/// <summary> /// Builds generic response. /// Original from http://www.x12.org/examples/005010X279/subscriber-who-is-also-the-patient/response-to-generic-request-by-clinic-for-patient-(subscriber)-eligibility/ /// </summary> static TS271 BuildGenericResponse(string controlNumber) { var result = new TS271(); // Transaction Set ID Code = 271 (Eligibility, Coverage or Benefit Information) // Transaction Set Control Number = 4321 // Implementation Convention Reference = 005010X279A1 result.ST = new ST(); result.ST.TransactionSetIdentifierCode_01 = "271"; result.ST.TransactionSetControlNumber_02 = controlNumber.PadLeft(9, '0'); result.ST.ImplementationConventionPreference_03 = "005010X279A1"; // Hierarchical Structure Code = 0022 (Information Source, Information Receiver, Subscriber, Dependent) // Transaction Set Purpose Code = 11(Response) Identification // Reference Identification = 10001234 // Date = 20060501(May 1, 2006) // Time = 1:19 PM result.BHT_BeginningofHierarchicalTransaction = new BHT_BeginningofHierarchicalTransaction_2(); result.BHT_BeginningofHierarchicalTransaction.HierarchicalStructureCode_01 = "0022"; result.BHT_BeginningofHierarchicalTransaction.TransactionSetPurposeCode_02 = "11"; result.BHT_BeginningofHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "10001234"; result.BHT_BeginningofHierarchicalTransaction.TransactionSetCreationDate_04 = "20060501"; result.BHT_BeginningofHierarchicalTransaction.TransactionSetCreationTime_05 = "1319"; // Repeating 2000A Loops result.Loop2000A = new List <Loop_2000A_271>(); // Begin 2000A Loop var loop2000A = new Loop_2000A_271(); // Hierarchical ID Number = 1 // Hierarchical Parent ID Number = *not used // Hierarchical Level Code = 20(Information Source) // Hierarchical Child Code = 1 loop2000A.HL_InformationSourceLevel = new HL_BillingProviderHierarchicalLevel(); loop2000A.HL_InformationSourceLevel.HierarchicalIDNumber_01 = "1"; loop2000A.HL_InformationSourceLevel.HierarchicalLevelCode_03 = "20"; loop2000A.HL_InformationSourceLevel.HierarchicalChildCode_04 = "1"; // Begin 2100A Loop loop2000A.Loop2100A = new Loop_2100A_271(); // Entity Identifier Code = PR (Payer) // Entity Type Qualifier = 2(Non - person) // Last Name = ABC Company // First Name = *not used // Middle Name = *not used // Name Prefix = *not used // Name Suffix = *not used // Identification Code Qualifier = PI(Payer Identification) // Identification Code = 842610001 loop2000A.Loop2100A.NM1_InformationSourceName = new NM1_InformationSourceName(); loop2000A.Loop2100A.NM1_InformationSourceName.EntityIdentifierCode_01 = "PR"; loop2000A.Loop2100A.NM1_InformationSourceName.EntityTypeQualifier_02 = "2"; loop2000A.Loop2100A.NM1_InformationSourceName.ResponseContactLastorOrganizationName_03 = "ABC COMPANY"; loop2000A.Loop2100A.NM1_InformationSourceName.IdentificationCodeQualifier_08 = "PI"; loop2000A.Loop2100A.NM1_InformationSourceName.ResponseContactIdentifier_09 = "842610001"; // End 2100A Loop // Repeating 2000B Loops loop2000A.Loop2000B = new List <Loop_2000B_271>(); // Begin 2000B Loop var loop2000B = new Loop_2000B_271(); // Hierarchical ID Number = 2 // Hierarchical Parent ID Number = 1 // Hierarchical Level Code = 21(Information Receiver) // Hierarchical Child Code = 1 loop2000B.HL_InformationReceiverLevel = new HL_InformationReceiverLevel(); loop2000B.HL_InformationReceiverLevel.HierarchicalIDNumber_01 = "2"; loop2000B.HL_InformationReceiverLevel.HierarchicalParentIDNumber_02 = "1"; loop2000B.HL_InformationReceiverLevel.HierarchicalLevelCode_03 = "21"; loop2000B.HL_InformationReceiverLevel.HierarchicalChildCode_04 = "1"; // Begin 2100B Loop loop2000B.Loop2100B = new Loop_2100B_271(); // Entity Identifier Code = 1P (Provider) // Entity Type Qualifier = 2(Non - Person Entity) // Last Name = Bone and Joint Clinic // First Name = *not used // Middle Name = *not used // Name Prefix = *not used // Name Suffix = *not used // Identification Code Qualifier = SV(Service Provider Number) // Identification Code = 2000035 loop2000B.Loop2100B.NM1_InformationReceiverName = new NM1_InformationReceiverName(); loop2000B.Loop2100B.NM1_InformationReceiverName.EntityIdentifierCode_01 = "1P"; loop2000B.Loop2100B.NM1_InformationReceiverName.EntityTypeQualifier_02 = "2"; loop2000B.Loop2100B.NM1_InformationReceiverName.ResponseContactLastorOrganizationName_03 = "BONE AND JOINT CLINIC"; loop2000B.Loop2100B.NM1_InformationReceiverName.IdentificationCodeQualifier_08 = "SV"; loop2000B.Loop2100B.NM1_InformationReceiverName.ResponseContactIdentifier_09 = "2000035"; // End 2100B Loop // Repeating 2000C Loops loop2000B.Loop2000C = new List <Loop_2000C_271>(); // Begin 2000C Loop 1 var loop2000C1 = new Loop_2000C_271(); // Hierarchical ID Number = 3 // Hierarchical Parent ID Number = 2 // Hierarchical Level Code = 22(Subscriber) // Hierarchical Child Code = 0 loop2000C1.HL_SubscriberLevel = new HL_SubscriberHierarchicalLevel(); loop2000C1.HL_SubscriberLevel.HierarchicalIDNumber_01 = "3"; loop2000C1.HL_SubscriberLevel.HierarchicalParentIDNumber_02 = "2"; loop2000C1.HL_SubscriberLevel.HierarchicalLevelCode_03 = "22"; loop2000C1.HL_SubscriberLevel.HierarchicalChildCode_04 = "0"; // Repeating TRN loop2000C1.TRN_SubscriberTraceNumber = new List <TRN_DependentTraceNumber>(); // Trace Type Code = 2 (Referenced Transaction Trace Number) // Reference Identification = 93175 - 012547 // Originating Company Identifier = 9877281234 // Reference Identification = *not used var trn = new TRN_DependentTraceNumber(); trn.TraceTypeCode_01 = "2"; trn.CurrentTransactionTraceNumber_02 = "93175-012547"; trn.OriginatingCompanyIdentifier_03 = "9877281234"; loop2000C1.TRN_SubscriberTraceNumber.Add(trn); // Begin 2100C Loop loop2000C1.Loop2100C = new Loop_2100C_271(); // Entity Identifier Code = IL (Insured or Subscriber) // Entity Type Qualifier = 1(Person) // Last Name = Smith // First Name = John // Middle Name = *not used // Name Prefix = *not used // Name Suffix = *not used // Identification Code Qualifier = MI(Member Identification) // Identification Code = 123456789 loop2000C1.Loop2100C.NM1_SubscriberName = new NM1_InsuredName(); loop2000C1.Loop2100C.NM1_SubscriberName.EntityIdentifierCode_01 = "IL"; loop2000C1.Loop2100C.NM1_SubscriberName.EntityTypeQualifier_02 = "1"; loop2000C1.Loop2100C.NM1_SubscriberName.ResponseContactLastorOrganizationName_03 = "SMITH"; loop2000C1.Loop2100C.NM1_SubscriberName.ResponseContactFirstName_04 = "JOHN"; loop2000C1.Loop2100C.NM1_SubscriberName.IdentificationCodeQualifier_08 = "MI"; loop2000C1.Loop2100C.NM1_SubscriberName.ResponseContactIdentifier_09 = "123456789"; // Address Information = 15197 BROADWAY AVENUE // Address Information = APT 215 loop2000C1.Loop2100C.N3_SubscriberAddress = new N3_AdditionalPatientInformationContactAddress(); loop2000C1.Loop2100C.N3_SubscriberAddress.ResponseContactAddressLine_01 = "15197 BROADWAY AVENUE"; loop2000C1.Loop2100C.N3_SubscriberAddress.ResponseContactAddressLine_02 = "APT 215"; // City = KANSAS CITY // State or Prov Code = MO // Postal Code = 64108 loop2000C1.Loop2100C.N4_SubscriberCity_State_ZIPCode = new N4_AdditionalPatientInformationContactCity(); loop2000C1.Loop2100C.N4_SubscriberCity_State_ZIPCode.AdditionalPatientInformationContactCityName_01 = "KANSAS CITY"; loop2000C1.Loop2100C.N4_SubscriberCity_State_ZIPCode.AdditionalPatientInformationContactStateCode_02 = "MO"; loop2000C1.Loop2100C.N4_SubscriberCity_State_ZIPCode.AdditionalPatientInformationContactPostalZoneorZIPCode_03 = "64108"; // Date Time Period Format = D8 (Date Expressed in Format CCYYMMDD) // Date Time Period = 19630519 // Gender Code = M(Male) loop2000C1.Loop2100C.DMG_SubscriberDemographicInformation = new DMG_DependentDemographicInformation(); loop2000C1.Loop2100C.DMG_SubscriberDemographicInformation.DateTimePeriodFormatQualifier_01 = "D8"; loop2000C1.Loop2100C.DMG_SubscriberDemographicInformation.DependentBirthDate_02 = "19630519"; loop2000C1.Loop2100C.DMG_SubscriberDemographicInformation.DependentGenderCode_03 = "M"; // Repeating DTP loop2000C1.Loop2100C.DTP_SubscriberDate = new List <DTP_DependentDate_2>(); // Date/Time Qualifier = 346 (Plan Begin) // Date Time Period Format Qualifier D8(Dates Expressed in Format CCYYMMDD) // Date Time Period = 20060101(January 1, 2006) var dtp = new DTP_DependentDate_2(); dtp.DateTimeQualifier_01 = "346"; dtp.DateTimePeriodFormatQualifier_02 = "D8"; dtp.AccidentDate_03 = "20060101"; loop2000C1.Loop2100C.DTP_SubscriberDate.Add(dtp); // Repeating 2110C Loops loop2000C1.Loop2100C.Loop2110C = new List <Loop_2110C_271>(); // Begin 2110C Loop 1 var loop2110C1 = new Loop_2110C_271(); // Eligibility or Benefit Information Code = 1 (Active Coverage) // Coverage Level Code = *not used // Service Type Code = 30(Health Benefit Plan Coverage) // Insurance Type Code = *not used // Plan Coverage Description = Gold 123 Plan loop2110C1.EB_SubscriberEligibilityorBenefitInformation = new EB_SubscriberEligibilityorBenefitInformation(); loop2110C1.EB_SubscriberEligibilityorBenefitInformation.EligibilityorBenefitInformation_01 = "1"; loop2110C1.EB_SubscriberEligibilityorBenefitInformation.ServiceTypeCode_03 = new List <string> { "30" }; loop2110C1.EB_SubscriberEligibilityorBenefitInformation.PlanCoverageDescription_05 = "GOLD 123 PLAN"; // End 2110C Loop 1 loop2000C1.Loop2100C.Loop2110C.Add(loop2110C1); // Begin 2110C Loop 2 var loop2110C2 = new Loop_2110C_271(); // Eligibility or Benefit Information Code = L (Primary Care Provider) loop2110C2.EB_SubscriberEligibilityorBenefitInformation = new EB_SubscriberEligibilityorBenefitInformation(); loop2110C2.EB_SubscriberEligibilityorBenefitInformation.EligibilityorBenefitInformation_01 = "L"; // End 2110C Loop 2 loop2000C1.Loop2100C.Loop2110C.Add(loop2110C2); // Begin 2110C Loop 3 var loop2110C3 = new Loop_2110C_271(); // Eligibility or Benefit Information Code = 1 (Active Coverage) // Coverage Level Code = *not used // Service Type Code = 1(Medical Care) // Service Type Code = 33(Chiropractic) // Service Type Code = 35(Dental Care) // Service Type Code = 47(Hospital) // Service Type Code = 86(Emergency Services) // Service Type Code = 88(Pharmacy) // Service Type Code = 98(Professional(Physician) Visit - Office) // Service Type Code = AL(Vision(Optometry)) // Service Type Code = MH(Mental Health) // Service Type Code = UC(Urgent Care) loop2110C3.EB_SubscriberEligibilityorBenefitInformation = new EB_SubscriberEligibilityorBenefitInformation(); loop2110C3.EB_SubscriberEligibilityorBenefitInformation.EligibilityorBenefitInformation_01 = "1"; loop2110C3.EB_SubscriberEligibilityorBenefitInformation.ServiceTypeCode_03 = new List <string> { "1", "33", "35", "47", "86", "88", "98", "AL", "MH", "UC" }; // End 2110C Loop 3 loop2000C1.Loop2100C.Loop2110C.Add(loop2110C3); // Begin 2110C Loop 4 var loop2110C4 = new Loop_2110C_271(); // Eligibility or Benefit Information Code = B (Co-Payment) // Coverage Level Code = *not used // Service Type Code = 1(Medical Care) // Service Type Code = 33(Chiropractic) // Service Type Code = 35(Dental Care) // Service Type Code = 47(Hospital) // Service Type Code = 86(Emergency Services) // Service Type Code = 88(Pharmacy) // Service Type Code = 98(Professional(Physician) Visit - Office) // Service Type Code = AL(Vision(Optometry)) // Service Type Code = MH(Mental Health) // Service Type Code = UC(Urgent Care) // Insurance Type Code = HM (Health Management Organization (HMO)) // Plan Coverage Description = GOLD 123 PLAN // Time Period Qualifier = 27(Visit) // Monetary Value = 10(Dollar) // Percent = *not used // Quantity Qualifier = *not used // Quantity = *not used // Yes / No Condition Or Response Code(Certification/ Authorization Indicator) = *not used // Yes / No Condition Or Response Code(In Plan Network Indicator) = Y(Yes – In Network) loop2110C4.EB_SubscriberEligibilityorBenefitInformation = new EB_SubscriberEligibilityorBenefitInformation(); loop2110C4.EB_SubscriberEligibilityorBenefitInformation.EligibilityorBenefitInformation_01 = "B"; loop2110C4.EB_SubscriberEligibilityorBenefitInformation.ServiceTypeCode_03 = new List <string> { "1", "33", "35", "47", "86", "88", "98", "AL", "MH", "UC" }; loop2110C4.EB_SubscriberEligibilityorBenefitInformation.InsuranceTypeCode_04 = "HM"; loop2110C4.EB_SubscriberEligibilityorBenefitInformation.PlanCoverageDescription_05 = "GOLD 123 PLAN"; loop2110C4.EB_SubscriberEligibilityorBenefitInformation.TimePeriodQualifier_06 = "27"; loop2110C4.EB_SubscriberEligibilityorBenefitInformation.BenefitAmount_07 = "10"; loop2110C4.EB_SubscriberEligibilityorBenefitInformation.InPlanNetworkIndicator_12 = "Y"; // End 2110C Loop 4 loop2000C1.Loop2100C.Loop2110C.Add(loop2110C4); // Begin 2110C Loop 5 var loop2110C5 = new Loop_2110C_271(); // Eligibility or Benefit Information Code = B (Co-Payment) // Coverage Level Code = *not used // Service Type Code = 1(Medical Care) // Service Type Code = 33(Chiropractic) // Service Type Code = 35(Dental Care) // Service Type Code = 47(Hospital) // Service Type Code = 86(Emergency Services) // Service Type Code = 88(Pharmacy) // Service Type Code = 98(Professional(Physician) Visit - Office) // Service Type Code = AL(Vision(Optometry)) // Service Type Code = MH(Mental Health) // Service Type Code = UC(Urgent Care) // Insurance Type Code = HM (Health Management Organization (HMO)) // Plan Coverage Description = GOLD 123 PLAN // Time Period Qualifier = 27(Visit) // Monetary Value = 30(Dollar) // Percent = *not used // Quantity Qualifier = *not used // Quantity = *not used // Yes/No Condition Or Response Code (Certification/Authorization Indicator) = * not used // Yes / No Condition Or Response Code(In Plan Network Indicator) = N(No – Out of Network) loop2110C5.EB_SubscriberEligibilityorBenefitInformation = new EB_SubscriberEligibilityorBenefitInformation(); loop2110C5.EB_SubscriberEligibilityorBenefitInformation.EligibilityorBenefitInformation_01 = "B"; loop2110C5.EB_SubscriberEligibilityorBenefitInformation.ServiceTypeCode_03 = new List <string> { "1", "33", "35", "47", "86", "88", "98", "AL", "MH", "UC" }; loop2110C5.EB_SubscriberEligibilityorBenefitInformation.InsuranceTypeCode_04 = "HM"; loop2110C5.EB_SubscriberEligibilityorBenefitInformation.PlanCoverageDescription_05 = "GOLD 123 PLAN"; loop2110C5.EB_SubscriberEligibilityorBenefitInformation.TimePeriodQualifier_06 = "27"; loop2110C5.EB_SubscriberEligibilityorBenefitInformation.BenefitAmount_07 = "30"; loop2110C5.EB_SubscriberEligibilityorBenefitInformation.InPlanNetworkIndicator_12 = "N"; // Begin LS Loop loop2110C5.LoopLS = new Loop_LS_271_2(); // Loop Identifier Code = 2120 loop2110C5.LoopLS.LS_Header = new LS_AdditionalReportingCategories(); loop2110C5.LoopLS.LS_Header.LoopIdentifierCode_01 = "2120"; // Repeating 2120C Loops loop2110C5.LoopLS.Loop2120C = new List <Loop_2120C_271>(); // Begin 2110C Loop var loop2120C = new Loop_2120C_271(); // Entity Identifier Code = P3 (Primary Care Provider) // Entity Type Qualifier = 1(Person) // Last Name = Jones // First Name = Marcus // Middle Name = *not used // Name Prefix = *not used // Name Suffix = *not used // Identification Code Qualifier = SV Service Provider Number // Identification Code = 0202034 loop2120C.NM1_SubscriberBenefitRelatedEntityName = new NM1_DependentBenefitRelatedEntityName(); loop2120C.NM1_SubscriberBenefitRelatedEntityName.EntityIdentifierCode_01 = "P3"; loop2120C.NM1_SubscriberBenefitRelatedEntityName.EntityTypeQualifier_02 = "1"; loop2120C.NM1_SubscriberBenefitRelatedEntityName.ResponseContactLastorOrganizationName_03 = "JONES"; loop2120C.NM1_SubscriberBenefitRelatedEntityName.ResponseContactFirstName_04 = "MARCUS"; loop2120C.NM1_SubscriberBenefitRelatedEntityName.IdentificationCodeQualifier_08 = "SV"; loop2120C.NM1_SubscriberBenefitRelatedEntityName.ResponseContactIdentifier_09 = "0202034"; // End 2110C Loop loop2110C5.LoopLS.Loop2120C.Add(loop2120C); // Loop Identifier Code = 2120 loop2110C5.LoopLS.LE_Trailer = new LE_AdditionalReportingCategoriesTermination(); loop2110C5.LoopLS.LE_Trailer.LoopIdentifierCode_01 = "2120"; // End LS Loop // End 2110C Loop 5 loop2000C1.Loop2100C.Loop2110C.Add(loop2110C5); // End 2100C Loop // End 2000C Loop 1 loop2000B.Loop2000C.Add(loop2000C1); // End 2000B Loop loop2000A.Loop2000B.Add(loop2000B); // End 2000A Loop result.Loop2000A.Add(loop2000A); return(result); }
/// <summary> /// Builds generic request. /// Original from http://www.x12.org/examples/005010X279/subscriber-who-is-also-the-patient/generic-request-by-clinic-for-patient-(subscriber)-eligibility/ /// </summary> static TS270 BuildGenericRequest(string controlNumber) { var result = new TS270(); // Transaction Set ID Code = 270 (Eligibility, Coverage or Benefit Inquiry) // Transaction Set Control Number = 1234 // Implementation Convention Reference = 005010X279A1 result.ST = new ST(); result.ST.TransactionSetIdentifierCode_01 = "270"; result.ST.TransactionSetControlNumber_02 = controlNumber.PadLeft(9, '0'); result.ST.ImplementationConventionPreference_03 = "005010X279A1"; // Hierarchical Structure Code = 0022 (Information Source, Information Receiver, Subscriber, Dependent) // Transaction Set Purpose Code = 13(Request) Identification // Reference Identification = 10001234 // Date = 20060501(May 1, 2006) // Time = 1:19 PM result.BHT_BeginningOfHierarchicalTransaction = new BHT_BeginningOfHierarchicalTransaction(); result.BHT_BeginningOfHierarchicalTransaction.HierarchicalStructureCode_01 = "0022"; result.BHT_BeginningOfHierarchicalTransaction.TransactionSetPurposeCode_02 = "13"; result.BHT_BeginningOfHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "10001234"; result.