To provide eligibility or response information.
| Position | Element | Name | Type | Min/Max | Repeat | ||
|---|---|---|---|---|---|---|---|
1 | |||||||
2 | |||||||
| 3 | 7701 | Service Type, coded | Rel | Alphanumeric | 1/3 | 1 | |
1 | |||||||
| 5 | 4712 | Coverage Description | Rel | Alphanumeric | 1/70 | 1 | |
| 6 | 4701 | Coverage Level, coded | Rel | Alphanumeric | 1/3 | 1 | |
| 7 | 4703 | Insurance Type, coded | Rel | Alphanumeric | 1/3 | 1 | |
| 8 | 4711 | Condition/Response, coded | Rel | Alphanumeric | 1/3 | 1 | |
| 9 | 4711 | Condition/Response, coded | Rel | Alphanumeric | 1/3 | 1 | |
1 | |||||||