EDI X12 00304 EQ Segment Schema | 知行 EDI 规范查询平台

Elements

EQ01 1365 Service Type Code
ID
O可选(Optional)
Code identifying the classification of service
Codes (117)
- 1Medical Care
- 2Surgical
- 3Consultation
- 4Diagnostic X-Ray
- 5Diagnostic Lab
- 6Radiation Therapy
- 7Anesthesia
- 8Surgical Assistance
- 9Other Medical
- 10Blood Charges
- 11Used Durable Medical Equipment
- 12Durable Medical Equipment Purchase
- 13Ambulatory Service Center Facility
- 14Renal Supplies in the Home
- 15Alternate Method Dialysis
- 16Chronic Renal Disease (CRD) Equipment
- 17Pre-Admission Testing
- 18Durable Medical Equipment Rental
- 19Pneumonia Vaccine
- 20Second Surgical Opinion
- 21Third Surgical Opinion
- 30Health Benefit Plan Coverage
- 31Benefit Disclaimer
- 32Plan Waiting Period
- 33Chiropractic
- 34Chiropractic Office Visits
- 35Dental Care
- 36Dental Crowns
- 37Dental Accident
- 38Orthodontics
- 39Prosthodontics
- 40Oral Surgery
- 41Routine (Preventive) Dental
- 42Home Health Care
- 43Home Health Prescriptions
- 44Home Health Visits
- 45Hospice
- 46Respite Care
- 47Hospital
- 48Hospital - Inpatient
- 49Hospital - Room and Board
- 50Hospital - Outpatient
- 51Hospital - Emergency Accident
- 52Hospital - Emergency Medical
- 53Hospital - Ambulatory Surgical
- 54Long Term Care
- 55Major Medical
- 56Medically Related Transportation
- 57Air Transportation
- 58Cabulance
- 59Licensed Ambulance
- 60General Benefits
- 61In-vitro Fertilization
- 62MRI/CAT Scan
- 63Donor Procedures
- 64Acupuncture
- 65Newborn Care
- 66Pathology
- 67Smoking Cessation
- 68Well Baby Care
- 69Maternity
- 70Transplants
- 71Audiology Exam
- 72Inhalation Therapy
- 73Diagnostic Medical
- 74Private Duty Nursing
- 75Prosthetic Device
- 76Dialysis
- 77Otological Exam
- 78Chemotherapy
- 79Allergy Testing
- 80Immunizations
- 81Routine Physical
- 82Family Planning
- 83Infertility
- 84Abortion
- 85AIDS
- 86Emergency Services
- 87Cancer
- 88Pharmacy
- 89Free Standing Prescription Drug
- 90Mail Order Prescription Drug
- 91Brand Name Prescription Drug
- 92Generic Prescription Drug
- 93Podiatry
- 94Podiatry - Office Visits
- 95Podiatry - Nursing Home Visits
- 96Professional (Physician)
- 97Anesthesiologist
- 98Professional (Physician) Visit - Office
- 99Professional (Physician) Visit - Inpatient
- A0Professional (Physician) Visit - Outpatient
- A1Professional (Physician) Visit - Nursing Home
- A2Professional (Physician) Visit - Skilled Nursing Facility
- A3Professional (Physician) Visit - Home
- A4Psychiatric
- A5Psychiatric - Room and Board
- A6Psychotherapy
- A7Psychiatric - Inpatient
- A8Psychiatric - Outpatient
- A9Rehabilitation
- AARehabilitation - Room and Board
- ABRehabilitation - Inpatient
- ACRehabilitation - Outpatient
- ADOccupational Therapy
- AEPhysical Medicine
- AFSpeech Therapy
- AGSkilled Nursing Care
- AHSkilled Nursing Care - Room and Board
- AISubstance Abuse
- AJAlcoholism
- AKDrug Addiction
- ALVision (Optometry)
- AMFrames
- ANRoutine Exam
- AOLenses
- APRoutine Eye Exam
EQ02C003Composite Medical Procedure IdentifierO可选(Optional)
2352341339133913391339352
- EQ0201 235 Product/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)
- EQ0202 234 Product/Service ID
  AN
  M必须(Mandatory)
  Min 0 / Max 30
  Identifying number for a product or service.
- EQ0203 1339 Procedure 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
- EQ0204 1339 Procedure 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
- EQ0205 1339 Procedure 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
- EQ0206 1339 Procedure 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
- EQ0207 352 Description
  AN
  O可选(Optional)
  Min 1 / Max 80
  A free-form description to clarify the related data elements and their content.
EQ03 1207 Coverage Level Code
ID
O可选(Optional)
Code indicating the level of coverage being provided for this insured
Codes (18)
- CHDChildren Only
- DEPDependents Only
- E1DEmployee and One Dependent
- E2DEmployee and Two Dependents
- E3DEmployee and Three Dependents
- E5DEmployee and One or More Dependents
- E6DEmployee and Two or More Dependents
- E7DEmployee and Three or More Dependents
- E8DEmployee and Four or More Dependents
- E9DEmployee and Five or More Dependents
- ECHEmployee and Children
- EMPEmployee Only
- ESPEmployee and Spouse
- FAMFamily
- INDIndividual
- SPCSpouse and Children
- SPOSpouse Only
- TWOTwo Party
EQ04 1336 Insurance Type Code
ID
O可选(Optional)
Code identifying the type of insurance policy within a specific insurance program
Codes (30)
- 12Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan
- 13Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan
- 14Medicare Secondary, No-fault Insurance including Auto is Primary
- 15Medicare Secondary Worker's Compensation
- 16Medicare Secondary Public Health Service (PHS)or Other Federal Agency
- 41Medicare Secondary Black Lung
- 42Medicare Secondary Veteran's Administration
- 43Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)
- APAuto Insurance Policy
- C1Commercial
- COConsolidated Omnibus Budget Reconciliation Act (COBRA)
- CPMedicare Conditionally Primary
- FFFamily or Friends
- GPGroup Policy
- HMHealth Maintenance Organization (HMO)
- IPIndividual Policy
- LDLong Term Policy
- LTLitigation
- MAMedicare Part A
- MBMedicare Part B
- MCMedicaid
- MG
- MPMedicare Primary
- OTOther
- PLPersonal
- PPPersonal Payment (Cash - No Insurance)
- PRPreferred Provider Organization (PPO)
- PSPoint of Service (POS)
- SPSupplemental Policy
- TFTax Equity Fiscal Responsibility Act (TEFRA)