{
  "Submission": {
    "Header": {
      "SenderID": "7109",
      "ReceiverID": "TPA002",
      "TransactionDate": "20/10/2023 18:26",
      "RecordCount": "1",
      "DispositionFlag": "TEST",
      "PayerID": "INS201"
    },
    "Claim": [
      {
        "ID": "TPA002_INS201_20_10_2023_1617_AA2247",
        "IDPayer": null,
        "Type": "Submission",
        "MemberId": "234234",
        "DispensedID": null,
        "ProviderID": "7109",
        "Weight": null,
        "NationalIDNumber": "999-9999-9999999-9",
        "Gross": "200.00",
        "PatientShare": "20.0",
        "Net": "180.00",
        "ReferenceNumber": null,
        "DateOfBirth": "20/10/1989 00:00",
        "Gender": "Male",
        "Encounter": {
          "FacilityID": "7109",
          "Type": "1",
          "PatientID": "AA2247",
          "Start": "20/10/2023 00:00",
          "End": "20/10/2023 00:00",
          "StartType": "1",
          "EndType": "1",
          "TransferSource": null,
          "TransferDestination": null
        },
        "Diagnosis": [
          {
            "Type": "Principal",
            "Code": "R50.9",
            "DxInfo": null
          }
        ],
        "Activity": [
          {
            "ID": "1",
            "ActivityReference": null,
            "Start": "20/10/2023 00:00",
            "Type": "8",
            "Code": "9",
            "Location": null,
            "Quantity": "1.00",
            "Unit": null,
            "Net": "180.00",
            "Clinician": "D38180",
            "PatientShare": null,
            "Duration": null,
            "UnitId": null,
            "Refills": null,
            "RoutOfAdmin": null,
            "Instructions": null,
            "Frequency": null,
            "PriorAuthorizationID": null,
            "DenialCode": null,
            "List": null,
            "PaymentAmount": null,
            "DispensedActivityID": null,
            "Observation": []
          }
        ],
        "Resubmission": null
      }
    ]
  }
}