/// <summary>
/// Sample claim
/// </summary>
static TS837 CreateClaim(string controlNumber)
{
var result = new TS837();
result.ST = new ST();
result.ST.TransactionSetIdentifierCode_01 = "837";
result.ST.TransactionSetControlNumber_02 = controlNumber.PadLeft(9, '0');
result.ST.ImplementationConventionPreference_03 = "005010X222A1";
result.BHT_BeginningofHierarchicalTransaction = new BHT_BeginningofHierarchicalTransaction();
result.BHT_BeginningofHierarchicalTransaction.HierarchicalStructureCode_01 = "0019";
result.BHT_BeginningofHierarchicalTransaction.TransactionSetPurposeCode_02 = "00";
result.BHT_BeginningofHierarchicalTransaction.OriginatorApplicationTransactionIdentifier_03 = "010";
result.BHT_BeginningofHierarchicalTransaction.TransactionSetCreationDate_04 = "20170617";
result.BHT_BeginningofHierarchicalTransaction.TransactionSetCreationTime_05 = "1741";
result.BHT_BeginningofHierarchicalTransaction.ClaimorEncounterIdentifier_06 = "CH";
result.All_NM1 = new All_NM1();
result.All_NM1.Loop_1000A = new Loop_1000A();
result.All_NM1.Loop_1000A.NM1_SubmitterName = new NM1_SubmitterName();
result.All_NM1.Loop_1000A.NM1_SubmitterName.EntityIdentifierCode_01 = "41";
result.All_NM1.Loop_1000A.NM1_SubmitterName.EntityTypeQualifier_02 = "2";
result.All_NM1.Loop_1000A.NM1_SubmitterName.SubmitterLastorOrganizationName_03 = "SUBMITTER";
result.All_NM1.Loop_1000A.NM1_SubmitterName.IdentificationCodeQualifier_08 = "46";
result.All_NM1.Loop_1000A.NM1_SubmitterName.SubmitterIdentifier_09 = "ABC123";
result.All_NM1.Loop_1000A.PER_SubmitterEDIContactInformation = new List <PER_SubmitterEDIContactInformation>();
var per1 = new PER_SubmitterEDIContactInformation();
per1.ContactFunctionCode_01 = "IC";
per1.SubmitterContactName_02 = "BOB SMITH";
per1.CommunicationNumberQualifier_03 = "TE";
per1.CommunicationNumber_04 = "4805551212";
result.All_NM1.Loop_1000A.PER_SubmitterEDIContactInformation.Add(per1);
result.All_NM1.Loop_1000B = new Loop_1000B();
result.All_NM1.Loop_1000B.NM1_ReceiverName = new NM1_ReceiverName();
result.All_NM1.Loop_1000B.NM1_ReceiverName.EntityIdentifierCode_01 = "40";
result.All_NM1.Loop_1000B.NM1_ReceiverName.EntityTypeQualifier_02 = "2";
result.All_NM1.Loop_1000B.NM1_ReceiverName.ReceiverName_03 = "RECEIVER";
result.All_NM1.Loop_1000B.NM1_ReceiverName.IdentificationCodeQualifier_08 = "46";
result.All_NM1.Loop_1000B.NM1_ReceiverName.ReceiverPrimaryIdentifier_09 = "44556";
result.Loop_2000A = new List <Loop_2000A>();
var loop2000A1 = new Loop_2000A();
loop2000A1.HL_BillingProviderHierarchicalLevel = new HL_BillingProviderHierarchicalLevel();
loop2000A1.HL_BillingProviderHierarchicalLevel.HierarchicalIDNumber_01 = "1";
loop2000A1.HL_BillingProviderHierarchicalLevel.HierarchicalLevelCode_03 = "20";
loop2000A1.HL_BillingProviderHierarchicalLevel.HierarchicalChildCode_04 = "1";
loop2000A1.All_NM1_2 = new All_NM1_2();
loop2000A1.All_NM1_2.Loop_2010AA = new Loop_2010AA();
loop2000A1.All_NM1_2.Loop_2010AA.NM1_BillingProviderName = new NM1_BillingProviderName();
loop2000A1.All_NM1_2.Loop_2010AA.NM1_BillingProviderName.EntityIdentifierCode_01 = "85";
loop2000A1.All_NM1_2.Loop_2010AA.NM1_BillingProviderName.EntityTypeQualifier_02 = "2";
loop2000A1.All_NM1_2.Loop_2010AA.NM1_BillingProviderName.BillingProviderLastorOrganizationalName_03 = "BILLING PROVIDER";
loop2000A1.All_NM1_2.Loop_2010AA.NM1_BillingProviderName.IdentificationCodeQualifier_08 = "XX";
loop2000A1.All_NM1_2.Loop_2010AA.NM1_BillingProviderName.BillingProviderIdentifier_09 = "1122334455";
loop2000A1.All_NM1_2.Loop_2010AA.N3_BillingProviderAddress = new N3_BillingProviderAddress();
loop2000A1.All_NM1_2.Loop_2010AA.N3_BillingProviderAddress.BillingProviderAddressLine_01 = "1234 SOME ROAD";
loop2000A1.All_NM1_2.Loop_2010AA.N4_BillingProviderCity_State_ZIPCode = new N4_BillingProviderCity_State_ZIPCode();
loop2000A1.All_NM1_2.Loop_2010AA.N4_BillingProviderCity_State_ZIPCode.BillingProviderCityName_01 = "CHICAGO";
