IEA (Interchange Control Trailer Segment)
The Input Data column below contains text entered in [bracketed italics] indicates special input data dependent on sender, time, date, etc.
Elements Size Name Input Data Remarks
IEA01 1/5 Number of Included Functional Groups [Submitter-specific ID number] A count of the number of functional groups included in an interchange.
IEA02 9 Interchange Control Number [Submitter-specific ID number] A control number assigned by the interchange sender.
(Functional Group Header Segment)
This segment indicates the beginning of a functional group and to provide control information.
The Input Data column below contains text entered in [bracketed italics] indicates special input data dependent on sender, time, date, etc.
Elements Size Name Input Data Remarks
GS01 2 Functional Identifier Code HC Health Care Claim.
GS02 2/15 Application Sender’s Code [Tufts Health Plan Submitter ID] Code identifying party sending transmission.
GS03 2/15 Application Receiver’s Code 170558746 Code identifying party receiving transmission.
GS04 8 Date [Enter the date using the format YYYYMMDD; for example, January 1, 2012 would be entered as 20120101] Functional Group creation date.
GS05 4/8 Time [Enter the time using the format HHMM; for example, 1:30 PM would be entered as 1330] Functional Group creation time. Time expressed in 24-hour clock.
GS06 1/9 Group Control Number/Last Control Number [Submitter-specific number] Assigned and maintained by the sender, must be identical to the associated functional group trailer, GE-02.
GS07 1/2 Responsible Agency Code X Accredited Standards Committee X12.
GS08 1/12 Version/Release/Industry Identification Code 005010X223A2 Health Care Claim for Institutional or 005010X222A1 Health Care Claim for Professional.
GE (Functional Group Trailer Segment)
The Input Data column below contains text entered in [bracketed italics] indicates special input data dependent on sender, time, date, etc.
Elements Size Name Input Data Remarks
GE01 1/6 Number of Transaction Sets Included [Submitter-specific number] Total number of transaction sets included in the functional group or interchange (transmission) group terminated by the trailer containing this data element.
GE02 1/9 Group Control Number [Submitter-specific number] Assigned number originated and maintained by the sender