment(1000, s::REF, "Group Number", r::Situational, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Reference Identification Qualifier", b::Values("6P")),
+                    b::Element(e::Required,    "Group Number"),
+                    b::Element(e::NotUsed,     "Description"),
+                    b::Element(e::NotUsed,     "REFERENCE IDENTIFIER")),
+                  b::Segment(1000, s::REF, "Patient Control Number", r::Situational, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Reference Identification Qualifier", b::Values("EJ")),
+                    b::Element(e::Required,    "Patient Control Number"),
+                    b::Element(e::NotUsed,     "Description"),
+                    b::Element(e::NotUsed,     "REFERENCE IDENTIFIER")),
+                  b::Segment(1000, 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(1000, s::REF, "Claim Identification Number for Clearinghouses and Other Transmission Intermediaries", r::Situational, d::RepeatCount.bounded(1),
+                    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::AMT, "Claim Submitted Charges", r::Situational, d::RepeatCount.bounded(1),
+                    b::Element(e::Required,    "Amount Qualifier Code", b::Values("T3")),
+                    b::Element(e::Required,    "Total Claim Charge Amount"),
+                    b::Element(e::NotUsed,     "Credit/Debit Flag Code")),
+                  b::Segment(1200, s::DTP, "Claim Service Date", r::Situational, 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("2210E SERVICE LINE INFORMATION", d::RepeatCount.unbounded,
+                    b::Segment(1300, s::SVC, "Service Line Information", r::Situational, d::RepeatCount.bounded(1),
+                      b::Element(e::Required,    "COMPOSITE MEDICAL PROCEDURE IDENTIFIER",
+                      b::Element(e::Required,    "Product or Service ID Qualifier", b::Values("AD", "ER", "HC", "HP", "IV", "N4", "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, "Units of Service Count")),
+                    b::Segment(1400, s::REF, "Service Line Item Identification", r::Situational, 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(1500, 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.summary("3 - Summary",
+              b::Segment(1600, 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"))))
+
+        end
+      end
+    end
+  end
+end

data/lib/stupidedi/transaction_sets/005010/implementations/X214-HN277.rb

@@ -0,0 +1,356 @@
+# frozen_string_literal: true
+module Stupidedi
+  module TransactionSets
+    module FiftyTen
+      module Implementations
+        module X214
+          b = Builder
+          d = Schema
+          r = SegmentReqs
+          e = ElementReqs
+          s = SegmentDefs
+
+          HN277 = b.build("HN", "277", "Health Care Claim Acknowledgement",
+            d::TableDef.header("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("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("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("2 - Billing Provider of Service Detail + Patient Detail",
+              d::LoopDef.build("2000C BILLING PROVIDER OF SERVICE LEVEL", d::RepeatCount.unbounded,
+                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("2 - Patient Detail",
+              d::LoopDef.build("2000D PATIENT LEVEL", d::RepeatCount.unbounded,
+                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("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::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("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::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::Situational, 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.summary("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"))))
+
+        end
+      end
+    end
+  end
+end