loop2000A1.All_NM1_2.Loop_2010AA.N4_BillingProviderCity_State_ZIPCode.BillingProviderStateorProvinceCode_02 = "IL";
loop2000A1.All_NM1_2.Loop_2010AA.N4_BillingProviderCity_State_ZIPCode.BillingProviderPostalZoneorZIPCode_03 = "606739999";
loop2000A1.All_NM1_2.Loop_2010AA.All_REF = new All_REF();
loop2000A1.All_NM1_2.Loop_2010AA.All_REF.REF_BillingProviderTaxIdentification = new REF_BillingProviderTaxIdentification();
loop2000A1.All_NM1_2.Loop_2010AA.All_REF.REF_BillingProviderTaxIdentification
.ReferenceIdentificationQualifier_01 = "EI";
loop2000A1.All_NM1_2.Loop_2010AA.All_REF.REF_BillingProviderTaxIdentification
.BillingProviderTaxIdentificationNumber_02 = "999999999";
loop2000A1.Loop_2000B = new List <Loop_2000B>();
var loop2000B1 = new Loop_2000B();
loop2000B1.HL_SubscriberHierarchicalLevel = new HL_SubscriberHierarchicalLevel();
loop2000B1.HL_SubscriberHierarchicalLevel.HierarchicalIDNumber_01 = "2";
loop2000B1.HL_SubscriberHierarchicalLevel.HierarchicalParentIDNumber_02 = "1";
loop2000B1.HL_SubscriberHierarchicalLevel.HierarchicalLevelCode_03 = "22";
loop2000B1.HL_SubscriberHierarchicalLevel.HierarchicalChildCode_04 = "0";
loop2000B1.SBR_SubscriberInformation = new SBR_SubscriberInformation();
loop2000B1.SBR_SubscriberInformation.PayerResponsibilitySequenceNumberCode_01 = "P";
loop2000B1.SBR_SubscriberInformation.IndividualRelationshipCode_02 = "18";
loop2000B1.SBR_SubscriberInformation.ClaimFilingIndicatorCode_09 = "12";
loop2000B1.All_NM1_3 = new All_NM1_3();
loop2000B1.All_NM1_3.Loop_2010BA = new Loop_2010BA();
loop2000B1.All_NM1_3.Loop_2010BA.NM1_SubscriberName = new NM1_SubscriberName();
loop2000B1.All_NM1_3.Loop_2010BA.NM1_SubscriberName.EntityIdentifierCode_01 = "IL";
loop2000B1.All_NM1_3.Loop_2010BA.NM1_SubscriberName.EntityTypeQualifier_02 = "1";
loop2000B1.All_NM1_3.Loop_2010BA.NM1_SubscriberName.SubscriberLastName_03 = "BLOGGS";
loop2000B1.All_NM1_3.Loop_2010BA.NM1_SubscriberName.SubscriberFirstName_04 = "JOE";
loop2000B1.All_NM1_3.Loop_2010BA.NM1_SubscriberName.IdentificationCodeQualifier_08 = "MI";
loop2000B1.All_NM1_3.Loop_2010BA.NM1_SubscriberName.SubscriberPrimaryIdentifier_09 = "1234567890";
loop2000B1.All_NM1_3.Loop_2010BA.N3_SubscriberAddress = new N3_SubscriberAddress();
loop2000B1.All_NM1_3.Loop_2010BA.N3_SubscriberAddress.SubscriberAddressLine_01 = "1 SOME BLVD";
loop2000B1.All_NM1_3.Loop_2010BA.N4_SubscriberCity_State_ZIPCode = new N4_SubscriberCity_State_ZIPCode();
loop2000B1.All_NM1_3.Loop_2010BA.N4_SubscriberCity_State_ZIPCode.SubscriberCityName_01 = "CHICAGO";
loop2000B1.All_NM1_3.Loop_2010BA.N4_SubscriberCity_State_ZIPCode.SubscriberStateCode_02 = "IL";
loop2000B1.All_NM1_3.Loop_2010BA.N4_SubscriberCity_State_ZIPCode.SubscriberPostalZoneorZIPCode_03 = "606129998";
loop2000B1.All_NM1_3.Loop_2010BA.DMG_SubscriberDemographicInformation = new DMG_SubscriberDemographicInformation();
loop2000B1.All_NM1_3.Loop_2010BA.DMG_SubscriberDemographicInformation.DateTimePeriodFormatQualifier_01 = "D8";
loop2000B1.All_NM1_3.Loop_2010BA.DMG_SubscriberDemographicInformation.SubscriberBirthDate_02 = "19570111";
loop2000B1.All_NM1_3.Loop_2010BA.DMG_SubscriberDemographicInformation.SubscriberGenderCode_03 = "M";
loop2000B1.All_NM1_3.Loop_2010BB = new Loop_2010BB();
loop2000B1.All_NM1_3.Loop_2010BB.NM1_PayerName = new NM1_PayerName();
loop2000B1.All_NM1_3.Loop_2010BB.NM1_PayerName.EntityIdentifierCode_01 = "PR";
loop2000B1.All_NM1_3.Loop_2010BB.NM1_PayerName.EntityTypeQualifier_02 = "2";
loop2000B1.All_NM1_3.Loop_2010BB.NM1_PayerName.PayerName_03 = "PAYER";
loop2000B1.All_NM1_3.Loop_2010BB.NM1_PayerName.IdentificationCodeQualifier_08 = "PI";
loop2000B1.All_NM1_3.Loop_2010BB.NM1_PayerName.PayerIdentifier_09 = "12345";
loop2000B1.All_NM1_3.Loop_2010BB.N3_PayerAddress = new N3_PayerAddress();
loop2000B1.All_NM1_3.Loop_2010BB.N3_PayerAddress.PayerAddressLine_01 = "1 PAYER WAY";
loop2000B1.All_NM1_3.Loop_2010BB.N4_PayerCity_State_ZIPCode = new N4_PayerCity_State_ZIPCode();
loop2000B1.All_NM1_3.Loop_2010BB.N4_PayerCity_State_ZIPCode.PayerCityName_01 = "ST LOUIS";
