EDI Dictionary

Transaction Sets Segments

EDI-Dictionary

4060

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 Code	Mandatory	ID	1/2	1
2	1207	Coverage Level Code	Opt	ID	3/3	1
3	1365	Service Type Code	Opt	ID	1/2	99
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	Percentage as Decimal	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
C004Composite Diagnosis Code PointerOpt 1

Element Details

ID1390

NameEligibility or Benefit Information Code

LengthMin 1 / Max 2

Position1

RequirementMandatory

Codes

<>L
Primary Care Provider
<>G
Out of Pocket (Stop Loss)
<>7
Inactive - Pending Eligibility Update
<>W
Other Source of Data
<>AC
Co-insurance Maximum
<>J
Cost Containment
<>M
Pre-existing Condition
<>P
Benefit Disclaimer
<>K
Reserve
<>AB
Co-payment Maximum
<>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
<>AA
Patient Reimbursement
<>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
<>WV
Waiver
<>I
Non-Covered