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 through EB10.
Code indicating the level of coverage being provided for this insured
Code identifying the classification of service
Position of data in the repeating data element conveys no significance.
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 (e.g., 0.0 through 1.0 represents 0% through 100%)
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. An "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. An "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)
C003-01 qualifies C003-02 and C003-08.
Identifying number for a product or service
If C003-08 is used, then C003-02 represents the beginning value in the range in which the code occurs.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-03 modifies the value in C003-02 and C003-08.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-04 modifies the value in C003-02 and C003-08.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-05 modifies the value in C003-02 and C003-08.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-06 modifies the value in C003-02 and C003-08.
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.
Identifying number for a product or service
C003-08 represents the ending value in the range in which the code occurs.
A pointer to the diagnosis code in the order of importance to this service
C004-01 identifies the primary diagnosis code for this service line.
A pointer to the diagnosis code in the order of importance to this service
C004-02 identifies the second diagnosis code for this service line.
A pointer to the diagnosis code in the order of importance to this service
C004-03 identifies the third diagnosis code for this service line.
A pointer to the diagnosis code in the order of importance to this service
C004-04 identifies the fourth diagnosis code for this service line.