output.json

{
  "delimiter": "*",
  "header_0": {
    "before": "Hippa"
  },
  "isa": {
    "0": "InterchangeControlHeader2",
    "4": "SecurityInformation",
    "5": "InterchangeIdQualifier",
    "7": "InterchangeIdQualifier",
    "10": "RepetitionSeparator",
    "11": "InterchangeTime",
    "12": "InterchangeControlVersionNumber",
    "13": "InterchangeControlNumber",
    "15": "UsageIndicator",
    "16": "ComponentElementSeparator"
  },
  "header_1": {
    "before": "Group"
  },
  "gs": {
    "0": "FunctionalGroupHeader",
    "1": "FunctionalIdentifierCode",
    "2": "ApplicationSenderCode",
    "3": "ApplicationReceivercode",
    "4": "Date",
    "5": "Time",
    "6": "GroupControlNumber",
    "7": "ResponsibleAgencyCode",
    "8": "VersionReleaseNo"
  },
  "header_2": {
    "before": "Transaction"
  },
  "st": {
    "0": "TransactionSetHeader",
    "1": "TransactionSetIdentifier",
    "2": "TransactionSetControlNumber",
    "3": "ImplementationConventionReference"
  },
  "header_3": {
    "before": "Segment"
  },
  "bht": {
    "0": "BeginningOfHierarchicalSegment",
    "1": "HierarchicalStructureCode",
    "2": "TransactionSetPurposeCode",
    "3": "ReferenceIdentification",
    "4": "Date",
    "5": "InterchangeIdQualifier",
    "6": "TransactionTypeCode"
  },
  "nm1": {
    "1": "EntityIdentifierCode",
    "2": "EntityTypeQualifier",
    "4": "NameFirst",
    "5": "NameMiddle",
    "6": "NamePrefix",
    "7": "NameSuffix",
    "8": "IdentificationCodeQualifier",
    "9": "IdentificationCode",
    "0_1": "ReceiverName",
    "0_2": "BillingProviderName",
    "0_3": "SubscriberName",
    "0_4": "PayerName",
    "0_5": "ReferringProviderName",
    "0_6": "RenderingProviderName",
    "0_7": "ServiceFacilityLocation",
    "0_8": "OtherSubscriberName",
    "0_9": "OtherPayerName",
    "3_0": "NameLast",
    "3_1": "OrganizationName"
  },
  "n3": {
    "0": "SubscriberAddress",
    "1": "AddressLine1",
    "2": "AddressLine2"
  },
  "n4": {
    "0": "SubscriberCityStateZipCode",
    "1": "CityName",
    "2": "StateOrProvinceCode",
    "3": "PostalCode"
  },
  "hl": {
    "2": "HierarchicalParentIdNumber",
    "3": "HierarchicalLevelCode",
    "4": "HierarchicalChildCode",
    "0_0": "BillingHierarchicalLevel",
    "0_1": "SubscriberHierarchicalLevel",
    "0_2": "PatientHierarchicalLevel",
    "1_0": "HierarchicalIdNumber",
    "1_1": "SubscriberIDNumber"
  },
  "clm": {
    "0": "ClaimInformation",
    "1": "ClaimSubmitterIdentifier",
    "2": "MonetaryAmount",
    "3": "ClaimFillingIndicator",
    "4": "NonInstitutionalClaimType",
    "5": "FacilityCodeValue",
    "6": "FacilityCodeQualifier",
    "7": "ClaimFrequencyTypeCode",
    "8": "YesNoProviderSignatureonFile",
    "9": "ProviderAcceptAssignmentCode",
    "10": "YesNoAssignmentsofBenefit",
    "11": "YesNoReleaseofInformation",
    "12": "PatientSignatureSourceCode"
  },
  "dtp": {
    "1": "DateTimeQualifier",
    "2": "DateTimePeriodFormatQualifier",
    "3": "DateTimePeriod",
    "0_0": "DateOnsetOfCurrentIllnessSymptom",
    "0_1": "DateInitialTreatment",
    "0_2": "DateLastSeen",
    "0_3": "DateAcuteManifestation",
    "0_4": "DateAccident",
    "0_5": "DateInitialMenstrual",
    "0_6": "DateLastXRayMenstrual",
    "0_7": "DateHearingAndVisionPrescriptionDate",
    "0_8": "DateLastWorked"
  },
  "ref": {
    "1": "ReferenceIdentificationQualifier",
    "2": "ReferenceIdentification",
    "0_0": "CLIANumber",
    "0_1": "PriorAuthorizationOrReferralNumber"
  },
  "k3": {
    "0": "ClaimInformation",
    "1": "FixedFormatInformation"
  },
  "hi": {
    "0": "HealthCareDiagnosisCode",
    "1": "CodeListQualifierCode",
    "2": "IndustryCode"
  },
  "sbr": {
    "0": "SubscriberInformation",
    "1": "PayerResponsibilityCode",
    "2": "IndividualRelationshipCode",
    "3": "ReferenceIdentification",
    "4": "Name",
    "5": "InsuranceTypeCode",
    "6": "CoordinationOfBenefitCode",
    "7": "YesNoCondition",
    "8": "EmploymentStatusCode",
    "9": "ClaimFillingIndicatorCode"
  },
  "lx": {
    "0": "ServiceLine",
    "1": "AssignedNumber"
  },
  "sv1": {
    "0": "ProfessionalService",
    "1": "ProductServiceIdQualifier : ProductServiceID : ProcedureModifier : ProcedureModifier : ProcedureModifier : ProcedureModifier",
    "2": "MonetaryAmount",
    "3": "Unit",
    "4": "Quantity",
    "5": "FacilityCodeValue",
    "6": "ServiceTypeCode",
    "7": "DiagnosisCodePointer : DiagnosisCodePointer : DiagnosisCodePointer : DiagnosisCodePointer : MonetaryAmount : YesNoEmergencyIndicator: MultipleProcedureCode : YesNoEPSDTIndicator : YesNoFamilyPlanningIndicator : ReviewCode : NationalOrLocalAssignedReviewValue : CopayStatusCode",
    "_comment": "if : is file content separator"
  },
  "svd": {
    "0": "LineAdjudicationInformation",
    "1": "IdentificationCode",
    "2": "MonetaryAmount",
    "3": "ProductServiceIDQualifier",
    "4": "Description",
    "5": "Quantity"
  },
  "cas": {
    "0": "LineAdjustment",
    "1": "ClaimAdjustmentGroupCode",
    "2": "ClaimAdjustmentReasonCode",
    "3": "MonetaryAmount"
  },
  "trailer_3": {
    "after": "/Segment"
  },
  "se": {
    "0": "TransactionSetTrailer",
    "1": "NumberofIncludedSegments",
    "2": "TransactionSetControlNumber"
  },
  "trailer_2": {
    "after": "/Transaction"
  },
  "ge": {
    "1": "NumberOfTransactionsSetsIncluded",
    "2": "GroupControlNumber",
    "0_0": "FunctionalGroupTrailer",
    "0_1": "FunctionalGroupHeader"
  },
  "trailer_1": {
    "after": "/Group"
  },
  "iea": {
    "0": "InterchangeControlTrailer",
    "1": "NumberOfIncludedFunctionalGroups",
    "2": "InterchangeControlNumber20"
  },
  "trailer_0": {
    "after": "/Hippa"
  }
}