ACT

TPA/Broker Account Information

Pos: 120	Max: 1
Heading - Optional
Loop: 1100C	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

ACT01

508

Account Number
Description: Account number assigned
Industry: TPA or Broker Account Number

M

AN

1/35

Required

ACT06

508

Account Number
Description: Account number assigned
Industry: TPA or Broker Account Number
Send if more than 1 TPA or Broker Account Number applies to this transaction.

C

AN

1/35

Situational

1.

P0304 - If either ACT03,ACT04 is present, then all are required

2.

C0506 - If ACT05 is present, then all of ACT06 are required

3.

C0705 - If ACT07 is present, then all of ACT05 are required

1.

ACT02 is the name of the account in ACT01.

2.

ACT07 is the name associated with the account identified in ACT06.

1.

ACT06 is an account associated with the account in ACT01.

2.

ACT08 indicates if the data for the account in ACT01 is used for billing or information purposes.

Notes:

1. This segment is REQUIRED if the account number of the TPA or Broker is different than the account number for the sponsor.

Example:

ACT*1234*****23498765~