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationDate_04 = "20060501"; result.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationTime_05 = "1319"; // Repeating 2000A Loops result.Loop2000A = new List <Loop_2000A_270>(); // Begin 2000A Loop var loop2000A = new Loop_2000A_270(); // Hierarchical ID Number = 1 // Hierarchical Parent ID Number = *not used // Hierarchical Level Code = 20(Information Source) // Hierarchical Child Code = 1 loop2000A.HL_InformationSourceLevel = new HL_BillingProviderHierarchicalLevel(); loop2000A.HL_InformationSourceLevel.HierarchicalIDNumber_01 = "1"; loop2000A.HL_InformationSourceLevel.HierarchicalLevelCode_03 = "20"; loop2000A.HL_InformationSourceLevel.HierarchicalChildCode_04 = "1"; // Begin 2100A Loop loop2000A.Loop2100A = new Loop_2100A_270(); // Entity Identifier Code = PR (Payer) // Entity Type Qualifier = 2(Non - person) // Last Name = ABC Company // First Name = *not used // Middle Name = *not used // Name Prefix = *not used // Name Suffix = *not used // Identification Code Qualifier = PI(Payer Identification) // Identification Code = 842610001 loop2000A.Loop2100A.NM1_InformationSourceName = new NM1_InformationSourceName(); loop2000A.Loop2100A.NM1_InformationSourceName.EntityIdentifierCode_01 = "PR"; loop2000A.Loop2100A.NM1_InformationSourceName.EntityTypeQualifier_02 = "2"; loop2000A.Loop2100A.NM1_InformationSourceName.ResponseContactLastorOrganizationName_03 = "ABC COMPANY"; loop2000A.Loop2100A.NM1_InformationSourceName.IdentificationCodeQualifier_08 = "PI"; loop2000A.Loop2100A.NM1_InformationSourceName.ResponseContactIdentifier_09 = "842610001"; // End 2100A Loop // Repeating 2000B Loops loop2000A.Loop2000B = new List <Loop_2000B_270>(); // Begin 2000B Loop var loop2000B = new Loop_2000B_270(); // Hierarchical ID Number = 2 // Hierarchical Parent ID Number = 1 // Hierarchical Level Code = 21 // Hierarchical Child Code = 1 loop2000B.HL_InformationReceiverLevel = new HL_InformationReceiverLevel(); loop2000B.HL_InformationReceiverLevel.HierarchicalIDNumber_01 = "2"; loop2000B.HL_InformationReceiverLevel.HierarchicalParentIDNumber_02 = "1"; loop2000B.HL_InformationReceiverLevel.HierarchicalLevelCode_03 = "21"; loop2000B.HL_InformationReceiverLevel.HierarchicalChildCode_04 = "1"; // Begin 2100B Loop loop2000B.Loop2100B = new Loop_2100B_270(); // Entity Identifier Code = 1P (Provider) // Entity Type Qualifier = 2(Non - person) // Last Name = Bone and Joint Clinic // First Name = *not used // Middle Name = *not used // Name Prefix = *not used // Name Suffix = *not used // Identification Code Qualifier = SV Service Provider Number // Identification Code = 2000035 loop2000B.Loop2100B.NM1_InformationReceiverName = new NM1_InformationReceiverName(); loop2000B.Loop2100B.NM1_InformationReceiverName.EntityIdentifierCode_01 = "1P"; loop2000B.Loop2100B.NM1_InformationReceiverName.EntityTypeQualifier_02 = "2"; loop2000B.Loop2100B.NM1_InformationReceiverName.ResponseContactLastorOrganizationName_03 = "BONE AND JOINT CLINIC"; loop2000B.Loop2100B.NM1_InformationReceiverName.IdentificationCodeQualifier_08 = "SV"; loop2000B.Loop2100B.NM1_InformationReceiverName.ResponseContactIdentifier_09 = "2000035"; // End 2100B Loop // Repeating 2000C Loops loop2000B.Loop2000C = new List <Loop_2000C_270>(); // Begin 