loop2000B1.All_NM1_3.Loop_2010BB.N4_PayerCity_State_ZIPCode.PayerStateorProvinceCode_02 = "MO";
loop2000B1.All_NM1_3.Loop_2010BB.N4_PayerCity_State_ZIPCode.PayerPostalZoneorZIPCode_03 = "212441850";
loop2000B1.All_NM1_3.Loop_2010BB.All_REF_4 = new All_REF_4();
loop2000B1.All_NM1_3.Loop_2010BB.All_REF_4.REF_PayerSecondaryIdentification = new List <REF_PayerSecondaryIdentification>();
var refPayer1 = new REF_PayerSecondaryIdentification();
refPayer1.ReferenceIdentificationQualifier_01 = "2U";
refPayer1.PayerSecondaryIdentifier_02 = "W1014";
loop2000B1.All_NM1_3.Loop_2010BB.All_REF_4.REF_PayerSecondaryIdentification.Add(refPayer1);
loop2000B1.Loop_2300 = new List <Loop_2300>();
var loop23001 = new Loop_2300();
loop23001.CLM_ClaimInformation = new CLM_ClaimInformation();
loop23001.CLM_ClaimInformation.PatientControlNumber_01 = "1000A";
loop23001.CLM_ClaimInformation.TotalClaimChargeAmount_02 = "140";
loop23001.CLM_ClaimInformation.HealthCareServiceLocationInformation_05 = new C023_HealthCareServiceLocationInformation();
loop23001.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.PlaceofServiceCode_01 = "19";
loop23001.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.FacilityCodeQualifier_02 = "B";
loop23001.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.ClaimFrequencyCode_03 = "1";
loop23001.CLM_ClaimInformation.ProviderorSupplierSignatureIndicator_06 = "Y";
loop23001.CLM_ClaimInformation.AssignmentorPlanParticipationCode_07 = "A";
loop23001.CLM_ClaimInformation.BenefitsAssignmentCertificationIndicator_08 = "Y";
loop23001.CLM_ClaimInformation.ReleaseofInformationCode_09 = "Y";
loop23001.All_HI = new All_HI();
loop23001.All_HI.HI_HealthCareDiagnosisCode = new HI_HealthCareDiagnosisCode();
loop23001.All_HI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_01 = new C022_HealthCareCodeInformation();
loop23001.All_HI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_01.DiagnosisTypeCode_01 = "ABK";
loop23001.All_HI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_01.DiagnosisCode_02 = "I10";
loop23001.Loop_2400 = new List <Loop_2400>();
var loop24001 = new Loop_2400();
loop24001.LX_ServiceLineNumber = new LX_ServiceLineNumber();
loop24001.LX_ServiceLineNumber.AssignedNumber_01 = "1";
loop24001.SV1_ProfessionalService = new SV1_ProfessionalService();
loop24001.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01 = new C003_CompositeMedicalProcedureIdentifier();
loop24001.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProductorServiceIDQualifier_01 = "HC";
loop24001.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProcedureCode_02 = "99213";
loop24001.SV1_ProfessionalService.LineItemChargeAmount_02 = "140";
loop24001.SV1_ProfessionalService.UnitorBasisforMeasurementCode_03 = "UN";
loop24001.SV1_ProfessionalService.ServiceUnitCount_04 = "1";
loop24001.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07 = new C004_CompositeDiagnosisCodePointer();
loop24001.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07.DiagnosisCodePointer_01 = "1";
loop24001.All_DTP_2 = new All_DTP_2();
loop24001.All_DTP_2.DTP_Date_ServiceDate = new DTP_Date_ServiceDate();
loop24001.All_DTP_2.DTP_Date_ServiceDate.DateTimeQualifier_01 = "472";
loop24001.All_DTP_2.DTP_Date_ServiceDate.DateTimePeriodFormatQualifier_02 = "D8";
loop24001.All_DTP_2.DTP_Date_ServiceDate.ServiceDate_03 = "20151124";
loop23001.Loop_2400.Add(loop24001);
loop2000B1.Loop_2300.Add(loop23001);
loop2000A1.Loop_2000B.Add(loop2000B1);
// from here
var loop2000B2 = new Loop_2000B();
loop2000B2.HL_SubscriberHierarchicalLevel = new HL_SubscriberHierarchicalLevel();
loop2000B2.HL_SubscriberHierarchicalLevel.HierarchicalIDNumber_01 = "3";
loop2000B2.HL_SubscriberHierarchicalLevel.HierarchicalParentIDNumber_02 = "1";
loop2000B2.HL_SubscriberHierarchicalLevel.HierarchicalLevelCode_03 = "22";
loop2000B2.HL_SubscriberHierarchicalLevel.HierarchicalChildCode_04 = "0";
loop2000B2.SBR_SubscriberInformation = new SBR_SubscriberInformation();
