EQ Eligibility or Benefit Inquiry

To specify inquired eligibility or benefit information

Position

Element

Name

Type

Requirement

Min

Max

Repeat

EQ-01 C064 Service Type Composite (composite) Conditional 99

01 · 1271 · Industry Code · String (AN) · Mandatory · 1 · 30 · -

Code indicating a code from a specific industry code list

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

02 · 1271 · Industry Code · String (AN) · Optional · 1 · 30 · -

Code indicating a code from a specific industry code list

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

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

01 · 235 · Product/Service ID Qualifier · Identifier (ID) · Mandatory · 2 · 2 · -

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

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

02 · 234 · Product/Service ID · String (AN) · Mandatory · 1 · 80 · -

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.

03 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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.

04 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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.

05 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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.

06 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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.

07 · 352 · Description · String (AN) · Optional · 1 · 80 · -

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.

08 · 234 · Product/Service ID · String (AN) · Optional · 1 · 80 · -

Identifying number for a product or service

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

09 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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.

10 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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.

11 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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.

12 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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.

EQ-03 · 1207 · Coverage Level Code · Identifier (ID) · Optional · 3 · 3 · 1

Code indicating the level of coverage being provided for this insured

EQ-04 · 1788 · Insurance Product Code · Identifier (ID) · Optional · 1 · 3 · 1

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

EQ-05 · 1328 · Diagnosis Code Pointer · Numeric (N0) · Optional · 1 · 2 · 99

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.

EQ-06 · 1791 · Network Indicator Code · Identifier (ID) · Optional · 1 · 2 · 1

Code identifying a health plan network status.