270 Requests Sent: ISA*00*1234567 *00* *ZZ*155214 *ZZ*OFFALLY *190228*1024*^*00501*000000001*0*T*:~ GS*HS*155214*OFFALLY*20190228*102457*2*X*005010X279A1~ ST*270*000000003*005010X279A1~ BHT*0022*13*PROVTest600*20190228*1024~ HL*1**20*1~ NM1*PR*2*TRICARE*****46*OFFALLY~ HL*2*1*21*1~ NM1*FA*2*Occupational Clinic, LLC*****FI*1044010401~ HL*3*2*22*0~ NM1*IL*1*Jones*RAYMOND*S***MI*796347724~ DMG*D8*19800925*M~ DTP*291*D8*20190227~ EQ*30~ SE*12*000000003~ GE*1*2~ IEA*1*000000001~ Patient : 44 271 X12: ISA*00* *00* *ZZ*OFFALLY *ZZ*155214 *190228*1524*^*00501*126591372*0*T*:~ GS*HB*OFFALLY*155214*20190228*1524*426591372*X*005010X279A1~ ST*271*26591372*005010X279A1~ BHT*0022*11*326591372*20190228*1524~ HL*1**20*1~ NM1*PR*2*TRICARE*****46*OFFALLY~ AAA*Y**79*C~ HL*2*1*21*1~ NM1*FA*2*Occupational Clinic, LLC*****FI*1044010401~ HL*3*2*22*0~ NM1*IL*1*Jones*RAYMOND*S***MI*796347724~ DMG*D8*19800925*M~ DTP*291*D8*20190227~ SE*12*26591372~ GE*1*426591372~ IEA*1*126591372~ 2100 LoopsArray ( [pid] => 44 [isa_sender_id] => OFFALLY [isa_receiver_id] => 155214 [isa_control_number] => 126591372 [payer_lname] => TRICARE [payer_fname] => [payer_mname] => [payer_member_id] => OFFALLY [provider_lname] => Occupational Clinic, LLC [provider_fname] => [provider_mname] => [provider_member_id] => 1044010401 [subscriber_lname] => Jones [subscriber_fname] => RAYMOND [subscriber_mname] => S [subscriber_member_id] => 796347724 [subscriber_dob] => 19800925 [subscriber_sex] => M ) EB Segments: Array ( ) AAA Segments: Array ( [0] => Array ( [request_ind] => Y [reason_code] => 79 [follow_up] => C [reason_text] => 79 : 270 2100A NM103 or NM109 Source Invalid ) )