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
All EB01 values qualify EB06 through EB10. Position of data in the repeating data element conveys no significance.
Code indicating the level of coverage being provided for this insured
Code indicating a code from a specific industry code list
C064-01 is the Service Type (Code Source 958).
Code indicating a code from a specific industry code list
C064-02 is the Service Type Descriptor (Code Source 981).
Code identifying the type of insurance policy within a specific insurance program for eligibility purposes.
A description or number that identifies the plan or coverage
Code specifying 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 identifying a health plan network status.
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.
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.
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.
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.
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.
A pointer to the diagnosis code in the order of importance to this service
The first pointer designates the primary diagnosis and remaining diagnosis pointers indicate declining level of importance.
Code indicating a Yes or No condition or response
A "Y" indicates benefits are shared across Service Type Codes and Procedure Codes; an "N" indicates benefits are not shared.
Code indicating the type of heath care service review required for the service.