| IG Page | Loop | Segment | Data Element | Usage | Valid Options | Gateway Comments |
| 44 | ------ | BPR | BPR01 - Transaction Handling Code | R | "I" | Gateway Health Plan intends to send Remittance Information only |
| 44 | ------ | BPR | BPR03 - Credit/Debit Flag | R | "C" | Gateway Health Plan intends to always use the Credit flag |
| 44 | ------ | BPR | BPR04 - Payment Method | R | "CHK" | Gateway Health Plan will continue to make payment by check |
| 52 | ------ | TRN | TRN02 - Check/EFT Trace Number | R | "0" or Unique check Number | Gateway Health Plan will send a "0" for the check # when there is no payment |
| 52 | ------ | TRN | TRN03 - Originating Company Identifier | R | 1251691945 | Gateway Health Plan's tacid is 25-1691945 |
| 102 | 2100 | NM1 | NM108 - Patient Identifier Code | R | "MR" | Gateway Health Plan will send the member's Medicaid Recipient Number in NM109 |
| 111 | 2100 | NM1 | NM101- Sevice Provider Entity Identifier | R | "82" | Gateway will send the servicing provider name in NM103 and MN104 |
| 111 | 2100 | NM1 | NM108 - Service Provider Identifier Code Qualifier | R | "FI" | Gateway Health Plan will send the servicing provider's Federal Tax Identification Number in NM109 |
| 148 | 2100 | CAS | CAS02 - Service Adjustment | S | Claim Adjustment Reason Codes | See the Gateway Health Plan Adjustment Code Crosswalk at www.gatewayhealthplan.com/ |