loop2000B2.SBR_SubscriberInformation.PayerResponsibilitySequenceNumberCode_01 = "P";
loop2000B2.SBR_SubscriberInformation.IndividualRelationshipCode_02 = "18";
loop2000B2.SBR_SubscriberInformation.ClaimFilingIndicatorCode_09 = "12";
loop2000B2.All_NM1_3 = new All_NM1_3();
loop2000B2.All_NM1_3.Loop_2010BA = new Loop_2010BA();
loop2000B2.All_NM1_3.Loop_2010BA.NM1_SubscriberName = new NM1_SubscriberName();
loop2000B2.All_NM1_3.Loop_2010BA.NM1_SubscriberName.EntityIdentifierCode_01 = "IL";
loop2000B2.All_NM1_3.Loop_2010BA.NM1_SubscriberName.EntityTypeQualifier_02 = "1";
loop2000B2.All_NM1_3.Loop_2010BA.NM1_SubscriberName.SubscriberLastName_03 = "BLOGGS";
loop2000B2.All_NM1_3.Loop_2010BA.NM1_SubscriberName.SubscriberFirstName_04 = "FRED";
loop2000B2.All_NM1_3.Loop_2010BA.NM1_SubscriberName.IdentificationCodeQualifier_08 = "MI";
loop2000B2.All_NM1_3.Loop_2010BA.NM1_SubscriberName.SubscriberPrimaryIdentifier_09 = "9876543201";
loop2000B2.All_NM1_3.Loop_2010BA.N3_SubscriberAddress = new N3_SubscriberAddress();
loop2000B2.All_NM1_3.Loop_2010BA.N3_SubscriberAddress.SubscriberAddressLine_01 = "1 ANOTHER STR";
loop2000B2.All_NM1_3.Loop_2010BA.N4_SubscriberCity_State_ZIPCode = new N4_SubscriberCity_State_ZIPCode();
loop2000B2.All_NM1_3.Loop_2010BA.N4_SubscriberCity_State_ZIPCode.SubscriberCityName_01 = "CHICAGO";
loop2000B2.All_NM1_3.Loop_2010BA.N4_SubscriberCity_State_ZIPCode.SubscriberStateCode_02 = "IL";
loop2000B2.All_NM1_3.Loop_2010BA.N4_SubscriberCity_State_ZIPCode.SubscriberPostalZoneorZIPCode_03 = "606129998";
loop2000B2.All_NM1_3.Loop_2010BA.DMG_SubscriberDemographicInformation = new DMG_SubscriberDemographicInformation();
loop2000B2.All_NM1_3.Loop_2010BA.DMG_SubscriberDemographicInformation.DateTimePeriodFormatQualifier_01 = "D8";
loop2000B2.All_NM1_3.Loop_2010BA.DMG_SubscriberDemographicInformation.SubscriberBirthDate_02 = "19700601";
loop2000B2.All_NM1_3.Loop_2010BA.DMG_SubscriberDemographicInformation.SubscriberGenderCode_03 = "M";
loop2000B2.All_NM1_3.Loop_2010BB = new Loop_2010BB();
loop2000B2.All_NM1_3.Loop_2010BB.NM1_PayerName = new NM1_PayerName();
loop2000B2.All_NM1_3.Loop_2010BB.NM1_PayerName.EntityIdentifierCode_01 = "PR";
loop2000B2.All_NM1_3.Loop_2010BB.NM1_PayerName.EntityTypeQualifier_02 = "2";
loop2000B2.All_NM1_3.Loop_2010BB.NM1_PayerName.PayerName_03 = "PAYER";
loop2000B2.All_NM1_3.Loop_2010BB.NM1_PayerName.IdentificationCodeQualifier_08 = "PI";
loop2000B2.All_NM1_3.Loop_2010BB.NM1_PayerName.PayerIdentifier_09 = "12345";
loop2000B2.All_NM1_3.Loop_2010BB.N3_PayerAddress = new N3_PayerAddress();
loop2000B2.All_NM1_3.Loop_2010BB.N3_PayerAddress.PayerAddressLine_01 = "1 PAYER WAY";
loop2000B2.All_NM1_3.Loop_2010BB.N4_PayerCity_State_ZIPCode = new N4_PayerCity_State_ZIPCode();
loop2000B2.All_NM1_3.Loop_2010BB.N4_PayerCity_State_ZIPCode.PayerCityName_01 = "ST LOUIS";
loop2000B2.All_NM1_3.Loop_2010BB.N4_PayerCity_State_ZIPCode.PayerStateorProvinceCode_02 = "MO";
loop2000B2.All_NM1_3.Loop_2010BB.N4_PayerCity_State_ZIPCode.PayerPostalZoneorZIPCode_03 = "212441850";
loop2000B2.All_NM1_3.Loop_2010BB.All_REF_4 = new All_REF_4();
loop2000B2.All_NM1_3.Loop_2010BB.All_REF_4.REF_PayerSecondaryIdentification = new List <REF_PayerSecondaryIdentification>();
var refPayer2 = new REF_PayerSecondaryIdentification();
refPayer2.ReferenceIdentificationQualifier_01 = "2U";
refPayer2.PayerSecondaryIdentifier_02 = "W1014";
loop2000B2.All_NM1_3.Loop_2010BB.All_REF_4.REF_PayerSecondaryIdentification.Add(refPayer2);
loop2000B2.Loop_2300 = new List <Loop_2300>();
var loop23002 = new Loop_2300();
loop23002.CLM_ClaimInformation = new CLM_ClaimInformation();
loop23002.CLM_ClaimInformation.PatientControlNumber_01 = "1001A";
loop23002.CLM_ClaimInformation.TotalClaimChargeAmount_02 = "140";
loop23002.CLM_ClaimInformation.HealthCareServiceLocationInformation_05 = new C023_HealthCareServiceLocationInformation();
loop23002.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.PlaceofServiceCode_01 = "19";
