| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | transmit date/time | 0;1 | DATE-TIME | B | This is the date and time the claim was transmitted as test. | |
| .02 | batch # | 0;2 | POINTER | 364.1 | C | This is the batch # this claim was transmitted in. |
| .03 | transmitted by | 0;3 | POINTER | 200 | This is the user who transmitted the claim as test. | |
| .04 | current payer sequence | 0;4 | NUMERIC | This is the current payer sequence when this claim was resubmitted. |
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