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	25
2	1207	Coverage Level Code	Opt	ID	3/3	1
C064Service TypeOpt 99
4	1788	Insurance Product 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	1791	Network Indicator Code	Opt	ID	1/2	1
C003Composite Medical Procedure IdentifierOpt 99
14	1328	Diagnosis Code Pointer	Opt	Number	1/2	12
15	1073	Yes/No Condition or Response Code	Opt	ID	1/1	1
16	1796	Health Care Services Review Requirement Code	Opt	ID	1/2	10

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
<>HR
Health Reimbursement Account
<>J
Cost Containment
<>SF
Simple Forward Rolling Limitation (SFRL)
<>M
Pre-existing Condition
<>CF
Combination Forward Rolling Limitation (CFRL)
<>P
Benefit Disclaimer
<>K
Reserve
<>12
Inactive - Pending Receipt of Premium Payment
<>AB
Co-payment Maximum
<>N
Services Restricted to Following Provider
<>FG
First Dollar Coverage, Group of Services
<>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
<>SD
Shared Benefit Deductible
<>O
Not Deemed a Medical Necessity
<>B
Co-Payment
<>2
Active - Full Risk Capitation
<>R
Other or Additional Payor
<>FD
First Dollar Coverage
<>E
Exclusions
<>5
Active - Pending Investigation
<>U
Contact Following Entity for Eligibility or Benefit Information
<>FS
First Dollar Coverage, Single Service
<>FC
First Dollar Coverage, Applies to the Entire Plan
<>AA
Patient Reimbursement
<>H
Unlimited
<>8
Inactive - Pending Investigation
<>X
Health Care Facility
<>11
Active - Pending Receipt of Premium Payment
<>C
Deductible
<>3
Active - Services Capitated
<>S
Prior Year(s) History
<>V
Cannot Process
<>TB
Tiered Benefit
<>MC
Managed Care Coordinator
<>F
Limitations
<>6
Inactive
<>9
Coverage Never Activated
<>CB
Coverage Basis
<>Y
Spend Down
<>WV
Waiver
<>10
Inactive - Premium Payment Not Received
<>SB
Shared Benefit Limitation
<>I
Non-Covered

EDI Dictionary

EB Eligibility or Benefit Information

Elements

Element Details