loop23002.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.FacilityCodeQualifier_02 = "B";
loop23002.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.ClaimFrequencyCode_03 = "1";
loop23002.CLM_ClaimInformation.ProviderorSupplierSignatureIndicator_06 = "Y";
loop23002.CLM_ClaimInformation.AssignmentorPlanParticipationCode_07 = "A";
loop23002.CLM_ClaimInformation.BenefitsAssignmentCertificationIndicator_08 = "Y";
loop23002.CLM_ClaimInformation.ReleaseofInformationCode_09 = "Y";
loop23002.All_HI = new All_HI();
loop23002.All_HI.HI_HealthCareDiagnosisCode = new HI_HealthCareDiagnosisCode();
loop23002.All_HI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_01 = new C022_HealthCareCodeInformation();
loop23002.All_HI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_01.DiagnosisTypeCode_01 = "ABK";
loop23002.All_HI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_01.DiagnosisCode_02 = "I10";
loop23002.Loop_2400 = new List <Loop_2400>();
var loop24002 = new Loop_2400();
loop24002.LX_ServiceLineNumber = new LX_ServiceLineNumber();
loop24002.LX_ServiceLineNumber.AssignedNumber_01 = "1";
loop24002.SV1_ProfessionalService = new SV1_ProfessionalService();
loop24002.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01 = new C003_CompositeMedicalProcedureIdentifier();
loop24002.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProductorServiceIDQualifier_01 = "HC";
loop24002.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProcedureCode_02 = "99213";
loop24002.SV1_ProfessionalService.LineItemChargeAmount_02 = "140";
loop24002.SV1_ProfessionalService.UnitorBasisforMeasurementCode_03 = "UN";
loop24002.SV1_ProfessionalService.ServiceUnitCount_04 = "1";
loop24002.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07 = new C004_CompositeDiagnosisCodePointer();
loop24002.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07.DiagnosisCodePointer_01 = "1";
loop24002.All_DTP_2 = new All_DTP_2();
loop24002.All_DTP_2.DTP_Date_ServiceDate = new DTP_Date_ServiceDate();
loop24002.All_DTP_2.DTP_Date_ServiceDate.DateTimeQualifier_01 = "472";
loop24002.All_DTP_2.DTP_Date_ServiceDate.DateTimePeriodFormatQualifier_02 = "D8";
loop24002.All_DTP_2.DTP_Date_ServiceDate.ServiceDate_03 = "20151124";
loop23002.Loop_2400.Add(loop24002);
loop2000B2.Loop_2300.Add(loop23002);
loop2000A1.Loop_2000B.Add(loop2000B2);
result.Loop_2000A.Add(loop2000A1);
return(result);
}
/// <summary>
/// Sample claim
/// </summary>
static TS834 CreateBenefit(string controlNumber)
{
string CurrentDate = DateTime.Now.ToString("yyyyMMdd");
var result = new TS834();
//Heading
result.ST = new ST();
result.ST.TransactionSetIdentifierCode_01 = "834";
result.ST.TransactionSetControlNumber_02 = controlNumber.PadLeft(9, '0');
result.ST.ImplementationConventionPreference_03 = "005010X222A1";
result.BGN = new BGN();
result.BGN.TransactionSetPurposeCode_01 = "00";
result.BGN.TransactionSetReferenceNumber_02 = "WSU-WEY-20050221-1";
result.BGN.TransactionSetCreationDate_03 = CurrentDate;
result.BGN.TransactionSetCreationTime_04 = DateTime.Now.ToString("hhmmss");
result.BGN.TimeZoneCode_05 = "PT"; //Optional but most Carriers use
//result.BGN.ReferenceIdentification_06 = ""; //Not usually sent
result.BGN.ActionCode_07 = "4"; //2 = Change, 4 = Verify, RX = replace
//Optional REF
result.REF_TransactionSetPolicyNumber = new REF();
result.REF_TransactionSetPolicyNumber.ReferenceIdentificationQualifier_01 = "38";
result.REF_TransactionSetPolicyNumber.ReferenceIdentification_02 = "01-23456";//Carrier/Vendor specific
//Optional DTP
result.DTP_FileEffectiveDate.DateTimeQualifier_01 = "007";
result.DTP_FileEffectiveDate.DateTimePeriodFormatQualifier_02 = "D8";
result.DTP_FileEffectiveDate.DateTimePeriod_03 = CurrentDate;
//Optional QTY
result.QTY_TransactionSetControlTotals = new QTY();
result.QTY_TransactionSetControlTotals.QuantityQualifier_01 = "TO";
result.QTY_TransactionSetControlTotals.Quantity_02 = "1";//Only one record for this example.
