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: 99

Code identifying the classification of service

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

Position of data in the repeating data element conveys no significance.

EQ-02 C003 Composite Medical Procedure Identifier Composite (composite) Conditional 99

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)

C003-01 qualifies C003-02 and C003-08.

Position: 02 · Element: 234 · Name: Product/Service ID · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 48 · Repeat: -

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.

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 and C003-08.

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 and C003-08.

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 and C003-08.

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 and C003-08.

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: 08 · Element: 234 · Name: Product/Service ID · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 48 · Repeat: -

Identifying number for a product or service

C003-08 represents the ending value in the range in which the code occurs.

Position: 09 · 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

C003-09 modifies the value in C003-02 and C003-08.

Position: 10 · 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

C003-10 modifies the value in C003-02 and C003-08.

Position: 11 · 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

C003-11 modifies the value in C003-02 and C003-08.

Position: 12 · 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

C003-12 modifies the value in C003-02 and C003-08.

Position: EQ-03 · Element: 1207 · Name: Coverage Level Code · Type: Identifier (ID) · Requirement: Optional · Min: 3 · Max: 3 · Repeat: 1

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: 1

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

EQ-05 C004 Composite Diagnosis Code Pointer Composite (composite) Optional 1

Position: 01 · Element: 1328 · Name: Diagnosis Code Pointer · Type: Numeric (N0) · Requirement: Mandatory · Min: 1 · Max: 2 · Repeat: -

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.

Position: 02 · Element: 1328 · Name: Diagnosis Code Pointer · Type: Numeric (N0) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

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.

Position: 03 · Element: 1328 · Name: Diagnosis Code Pointer · Type: Numeric (N0) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

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.

Position: 04 · Element: 1328 · Name: Diagnosis Code Pointer · Type: Numeric (N0) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

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.