EDI Dictionary

Transaction Sets Segments

EDI-Dictionary

4010

EB

EB Eligibility or Benefit Information

Batch

To supply eligibility or benefit information

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1390	Eligibility or Benefit Information	Mandatory	ID	1/2	1
2	1207	Coverage Level Code	Opt	ID	3/3	1
3	1365	Service Type Code	Opt	ID	1/2	1
4	1336	Insurance Type Code	Opt	ID	1/3	1
5	1204	Plan Coverage Description	Opt	Alphanumeric	1/50	1
6	615	Time Period Qualifier	Opt	ID	1/2	1
7	782	Monetary Amount	Opt	Decimal	1/18	1
8	954	Percent	Opt	Decimal	1/10	1
9	673	Quantity Qualifier	Rel	ID	2/2	1
10	380	Quantity	Rel	Decimal	1/15	1
11	1073	Yes/No Condition or Response Code	Opt	ID	1/1	1
12	1073	Yes/No Condition or Response Code	Opt	ID	1/1	1
C003Composite Medical Procedure IdentifierOpt 1

Element Details

ID1390

NameEligibility or Benefit Information

LengthMin 1 / Max 2

Position1

RequirementMandatory

Codes

<>LPrimary Care Provider
<>GOut of Pocket (Stop Loss)
<>7Inactive - Pending Eligibility Update
<>WOther Source of Data
<>JCost Containment
<>MPre-existing Condition
<>PBenefit Disclaimer
<>KReserve
<>NServices Restricted to Following Provider
<>ACo-Insurance
<>1Active Coverage
<>QSecond Surgical Opinion Required
<>DBenefit Description
<>4Active - Services Capitated to Primary Care Physician
<>TCard(s) Reported Lost/Stolen
<>ONot Deemed a Medical Necessity
<>BCo-Payment
<>2Active - Full Risk Capitation
<>ROther or Additional Payor
<>EExclusions
<>5Active - Pending Investigation
<>UContact Following Entity for Eligibility or Benefit Information
<>HUnlimited
<>8Inactive - Pending Investigation
<>XHealth Care Facility
<>CDeductible
<>3Active - Services Capitated
<>SPrior Year(s) History
<>VCannot Process
<>MCManaged Care Coordinator
<>FLimitations
<>6Inactive
<>CBCoverage Basis
<>YSpend Down
<>INon-Covered