//Loop 1000
result.All_NM1 = new All_NM1();
//Loop 1000A
result.All_NM1.Loop_1000A = new Loop_1000A();
result.All_NM1.Loop_1000A.NM1_SponsorName.EntityIdentifierCode_01 = "P5";
result.All_NM1.Loop_1000A.NM1_SponsorName.Name_02 = "Sponsor Name";
result.All_NM1.Loop_1000A.NM1_SponsorName.IdentificationCodeQualifier_03 = "FI";
result.All_NM1.Loop_1000A.NM1_SponsorName.IdentificationCode_04 = "1223456";
//Loop 1000B
result.All_NM1.Loop_1000B = new Loop_1000B();
result.All_NM1.Loop_1000B.NM1_PayerName.EntityIdentifierCode_01 = "IN";
result.All_NM1.Loop_1000B.NM1_PayerName.Name_02 = "ABC PAYER";
result.All_NM1.Loop_1000B.NM1_PayerName.IdentificationCodeQualifier_03 = "FI";
result.All_NM1.Loop_1000B.NM1_PayerName.IdentificationCode_04 = "11-111111";
//result.All_NM1.Loop_1000C = new Loop_1000C();
//Usually brokers are optional fields
//Loop 2000
//INS
result.Loop_2000 = new List <Loop_2000>();
Loop_2000 Loop_2000 = new Loop_2000();
Loop_2000.INS = new INS();
Loop_2000.INS.YesNoConditionorResponseCode_01 = "Y";//Subscriber/Member record
Loop_2000.INS.IndividualRelationshipCode_02 = "18";
Loop_2000.INS.MaintenanceTypeCode_03 = "021";
Loop_2000.INS.MaintenanceReasonCode_04 = "20";
Loop_2000.INS.BenefitStatusCode_05 = "A";
Loop_2000.INS.MedicarePlanCode_06 = "E";
//Loop_2000.INS.ConsolidatedOmnibusBudgetReconciliationActCOBRAQualifyingEventCode_07 = "0";
Loop_2000.INS.EmploymentStatusCode_08 = "AC";
//Loop_2000.INS.StudentStatusCode_09 = "N";
Loop_2000.INS.YesNoConditionorResponseCode_10 = "N";
//Loop_2000.INS.DateTimePeriodFormatQualifier_11 = "";//Dealth Date: Carrier specific
//Loop_2000.INS.DateTimePeriod_12 = "";
Loop_2000.INS.ConfidentialityCode_13 = "";//Usually left blank.
//Loop_2000.INS.CityName_14 = "City"; //14-17 usually not sent in favor of N3/N4 segments
Loop_2000.Ref_SubscriberIdentifier = new REF();
Loop_2000.Ref_SubscriberIdentifier.ReferenceIdentificationQualifier_01 = "0F";
Loop_2000.Ref_SubscriberIdentifier.ReferenceIdentification_02 = "12345678";//typically a UUID or SSN
Loop_2000.Ref_MemberSupplementalIdentifier = new REF();
Loop_2000.Ref_MemberSupplementalIdentifier.ReferenceIdentificationQualifier_01 = "1L";
Loop_2000.Ref_MemberSupplementalIdentifier.ReferenceIdentification_02 = "ABC123";//Group or Policy Number usually Carrier specific
DTP DTP_MemberHireSegment = new DTP();
DTP_MemberHireSegment.DateTimeQualifier_01 = "336";
DTP_MemberHireSegment.DateTimePeriodFormatQualifier_02 = "D8";
DTP_MemberHireSegment.DateTimePeriod_03 = "20170501";
DTP DTP_MemberEffectiveSegment = new DTP();
DTP_MemberEffectiveSegment.DateTimeQualifier_01 = "356";
DTP_MemberEffectiveSegment.DateTimePeriodFormatQualifier_02 = "D8";
DTP_MemberEffectiveSegment.DateTimePeriod_03 = "20170601";
//Example term of coverage
//DTP DTP_MemberEligibilityEndSegment = new DTP();
//DTP_MemberEligibilityEndSegment.DateTimeQualifier_01 = "357";
//DTP_MemberEligibilityEndSegment.DateTimePeriodFormatQualifier_02 = "D8";
//DTP_MemberEligibilityEndSegment.DateTimePeriod_03 = "20171231";
Loop_2000.DTP_MemberLevelDates.Add(DTP_MemberHireSegment);
Loop_2000.DTP_MemberLevelDates.Add(DTP_MemberEffectiveSegment);
result.Loop_2000.Add(Loop_2000);
result.Loop_2100A = new List <Loop_2100A>();
Loop_2100A Loop_2100A = new Loop_2100A();
Loop_2100A.NM1_MemberName = new NM1();
Loop_2100A.NM1_MemberName.EntityIdentifierCode_01 = "IL";
Loop_2100A.NM1_MemberName.Name_02 = "1";
Loop_2100A.NM1_MemberName.IdentificationCodeQualifier_03 = "MemberLastName";
Loop_2100A.NM1_MemberName.IdentificationCode_04 = "MemberFirstname";
//Optional Loop 2100A Segment NM1 05-09
Loop_2100A.Per_MemberCommunicationNumbers = new PER();
Loop_2100A.Per_MemberCommunicationNumbers.ContactFunctionCode_01 = "IP";
//Loop_2100A.Per_MemberCommunicationNumbers.Name_02 = "abc123";
Loop_2100A.Per_MemberCommunicationNumbers.CommunicationNumberQualifier_03 = "CP";
Loop_2100A.Per_MemberCommunicationNumbers.CommunicationNumber_04 = "9991111111";
//Optional Loop 2100A Segment Per
Loop_2100A.N3_MemberResidenceStreetAddress = new N3_MemberResidenceStreetAddress();
Loop_2100A.N3_MemberResidenceStreetAddress.Address_Information_01 = "444 Fake street";
Loop_2100A.N3_MemberResidenceStreetAddress.Address_Information_02 = "Apt 300";
Loop_2100A.N4_OtherSubscriberCity_State_ZIPCode = new N4_OtherSubscriberCity_State_ZIPCode();
Loop_2100A.N4_OtherSubscriberCity_State_ZIPCode.OtherSubscriberCityName_01 = "TestCity";
Loop_2100A.N4_OtherSubscriberCity_State_ZIPCode.OtherSubscriberStateorProvinceCode_02 = "CA";
Loop_2100A.N4_OtherSubscriberCity_State_ZIPCode.OtherSubscriberPostalZoneorZIPCode_03 = "93710";
//Loop_2100A.N4_OtherSubscriberCity_State_ZIPCode.CountryCode_04 = "US";//Optional. Only outside the US.
