EB Eligibility or Benefit Information

To supply eligibility or benefit information

Position: EB-01 · Element: 1390 · Name: Eligibility or Benefit Information Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 2 · Repeat: 25

Code identifying eligibility or benefit information

All EB01 values qualify EB06 through EB10. Position of data in the repeating data element conveys no significance.

Position: EB-02 · 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

EB-03 C064 Service Type Composite (composite) Optional 99

Position: 01 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C064-01 is the Service Type (Code Source 958).

Position: 02 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C064-02 is the Service Type Descriptor (Code Source 981).

Position: EB-04 · Element: 1788 · Name: Insurance Product Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 3 · Repeat: 1

Code identifying the type of insurance policy within a specific insurance program for eligibility purposes.

Position: EB-05 · Element: 1204 · Name: Plan Coverage Description · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 50 · Repeat: 1

A description or number that identifies the plan or coverage

Position: EB-06 · Element: 615 · Name: Time Period Qualifier · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 1

Code specifying periods

Position: EB-07 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 18 · Repeat: 1

Monetary amount

Position: EB-08 · Element: 954 · Name: Percentage as Decimal · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 10 · Repeat: 1

Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)

Position: EB-09 · Element: 673 · Name: Quantity Qualifier · Type: Identifier (ID) · Requirement: Conditional · Min: 2 · Max: 2 · Repeat: 1

Code specifying the type of quantity

P0910: If either EB-09 or EB-10 is present, then the other is required

Position: EB-10 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: 1

Numeric value of quantity

Position: EB-11 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: 1

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.

Position: EB-12 · Element: 1791 · Name: Network Indicator Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 1

Code identifying a health plan network status.

EB-13 C003 Composite Medical Procedure Identifier Composite (composite) Optional 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: 80 · 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: 80 · 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: EB-14 · Element: 1328 · Name: Diagnosis Code Pointer · Type: Numeric (N0) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 12

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.

Position: EB-15 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: 1

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.

Position: EB-16 · Element: 1796 · Name: Health Care Services Review Requirement Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: 10

Code indicating the type of heath care service review required for the service.

EB-17 C022 Health Care Code Information Composite (composite) Optional 99

Position: 01 · Element: 1270 · Name: Code List Qualifier Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 3 · Repeat: -

Code identifying a specific industry code list

C022-01 qualifies C022-02, C022-04, C022-05, C022-06, C022-08 and C022-10.

Position: 02 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

If C022-08 is used, then C022-02 represents the beginning value in a range of codes.

Position: 03 · Element: 1250 · Name: Date Time Period Format Qualifier · Type: Identifier (ID) · Requirement: Conditional · Min: 2 · Max: 3 · Repeat: -

Code indicating the date format, time format, or date and time format

P0304: If either C022-03 or C022-04 is present, then the other is required

C022-03 is the date format that will appear in C022-04.

Position: 04 · Element: 1251 · Name: Date Time Period · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 35 · Repeat: -

Expression of a date, a time, or range of dates, times or dates and times

Position: 05 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 18 · Repeat: -

Monetary amount

Position: 06 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Numeric value of quantity

Position: 07 · Element: 799 · Name: Version Identifier · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Revision level of a particular format, program, technique or algorithm

C022-07 qualifies C022-01.

Position: 08 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

E0809: Only one of C022-08 or C022-09 may be present

C022-08 represents the ending value in a range of codes.

Position: 09 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C022-09 is a value from Code Source 959 for the Present on Admission Indicator.

C022-09 would only need to be reported when C022-02 is a Diagnosis Code and range of diagnosis codes were NOT given in C022-08.

Position: 10 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C022-10 is the attribute of the code in C022-02 from the same code list.