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Please select the field below and enter your details.

* Indicates a required field

x12 100 Insurance Plan Description

100 Example

ISA*00* *00* *01*1234567890 *01*999999999 *120125*1325*U*00401*000000001*0*P~
GS*PG*1234567890 *999999999 *20120125*1325*1*T*004010~
ST*100*0001~
BGN*00*Reference Identification*20120125*1325*01*Reference Identification*01*1*00~
C3*CUR*433283*CUR*CUR~
DTP*001*CC*Date Time Period~
NM1*01*1*Name Last or Organization Name*Name First*Name Middle*Name Prefi*Name Suffi*1*Identification Code*01*01~
N3*Address Information*Address Information~
N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier~
REF*01*Reference Identification*Description*01\Reference Identification\01\Reference Identification\01\Reference Identification~
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe~
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe~
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe~
N1*01*Name*1*Identification Code*01*01~
N2*Name*Name~
N3*Address Information*Address Information~
N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier~
COM*AA*Communication Number~
III*0*Industry Code*01*Free-Form Message ~
Text*21485498*01\4\3158\01\30293911918169\71562414\01\98\22\01\242598854187\29853\01\206791526722\2*1S*1S*1S~
MSG*Free-Form Message Text*AA*6187232~
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe~
N3*Address Information*Address Information~
N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier~
PID*F*01*10*Product Desc*Description*1S*Source Subquali*N*LAN~
LIN*Assigned Identificat*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service~
ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service~
ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID~
DTP*001*CC*Date Time Period~
NM1*01*1*Name Last or Organization Name*Name First*Name Middle*Name Prefi*Name Suffi*1*Identification Code*01*01~
BLI*A1*Product/Service ID*27920257061*01*ACT*2798913313178101*01*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*1*1*1*1*1~
DTP*001*CC*Date Time Period~
III*0*Industry Code*01*Free-Form Message~
Text*19*01\58091304630633\213771918\01\2\4539111\01\32422858125946\1457323733\01\395292\1068\01\231383050086\90271483*1S*1S*1S~
AMT*1*514476602*C~
QTY*01*65*01\260941387\304321657\01\29381113216\166161\01\2\23743\01\25624235013121\7311781225\01\21052541\2~
SI*10*Se*Product/Service ID*Se*Product/Service ID*Se*Product/Service ID*Se*Product/Service ID*Se*Product/Service ID*Se*Product/Service~
ID*Se*Product/Service ID*Se*Product/Service ID*Se*Product/Service ID*Se*Product/Service ID~
AMT*1*538813688*C~
QTY*01*1479*01\174811539\1637885\01\350323529\221217\01\3256915\1696826\01\129\218314\01\257821719732038\1~
AM1*01*A1*Product/Service ID*124402331*245*29956146~
MSG*Free-Form Message Text*AA*258~
PO1*Assigned Identificat*4841*01*7561*AA*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service~
ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID~
LIN*Assigned Identificat*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service~
ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service~
ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID~
SPA*01*CC*Date Time Period*1*15*001*001*001*10*Product Desc*Source Subquali~
III*0*Industry Code*01*Free-Form Message Text*17119*01\23325\1073\01\2125505\24661\01\5501036\2004\01\2\14\01\2\2795*1S*1S*1S~
N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier~
SPA*01*CC*Date Time Period*1*1495*001*001*001*10*Product Desc*Source Subquali~
AM1*01*A1*Product/Service ID*3056328601*26957647*1439~
MSG*Free-Form Message Text*AA*20147~
PO1*Assigned Identificat*3065*01*12199*AA*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service~
ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID~
SPA*01*CC*Date Time Period*1*2596930853611*001*001*001*10*Product Desc*Source Subquali~
SPA*01*CC*Date Time Period*1*136662354327753*001*001*001*10*Product Desc*Source Subquali~
III*0*Industry Code*01*Free-Form Message Text*169834*01\2385523\119134\01\24922\66827451\01\24\2\01\12\1\01\2761465761\16*1S*1S*1S~
SE*48*0001~
GE*1*1~
IEA*1*000000001~