//Loop_2100A.N4_OtherSubscriberCity_State_ZIPCode.LocationQualifier_05 = "";//Optional. 60 = Area and CY = Country/Parish
//Loop_2100A.N4_OtherSubscriberCity_State_ZIPCode.LocationIdentifier_06 = "";//Optional. Carrier/Plan specific.
//Loop_2100A.N4_OtherSubscriberCity_State_ZIPCode.CountrySubdivisionCode_07 = "";//Optional. Use country subdivision codes ISO 3166.
Loop_2100A.DMG_MemberDemographicInformation = new DMG_MemberDemographicInformation();
Loop_2100A.DMG_MemberDemographicInformation.DateTimePeriodFormatQualifier_01 = "D8";
Loop_2100A.DMG_MemberDemographicInformation.SubscriberBirthDate_02 = "19330706";
Loop_2100A.DMG_MemberDemographicInformation.SubscriberGenderCode_03 = "M";
//Optional Loop 2100A Segment DMG 04-11
//Optional sgment unless Carrier/Client specifically ask for it.
Loop_2100A.EC_EmploymentClass = new EC_EmploymentClass();
Loop_2100A.EC_EmploymentClass.EmpoymentClassCode_01 = "01";
Loop_2100A.EC_EmploymentClass.EmpoymentClassCode_02 = "03";
Loop_2100A.EC_EmploymentClass.EmpoymentClassCode_03 = "11";
//Optional Member Income segment
//Used for Carriers/Employeers that need specific member income amounts as part of billable plans.
Loop_2100A.ICM_MemberIncome.FrequencyCode_01 = "1";//Typically weekly or monthly
Loop_2100A.ICM_MemberIncome.MonetaryAmount_02 = "2000";
Loop_2100A.ICM_MemberIncome.Quantity_03 = "40";
Loop_2100A.ICM_MemberIncome.LocationIdentifier_04 = "93710"; //Most will default to a an internal location code or Zip
Loop_2100A.ICM_MemberIncome.SalaryGrade_05 = "A"; //Abitrary Code set by the employeer
//TODO: Optional Segments
//AMT Member Policy Amounts
//HLH Member Health Information
//LUI Member Language
//NM1 Member mailing Address
//N3 Member Mail Street Address
//N4 Member Mail city, State, Zip
result.Loop_2100A.Add(Loop_2100A);
//Loop 2200:
//DSB Disability Info
//DTP Disability Eligibility Dates
//Loop 2300 (Required on most Carriers)
result.Loop_2300 = new List <Loop_2300>();
Loop_2300 Loop_2300 = new Loop_2300();
Loop_2300.HD_HealthCoverage = new HD();
Loop_2300.HD_HealthCoverage.MaintenanceTypeCode_01 = "026";
//Loop_2300.HD_HealthCoverage.MaintenanceReasonCode_02 = "1";//usually Carrier specific
Loop_2300.HD_HealthCoverage.InsuranceLineCode_03 = "PPO";
Loop_2300.HD_HealthCoverage.PlanCoverageDescription_04 = "Test PPO Plan"; //Optional. Some carriers make this a required field with specific reporting values.
