Attachments JSON-to-EDI Map in a Request

The following JSON code block shows the direct relationship between JSON fields in an attachment request and the X12 EDI loop associated with each field in the 275 request.

  "controlNumber": "controlNumber",
  "tradingPartnerServiceId": "LOOP 1000A; NM109",
  "tradingPartnerName": "LOOP 1000A NM103",
  "payerFaxNumber": "fax number of the payer",
  "payerAddress": {
        "address1": "",
        "address2": "",
        "city": "",
        "state": "",
        "postalCode": ""
      "organizationName": "LOOP 1000B NM103",
      "firstName": "LOOP 1000B NM104",
      "lastName": "LOOP 1000B NM103",
      "etin": "LOOP 1000B NM109; "
      "organizationName": "LOOP 1000C NM103",
      "lastName": "LOOP 1000C NM103",
      "firstName": "LOOP 1000C NM104",
      "middleName": "LOOP 1000C NM105",
      "suffix": "LOOP 1000C NM107",
      "npi": "LOOP 1000C NM109",
      "taxonomyCode": "LOOP 1000C PRV03",
      "providerCommercialNumber": "Loops to 1000C; Maps to REF02; REF01=G2",
	    "locationNumber": "Loops to 1000C; Maps to REF02; REF01=LU",
	    "stateLicenseNumber": "Loops to 1000C; Maps to REF02; REF01=0B",
	    "providerUpinNumber": "Loops to 1000C; Maps to REF02; REF01=1G",
           "address1": "LOOP 1100C",
           "address2": "LOOP 1100C; maps N302",
           "city": "LOOP 1100C; N401",
           "state": "LOOP 1100C; N402",
           "postalCode": "LOOP 1100C; N403"
      "phoneNumber": "Used in fax cover sheet",
      "faxNumber": "Used in fax cover sheet"
      "memberId": "LOOP 1000D NM segment; NM108=MI",
      "firstName" : "LOOP 1000D NM segment; NM104",
      "lastName" : "LOOP 1000D NM segment; NM103"
      "patientControlNumber": "LOOP 1000D REF=EJ segment",
      "billingTypeIdentifier": "LOOP 1000D REF=BLT",
      "medicalRecordIdentifier": "LOOP 1000D REF=EA",
      "claimNumber": "LOOP 1000D REF=D9",
      "beginClaimServiceDate": "LOOP 1000D DTP segment; DTP01=472; DTP02=RD8",
      "endClaimServiceDate": "LOOP 1000D DTP segment; DTP01=472; DTP02=RD8",
      "claimServiceDate": "LOOP 1000D DTP segment; DTP01=472; DTP02=D8",
      "serviceLines":[ //Note: for each serviceLine, we will add LX segment and keep incrementing LX01
        "payerClaimControlNumber": "LOOP 2000A; TRNO1=2; Payer Claim Control Number is the value from the TRN segment loop 2200D of the 277 when in response to a solicited request",
        "providerAttachmentControlNumber" : "LOOP 2000A TRN01=1; For the unsolicited 275, the Attachment Control Number is the value from PWK06 loop 2300 of the 837. This is the main matching criteria and must be unique on a per attachment basis.",
        "claimStatus": [
            "claimStatusCategoryCode": "LOOP 2000A; STC01-1",
            "additionalInformationRequestCode": "LOOP 2000A; STC01-2"
        "providerControlNumber": "LOOP 2000A; REF01=6R",
        "lineItemControlNumber": "LOOP 2000A; REF01=FJ",
            "procedureOrRevenueCode": "LOOP 2000A; REF01; valid values: CPT, F8, FO, PRT,RB, VP, YJ, ZZ",
            "procedureOrRevenueValue": "value of the code provided in REF01; this would be REF02",
            "revenueCode": "LOOP 2000A; REF04-02"
            "serviceChangeNumber": "LOOP 2000A; REF01=SK; REF02",
            "objectCode" : "LOOP 2000A; REF04-1=XX4; REF04-2",
            "systemNumber": "LOOP 2000A; REF04-3=06; REF04-4",
            "specialPaymentReferenceNumber": "LOOP 2000A; REF04-5=4N; REF04-6"
            "serviceDate": "LOOP 2100A; DTP01=472; DTP03=value; DTP02=D8",
            "beginServiceDate": "LOOP 2100A; DTP01=472; DTP03=value ; DTP02=RD8",
            "endServiceDate": "LOOP 2100A; DTP01=472; DTP03=value ; DTP02=RD8",
            "submissionDate": "LOOP 2100B; DTP01=472; DTP03=value; DTP02=D8"
              "name": "Should match a file name sent with Form-Data files, Used to complete LOOP 2110B; BIN02 and LOOP 2110B; BIN01"