{
"heading": {
"transaction_set_header_ST": {
"transaction_set_identifier_code_01": "834",
"transaction_set_control_number_02": 12345,
"implementation_convention_reference_03": "005010X220A1"
},
"beginning_segment_BGN": {
"transaction_set_purpose_code_01": "00",
"transaction_set_reference_number_02": "12456",
"transaction_set_creation_date_03": "1998-05-20",
"transaction_set_creation_time_04": "12:00",
"action_code_08": "2"
},
"transaction_set_policy_number_REF": {
"reference_identification_qualifier_01": "38",
"master_policy_number_02": "ABCD012354"
},
"sponsor_name_N1_loop": {
"sponsor_name_N1": {
"entity_identifier_code_01": "P5",
"identification_code_qualifier_03": "FI",
"sponsor_identifier_04": "999888777"
}
},
"payer_N1_loop": {
"payer_N1": {
"entity_identifier_code_01": "IN",
"identification_code_qualifier_03": "FI",
"insurer_identification_code_04": "654456654"
}
}
},
"detail": {
"member_level_detail_INS_loop": [
{
"member_level_detail_INS": {
"member_indicator_01": "N",
"individual_relationship_code_02": "19",
"maintenance_type_code_03": "024",
"maintenance_reason_code_04": "07",
"benefit_status_code_05": "A"
},
"subscriber_identifier_REF": {
"reference_identification_qualifier_01": "0F",
"subscriber_identifier_02": "123456789"
},
"member_policy_number_REF": {
"reference_identification_qualifier_01": "1L",
"member_group_or_policy_number_02": "123456001"
},
"member_level_dates_DTP": [
{
"date_time_qualifier_01": "357",
"date_time_period_format_qualifier_02": "D8",
"status_information_effective_date_03": "19960801"
}
],
"member_name_NM1_loop": {
"member_name_NM1": {
"entity_identifier_code_01": "IL",
"entity_type_qualifier_02": "1",
"member_last_name_03": "DOE",
"member_first_name_04": "JAMES",
"member_middle_name_05": "E",
"identification_code_qualifier_08": "34",
"member_identifier_09": "103229876"
},
"member_demographics_DMG": {
"date_time_period_format_qualifier_01": "D8",
"member_birth_date_02": "19770816",
"gender_code_03": "M"
}
}
}
],
"transaction_set_trailer_SE": {
"transaction_segment_count_01": 12,
"transaction_set_control_number_02": 12345
}
}
}