Loop_2300.HD_HealthCoverage.CoverageLevelCode_05 = "EMP"; //Employee only is usually EMP or IND Carrier specific
//06-07 almost never used
Loop_2300.HD_HealthCoverage.UnderwritingDecisionCode_08 = "Y"; //Y/N value but can be removed if nessessary
Loop_2300.HD_HealthCoverage.YesNoConditionorResponseCode_09 = "N"; //Sometimes used as a Late Enrollment Indicator
DTP DTP_MaintenanceEffective = new DTP();
DTP_MaintenanceEffective.DateTimeQualifier_01 = "303";
DTP_MaintenanceEffective.DateTimePeriodFormatQualifier_02 = "D3";
DTP_MaintenanceEffective.DateTimePeriod_03 = "20151001";
Loop_2300.DTP_HealthCoverageDates.Add(DTP_MaintenanceEffective);
DTP DTP_BenefitBegin = new DTP();
DTP_BenefitBegin.DateTimeQualifier_01 = "348";
DTP_BenefitBegin.DateTimePeriodFormatQualifier_02 = "348";
DTP_BenefitBegin.DateTimePeriod_03 = "20150901";
Loop_2300.DTP_HealthCoverageDates.Add(DTP_BenefitBegin);
REF REF_ClientReportingCategory = new REF();
REF_ClientReportingCategory.ReferenceIdentificationQualifier_01 = "17";
REF_ClientReportingCategory.ReferenceIdentification_02 = "12345";
Loop_2300.REF_HealthCoveragePolicyNumbers.Add(REF_ClientReportingCategory);
REF REF_GroupPolicyNumber = new REF();
REF_GroupPolicyNumber.ReferenceIdentificationQualifier_01 = "1L";
REF_GroupPolicyNumber.ReferenceIdentification_02 = "54321";
Loop_2300.REF_HealthCoveragePolicyNumbers.Add(REF_GroupPolicyNumber);
result.Loop_2300.Add(Loop_2300);
result.Loop_2310 = new List <Loop_2310>();
Loop_2310 Loop_2310 = new Loop_2310();
Loop_2310.LX_ProviderInformation = new LX();
Loop_2310.LX_ProviderInformation.AssignedNumber_01 = "1";
Loop_2310.NM1_ReferingProviderName = new NM1_ReferringProviderName();
Loop_2310.NM1_ReferingProviderName.EntityIdentifierCode_01 = "OD";
Loop_2310.NM1_ReferingProviderName.EntityTypeQualifier_02 = "1";
Loop_2310.NM1_ReferingProviderName.ReferringProviderLastName_03 = "ABC Hospital";
Loop_2310.NM1_ReferingProviderName.ReferringProviderFirstName_04 = "Care";
Loop_2310.NM1_ReferingProviderName.ReferringProviderMiddleNameorInitial_05 = "A";
Loop_2310.NM1_ReferingProviderName.NamePrefix_06 = "Sr";
Loop_2310.NM1_ReferingProviderName.ReferringProviderNameSuffix_07 = "";
Loop_2310.NM1_ReferingProviderName.IdentificationCodeQualifier_08 = "SV";
Loop_2310.NM1_ReferingProviderName.ReferringProviderIdentifier_09 = "Doc PPO";
Loop_2310.NM1_ReferingProviderName.EntityRelationshipCode_10 = "25";
result.Loop_2310.Add(Loop_2310);
result.Loop_2320 = new List <Loop_2320>();
Loop_2320 Loop_2320 = new Loop_2320();
Loop_2320.COB_CoordinationOfBenefits.PayerResponsibilitySequenceNumberCode_01 = "P";
Loop_2320.COB_CoordinationOfBenefits.ReferenceIdentification_02 = "A";
Loop_2320.COB_CoordinationOfBenefits.CoordinationofBenefitsCode_03 = "1";
Loop_2320.COB_CoordinationOfBenefits.ServiceTypeCode_04 = "1";
Loop_2320.REF_AdditionalCoordinationOfBenefitsIdentifiers = new List <REF>();
REF REFAccountCode = new REF();
REFAccountCode.ReferenceIdentificationQualifier_01 = "60";
REFAccountCode.ReferenceIdentification_02 = "12345";
Loop_2320.REF_AdditionalCoordinationOfBenefitsIdentifiers.Add(REFAccountCode);
Loop_2320.DTP_CoordinationOfBenefitsEleigibilityDates = new List <DTP>();
DTP DTP_CoordinationOfBenefitBegin = new DTP();
DTP_CoordinationOfBenefitBegin.DateTimeQualifier_01 = "334";
DTP_CoordinationOfBenefitBegin.DateTimePeriodFormatQualifier_02 = "D8";
DTP_CoordinationOfBenefitBegin.DateTimePeriod_03 = "20150101";
result.Loop_2320.Add(Loop_2320);
Loop_2330 Loop_2330 = new Loop_2330();
Loop_2330.NM1_CoordinationOfBenefitsRelatedEntity = new NM1_InsuranceProviderName();
Loop_2330.NM1_CoordinationOfBenefitsRelatedEntity.EntityIdentifierCode_01 = "IN";
Loop_2330.NM1_CoordinationOfBenefitsRelatedEntity.EntityTypeQualifier_02 = "2";
Loop_2330.NM1_CoordinationOfBenefitsRelatedEntity.ReferringProviderLastName_03 = "Insurance";
Loop_2330.NM1_CoordinationOfBenefitsRelatedEntity.ReferringProviderFirstName_04 = "ABC";
Loop_2330.NM1_CoordinationOfBenefitsRelatedEntity.IdentificationCodeQualifier_08 = "FI";
Loop_2330.NM1_CoordinationOfBenefitsRelatedEntity.ReferringProviderIdentifier_09 = "12-345678";
//Misleading as "Loop" only contains NM1 element once.
result.Loop_2330 = Loop_2330;
//Optional Report Category
//Misleading as "Loop" usually contains LX element only once.
Loop_2700 Loop_2700 = new Loop_2700();
Loop_2700.LX_MemberReportingCategories = new LX();
Loop_2700.LX_MemberReportingCategories.AssignedNumber_01 = "2";
return(result);
}
