EDI Dictionary

Transaction Sets Segments

EDI-Dictionary

7020

SBI

SBI Specific Benefit Information

Batch

To specify specifc benefit scenarios

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1390	Eligibility or Benefit Information Code	Mandatory	ID	1/2	1
2	615	Time Period Qualifier	Rel	ID	1/2	1
3	616	Number of Periods	Opt	Number	1/3	1
4	954	Percentage as Decimal	Opt	Decimal	1/10	1
5	782	Monetary Amount	Mandatory	Decimal	1/18	1
6	782	Monetary Amount	Opt	Decimal	1/18	1
7	1790	Tier identifier	Opt	Number	1/2	1
8	1204	Plan Coverage Description	Opt	Alphanumeric	1/50	1
9	1073	Yes/No Condition or Response Code	Opt	ID	1/1	1
10	1073	Yes/No Condition or Response Code	Opt	ID	1/1	1

Element Details

ID1390

NameEligibility or Benefit Information Code

LengthMin 1 / Max 2

Position1

RequirementMandatory

Codes

<>LPrimary Care Provider
<>GOut of Pocket (Stop Loss)
<>7Inactive - Pending Eligibility Update
<>WOther Source of Data
<>ACCo-insurance Maximum
<>HRHealth Reimbursement Account
<>JCost Containment
<>SFSimple Forward Rolling Limitation (SFRL)
<>MPre-existing Condition
<>CFCombination Forward Rolling Limitation (CFRL)
<>PBenefit Disclaimer
<>KReserve
<>12Inactive - Pending Receipt of Premium Payment
<>ABCo-payment Maximum
<>NServices Restricted to Following Provider
<>FGFirst Dollar Coverage, Group of Services
<>ACo-Insurance
<>1Active Coverage
<>QSecond Surgical Opinion Required
<>DBenefit Description
<>4Active - Services Capitated to Primary Care Physician
<>TCard(s) Reported Lost/Stolen
<>SDShared Benefit Deductible
<>ONot Deemed a Medical Necessity
<>BCo-Payment
<>2Active - Full Risk Capitation
<>ROther or Additional Payor
<>FDFirst Dollar Coverage
<>EExclusions
<>5Active - Pending Investigation
<>UContact Following Entity for Eligibility or Benefit Information
<>FSFirst Dollar Coverage, Single Service
<>FCFirst Dollar Coverage, Applies to the Entire Plan
<>AAPatient Reimbursement
<>HUnlimited
<>8Inactive - Pending Investigation
<>XHealth Care Facility
<>11Active - Pending Receipt of Premium Payment
<>CDeductible
<>3Active - Services Capitated
<>SPrior Year(s) History
<>VCannot Process
<>TBTiered Benefit
<>MCManaged Care Coordinator
<>FLimitations
<>6Inactive
<>9Coverage Never Activated
<>CBCoverage Basis
<>YSpend Down
<>WVWaiver
<>10Inactive - Premium Payment Not Received
<>SBShared Benefit Limitation
<>INon-Covered