EB Eligibility or Benefit Information
To supply eligibility or benefit information
Position
Element
Name
Type
Requirement
Min
Max
Repeat
Code identifying eligibility or benefit information
EB01 qualifies EB06 thru EB10.
Code indicating the level of coverage being provided for this insured
Code identifying the classification of service
Code identifying the type of insurance policy within a specific insurance program
A description or number that identifies the plan or coverage.
Code defining periods.
Monetary amount.
Percentage expressed as a decimal
Code specifying the type of quantity.
P0910: If either EB-09 or EB-10 is present, then the other is required
Numeric value of quantity.
Code indicating a Yes or No condition or response.
EB11 is the Authorization or Certification Indicator. A ``Y'' value indicates that an authorization or certification is required per plan provisions. A ``N'' value indicates that an authorization or certification is not required per plan provisions. A ``U'' value indicates it is unknown whether the plan provisions require an authorization or certification.
Code indicating a Yes or No condition or response.
EB12 is the Plan Network Indicator. A ``Y'' value indicates the benefits identified are considered In-Plan-Network. A ``N'' value indicates that the benefits identified are considered Out-Of-Plan-Network. A ``U'' value indicates it is unknown whether the benefits identified are part of the Plan Network.
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
Identifying number for a product or service.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-03 modifies the value in C003-02.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-04 modifies the value in C003-02.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-05 modifies the value in C003-02.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-06 modifies the value in C003-02.
A free-form description to clarify the related data elements and their content.
C003-07 is the description of the procedure identified in C003-02.