2000C Loop 1 var loop2000C1 = new Loop_2000C_270(); // Hierarchical ID Number = 3 // Hierarchical Parent ID Number = 2 // Hierarchical Level Code = 22 // Hierarchical Child Code = 0 loop2000C1.HL_SubscriberLevel = new HL_SubscriberHierarchicalLevel(); loop2000C1.HL_SubscriberLevel.HierarchicalIDNumber_01 = "3"; loop2000C1.HL_SubscriberLevel.HierarchicalParentIDNumber_02 = "2"; loop2000C1.HL_SubscriberLevel.HierarchicalLevelCode_03 = "22"; loop2000C1.HL_SubscriberLevel.HierarchicalChildCode_04 = "0"; // Repeating TRN loop2000C1.TRN_SubscriberTraceNumber = new List <TRN_DependentTraceNumber>(); // Trace Type Code = 1 (Current Transaction Trace Number) // Reference Identification = 93175 - 012547 // Originating Company Identifier = 9877281234 // Reference Identification = *not used var trn = new TRN_DependentTraceNumber(); trn.TraceTypeCode_01 = "1"; trn.CurrentTransactionTraceNumber_02 = "93175-012547"; trn.OriginatingCompanyIdentifier_03 = "9877281234"; loop2000C1.TRN_SubscriberTraceNumber.Add(trn); // Begin 2100C Loop loop2000C1.Loop2100C = new Loop_2100C_270(); // Entity Identifier Code = IL (Insured or Subscriber) // Entity Type Qualifier = 1(Person) // Last Name = Smith // First Name = Robert // Middle Name = *not used // Name Prefix = *not used // Name Suffix = *not used // Identification Code Qualifier = MI(Member Identification Number) // Identification Code = 11122333301 loop2000C1.Loop2100C.NM1_SubscriberName = new NM1_SubscriberName(); loop2000C1.Loop2100C.NM1_SubscriberName.EntityIdentifierCode_01 = "IL"; loop2000C1.Loop2100C.NM1_SubscriberName.EntityTypeQualifier_02 = "1"; loop2000C1.Loop2100C.NM1_SubscriberName.ResponseContactLastorOrganizationName_03 = "SMITH"; loop2000C1.Loop2100C.NM1_SubscriberName.ResponseContactFirstName_04 = "ROBERT"; loop2000C1.Loop2100C.NM1_SubscriberName.IdentificationCodeQualifier_08 = "MI"; loop2000C1.Loop2100C.NM1_SubscriberName.ResponseContactIdentifier_09 = "11122333301"; // Date Time Period Format = D8 (Date Expressed in Format CCYYMMDD) // Date Time Period = 19430519 loop2000C1.Loop2100C.DMG_SubscriberDemographicInformation = new DMG_DependentDemographicInformation(); loop2000C1.Loop2100C.DMG_SubscriberDemographicInformation.DateTimePeriodFormatQualifier_01 = "D8"; loop2000C1.Loop2100C.DMG_SubscriberDemographicInformation.DependentBirthDate_02 = "19430519"; // Repeating DTP loop2000C1.Loop2100C.DTP_SubscriberDate = new List <DTP_SubscriberOrDependentDate>(); // Date/Time Qualifier = 291 (Plan) // Date Time Period Format Qualifier D8(Dates Expressed in Format CCYYMMDD) // Date Time Period = 20060501(May 1, 2006) var dtp = new DTP_SubscriberOrDependentDate(); dtp.DateTimeQualifier_01 = "291"; dtp.DateTimePeriodFormatQualifier_02 = "D8"; dtp.DateTimePeriod_03 = "20060501"; loop2000C1.Loop2100C.DTP_SubscriberDate.Add(dtp); // Repeating 2110C Loops loop2000C1.Loop2100C.Loop2110C = new List <Loop_2110C_270>(); // Begin 2110C Loop var loop2110C = new Loop_2110C_270(); // Service Type Code = 30 (Health Benefit Plan Coverage loop2110C.EQ_SubscriberEligibilityorBenefitInquiry = new EQ_SubscriberEligibilityorBenefitInquiry(); loop2110C.EQ_SubscriberEligibilityorBenefitInquiry.ServiceTypeCode_01 = new List <string> { "30" }; // End 2110C Loop loop2000C1.Loop2100C.Loop2110C.Add(loop2110C); // End 2100C Loop // End 2000C Loop 1 loop2000B.Loop2000C.Add(loop2000C1); // End 2000B Loop loop2000A.Loop2000B.Add(loop2000B); // End 2000A Loop result.Loop2000A.Add(loop2000A); return(result); }