知行 EDI 规范查询平台™
Segment
X12 EDI Release 00304
EBEligibility or Benefit Information
To supply eligibility or benefit information
Elements
  • EB011390Eligibility or Benefit Information
    ID
    M必须(Mandatory)

    Code identifying eligibility or benefit information

    Codes (30)
  • EB021207Coverage Level Code
    ID
    O可选(Optional)

    Code indicating the level of coverage being provided for this insured

    Codes (18)
  • EB031365Service Type Code
    ID
    O可选(Optional)

    Code identifying the classification of service

    Codes (117)
  • EB041336Insurance Type Code
    ID
    O可选(Optional)

    Code identifying the type of insurance policy within a specific insurance program

    Codes (30)
  • EB051204Plan Coverage Description
    AN
    O可选(Optional)
    Min 1 / Max 50

    A description or number that identifies the plan or coverage.

  • EB06615Time Period Qualifier
    ID
    O可选(Optional)

    Code defining periods.

    Codes (34)
  • EB07782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • EB08954Percent
    R
    O可选(Optional)
    Min 1 / Max 10

    Percentage expressed as a decimal

  • EB09673Quantity Qualifier
    ID
    O可选(Optional)

    Code specifying the type of quantity.

    Codes (326)
  • EB10380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity.

  • EB111073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response.

    Codes (3)
  • EB121073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response.

    Codes (3)
  • EB13C003Composite Medical Procedure IdentifierO可选(Optional)
    2352341339133913391339352
    • EB1301235Product/Service ID Qualifier
      ID
      M必须(Mandatory)

      Code identifying the type/source of the descriptive number used in Product/Service ID (234).

      Codes (307)
    • EB1302234Product/Service ID
      AN
      M必须(Mandatory)
      Min 0 / Max 30

      Identifying number for a product or service.

    • EB13031339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • EB13041339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • EB13051339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • EB13061339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • EB1307352Description
      AN
      O可选(Optional)
      Min 1 / Max 80

      A free-form description to clarify the related data elements and their content.

知行 EDI 规范查询平台™ 2023 - 3.1.18
© 2023 西安知行软件
陕ICP备09022277号
知行软件二维码