EDI Dictionary
Schedule demo
X12 Release 4010
X12 Release
4010
4020
4030
4040
4050
4060
5010
5020
5030
5040
5050
6010
6020
6030
6040
6050
7010
7020
7030
7040
7050
7060
8010
Transaction Sets
Segments
Elements
EDI-Dictionary
4010
1390
1390
Eligibility or Benefit Information
Batch
Code identifying eligibility or benefit information
Element Details
Type
ID
Length
Min 1 / Max 2
Codes
<>
L
Primary Care Provider
<>
G
Out of Pocket (Stop Loss)
<>
7
Inactive - Pending Eligibility Update
<>
W
Other Source of Data
<>
J
Cost Containment
<>
M
Pre-existing Condition
<>
P
Benefit Disclaimer
<>
K
Reserve
<>
N
Services Restricted to Following Provider
<>
A
Co-Insurance
<>
1
Active Coverage
<>
Q
Second Surgical Opinion Required
<>
D
Benefit Description
<>
4
Active - Services Capitated to Primary Care Physician
<>
T
Card(s) Reported Lost/Stolen
<>
O
Not Deemed a Medical Necessity
<>
B
Co-Payment
<>
2
Active - Full Risk Capitation
<>
R
Other or Additional Payor
<>
E
Exclusions
<>
5
Active - Pending Investigation
<>
U
Contact Following Entity for Eligibility or Benefit Information
<>
H
Unlimited
<>
8
Inactive - Pending Investigation
<>
X
Health Care Facility
<>
C
Deductible
<>
3
Active - Services Capitated
<>
S
Prior Year(s) History
<>
V
Cannot Process
<>
MC
Managed Care Coordinator
<>
F
Limitations
<>
6
Inactive
<>
CB
Coverage Basis
<>
Y
Spend Down
<>
I
Non-Covered
