EQ Eligibility or Benefit Inquiry

To specify inquired eligibility or benefit information

Position: EQ-01 · Element: 1365 · Name: Service Type Code · Type: Identifier (ID) · Requirement: Conditional · Min: 1 · Max: 2 · Repeat: -

Code identifying the classification of service

R0102: At least one of EQ-01 or EQ-02 is required

EQ-02 C003 Composite Medical Procedure Identifier Composite (composite) Conditional

Position: 01 · Element: 235 · Name: Product/Service ID Qualifier · Type: Identifier (ID) · Requirement: Mandatory · Min: 2 · Max: 2 · Repeat: -

Code identifying the type/source of the descriptive number used in Product/Service ID (234).

Position: 02 · Element: 234 · Name: Product/Service ID · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 40 · Repeat: -

Identifying number for a product or service.

Position: 03 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

This identifies special circumstances related to the performance of the service, as defined by trading partners

C003-03 modifies the value in C003-02.

Position: 04 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

This identifies special circumstances related to the performance of the service, as defined by trading partners

C003-04 modifies the value in C003-02.

Position: 05 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

This identifies special circumstances related to the performance of the service, as defined by trading partners

C003-05 modifies the value in C003-02.

Position: 06 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

This identifies special circumstances related to the performance of the service, as defined by trading partners

C003-06 modifies the value in C003-02.

Position: 07 · Element: 352 · Name: Description · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 80 · Repeat: -

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.

Position: EQ-03 · Element: 1207 · Name: Coverage Level Code · Type: Identifier (ID) · Requirement: Optional · Min: 3 · Max: 3 · Repeat: -

Code indicating the level of coverage being provided for this insured

Position: EQ-04 · Element: 1336 · Name: Insurance Type Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 3 · Repeat: -

Code identifying the type of insurance policy within a specific insurance program