EDI Dictionary

Transaction Sets Segments

EDI-Dictionary

4020

1390

1390Eligibility or Benefit Information

Batch

Code identifying eligibility or benefit information

Element Details

Type ID

LengthMin 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