NoA Response Body

{
  "authorizationId": "16665bb7-3040-4d4d-a889-123a27b29789",
  "noa": {
    "x12": "ISA*00*6666      *00*5555      *ZZ*NOADEMO        *ZZ*6546564        *0623  *1301*^*00501*000000001*0*T*:~GS*HI*FL0738*PERSEPVS*20090601*040612*1*X*005010X216~ST*278*0001*005010X216~BHT*0007*11*165932*20055002*0815*18~HL*1**20*1~NM1*X3*2*ABC PAYER*****PI*1234560010~HL*2*1*21*1~NM1*1P*1*XYZ AMBULANCE SVC*****24*7759621873~HL*3*2*22*1~NM1*IL*1*SMITH*JOE****MI*12345689001~REF*EJ*1234567890~DMG*D8*19700101*M~HL*4*3*EV*1~UM*HS*I*56*41:B~HCR*A1*1234567890123~DTP*AAH*D8*20250101~CR1***X**DH*27~NM1*PW*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*ND*2*DOCTOR OFFICE~N3*123 SOME AVENUE~N4*SACRAMENTO*CA*95624~NM1*R3*2*SOME DIALYSIS CENTER~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*FS*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~HL*5*4*SS*0~SV1*HC:A0428:RX**UN*5~HL*6*4*SS*0~SV1*HC:A0428:PD**UN*8~HL*7*4*SS*0~SV1*HC:A0428:DR**UN*14~SE*34*0001~GE*1*1~IEA*1*000000001~",
    "json": {
      "submitterTransactionIdentifier": "165932",
      "payerId": "1234560010",
      "payerName": "ABC PAYER",
      "umClearingHouseId": "NOADEMO",
      "umRequestValidation": null,
      "requester": {
        "requesterType": "1P",
        "lastName": "XYZ AMBULANCE SVC",
        "requesterIdentification": {},
        "employersId": "7759621873"
      },
      "subscriber": {
        "lastName": "SMITH",
        "firstName": "JOE",
        "memberId": "12345689001",
        "dateOfBirth": "19700101",
        "genderCode": "M",
        "supplementalIdentification": {
          "patientAccountNumber": "1234567890"
        }
      },
      "dependent": {
        "supplementalIdentification": {}
      },
      "patientEventDetail": {
        "requestCategoryCode": "HS",
        "certificationTypeCode": "I",
        "serviceTypeCode": "56",
        "facilityTypeCode": "41",
        "facilityCodeQualifier": "B",
        "certificationActionCode": "A1",
        "reviewIdentificationNumber": "1234567890123",
        "eventDateBegin": "20250101",
        "ambulanceTransportCode": "X",
        "ambulanceUnitOrBasisForMeasurementCode": "DH",
        "ambulanceTransportDistance": "27",
        "patientEventAdditionalPatientInformationContactName": [
          {}
        ],
        "patientEventTransportInformation": [
          {
            "entityIdentifierCode": "PW",
            "transportLocationName": "HOME",
            "address1": "123 SOME ROAD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postalCode": "95826"
          },
          {
            "entityIdentifierCode": "ND",
            "transportLocationName": "DOCTOR OFFICE",
            "address1": "123 SOME AVENUE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postalCode": "95624"
          },
          {
            "entityIdentifierCode": "R3",
            "transportLocationName": "SOME DIALYSIS CENTER",
            "address1": "123 SOME ROAD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postalCode": "95826"
          },
          {
            "entityIdentifierCode": "FS",
            "transportLocationName": "HOME",
            "address1": "123 SOME ROAD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postalCode": "95826"
          }
        ],
        "serviceLevel": [
          {
            "professionalService": {
              "productOrServiceIDQualifier": "HC",
              "procedureCode": "A0428",
              "procedureModifier": "RX",
              "unitOrBasisForMeasurementCode": "UN",
              "serviceUnitCount": "5"
            },
            "institutionalService": {},
            "dentalService": {},
            "serviceDetailAdditionalServiceInformationContactName": [
              {}
            ]
          },
          {
            "professionalService": {
              "productOrServiceIDQualifier": "HC",
              "procedureCode": "A0428",
              "procedureModifier": "PD",
              "unitOrBasisForMeasurementCode": "UN",
              "serviceUnitCount": "8"
            },
            "institutionalService": {},
            "dentalService": {},
            "serviceDetailAdditionalServiceInformationContactName": [
              {}
            ]
          },
          {
            "professionalService": {
              "productOrServiceIDQualifier": "HC",
              "procedureCode": "A0428",
              "procedureModifier": "DR",
              "unitOrBasisForMeasurementCode": "UN",
              "serviceUnitCount": "14"
            },
            "institutionalService": {},
            "dentalService": {},
            "serviceDetailAdditionalServiceInformationContactName": [
              {}
            ]
          }
        ]
      }
    }
  }
}