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

Elements

INS01 1073 Yes/No Condition or Response Code
ID
M必须(Mandatory)
Code indicating a Yes or No condition or response.
Codes (3)
- NNo
- UUnknown
- YYes
INS02 1069 Individual Relationship Code
ID
M必须(Mandatory)
Code indicating the relationship between two individuals or entities.
Codes (50)
- 10Foster Child
- 11Son-in-law or Daughter-in-law
- 12Brother-in-law or Sister-in-law
- 13Mother-in-law or Father-in-law
- 14Brother or Sister
- 15Ward
- 17Stepson or Stepdaughter
- 18Self
- 19Child
- 20Employee
- 21Unknown
- 22Handicapped Dependent
- 23Sponsored Dependent
- 24Dependent of a Minor Dependent
- 25Ex-spouse
- 26Guardian
- 27Student
- 28Friend
- 29Significant Other
- 30Both Parents
- 31Court Appointed Guardian
- 32Mother
- 33Father
- 34Other Adult
- 36Emancipated Minor
- 37Agency Representative
- 38Collateral Dependent
- 39Organ Donor
- 40Cadaver Donor
- 41Injured Plaintiff
- 43Child Where Insured Has No Financial Responsibility
- 45Widow
- 46Widower
- 47State Fund
- 48Stepfather
- 49Stepmother
- 50Foster Parent
- 51Emergency Contact
- 52Employer
- 53Life Partner
- 01Spouse
- 02Son or Daughter
- 03Father or Mother
- 04Grandfather or Grandmother
- 05Grandson or Granddaughter
- 06Uncle or Aunt
- 07Nephew or Niece
- 08Cousin
- 09Adopted Child
- ZZMutually Defined
INS03 875 Maintenance Type Code
ID
O可选(Optional)
Code identifying the specific type of item maintenance.
Codes (41)
- 001Change
- 002Delete
- 003Add Full Item Detail
- 004Withdraw Item (Temporary)
- 005Restore Item
- 006Membership Type
- 007Purchase Eligibility
- 008Verified
- 009Not Verified
- 010Periodic Report
- 021Addition
- 022Change in Status
- 023Change in Rate Factors
- 024Cancellation or Termination
- 025Reinstatement
- 026Correction
- 028Policy Adjustment
- 029Inquiry
- 030Audit or Compare
- 032Employee Information Not Applicable
- 050Original
- 051Denial
- 052Initial Payment
- 053Change in Benefit Amount
- 054Change in Benefit Type
- 055Reinstatement of Benefit
- 056Reduced Earnings
- 057Final
- 058
- 059Suspension Medically Determined or Qualified to Return to Work
- 060Non-compliance of Medical Requirements
- 061Non-compliance of Administrative Requirements
- 062Compensable Death
- 063Incarceration
- 064Claimant's Whereabouts Unknown
- 065Volunteer
- 066Status Request
- 067Benefits Exhausted
- 068Jurisdictional Change
- 069Payment Notification
- ZZZMutually Defined
INS04 1203 Maintenance Reason Code
ID
O可选(Optional)
Code identifying the reason for the maintenance change.
Codes (56)
- 10Consolidation Omnibus Budget Reconciliation Act (COBRA) Premium Paid
- 11Surviving Spouse
- 12Lay Off
- 13Leave of Absence
- 14Voluntary Withdrawal
- 15Primary Care Provider (PCP) Change
- 16Quit
- 17Fired
- 18Suspended
- 19Sabbatical
- 20Active
- 21Disability
- 22Plan Change
- 23Furloughed
- 24Resigned
- 25Change in Identifying Data Elements
- 26Declined Coverage
- 27Pre-Enrollment
- 28Initial Enrollment
- 29Benefit Selection
- 30Discrimination Test
- 31Legal Separation
- 32Marriage
- 33Personnel Data
- 34Investment Elections and Contribution Rates
- 35Loan Repayment
- 36Contribution or Plan Allocation
- 37Leave of Absence with Benefits
- 38Leave of Absence without Benefits
- 39Lay Off with Benefits
- 40Lay Off without Benefits
- 41Re-enrollment
- 42New Entity
- 43Change of Location
- 44Change of Telephone Number
- 45Went Out of Business
- 46Current Customer Information File in Error
- 47Account Balance Reporting
- 48Fees Processing
- 49Interfund Transfer
- 01Divorce
- 02Birth
- 03Death
- 04Retirement
- 05Adoption
- 06Strike
- 07Termination of Benefits
- 08Termination of Employment
- 09Consolidation Omnibus Budget Reconciliation Act (COBRA)
- XBBecame Medical Only
- XIIndemnity
- XLBecame Lost Time
- XMMedical Only
- XNNotification Only
- XTTransfer
- ZZMutually Defined
INS05 1216 Benefit Status Code
ID
O可选(Optional)
The type of coverage under which benefits are paid.
Codes (3)
- AActive
- CConsolidated Omnibus Budget Reconciliation Act (COBRA)
- SSurviving Insured
INS06 1218 Medicare Plan Code
ID
O可选(Optional)
Code identifying the Medicare Plan.
Codes (5)
- AMedicare Part A
- BMedicare Part B
- CMedicare Part A and B
- DMedicare
- ENo Medicare
INS07 1219 Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code
ID
O可选(Optional)
A Qualifying Event is any of the following which results in loss of coverage for a Qualified Beneficiary.
Codes (9)
- 1Termination of Employment
- 2Reduction of work hours
- 3Medicare
- 4Death
- 5Divorce
- 6Separation
- 7Ineligible Child
- 8Bankruptcy of Retiree's Former Employer (26 U.S.C. 4980B(f)(3)(F))
- ZZMutually Defined
INS08 584 Employment Status Code
ID
O可选(Optional)
Code showing the general employment status of an employee/claimant.
Codes (46)
- AALeave of Absence with Pay
- ABLeave of Absence without Pay
- ACActive
- ADApprenticeship Full-time
- AFFlexible Work Plan
- AOActive Military - Overseas
- APApprenticeship Part-time
- AUActive Military - USA
- COConsolidated Omnibus Budget Reconciliation Act (COBRA)
- CTContinued
- DCDischarged or Terminated for Cause
- DIDeceased
- DQDisqualified: Medical or Physical Condition
- DRDisqualified: Other
- DSDisabled
- FAFurloughed: Job Abolished, Force Reduction
- FBFurloughed: Bumped or Displaced
- FCFurloughed: Facility Closed
- FOFurloughed: Other
- FTFull-time
- IAInactive
- L1Leave of Absence
- LALeave of Absence: Personal
- LELeave of Absence: Education
- LMLeave of Absence: Maternity
- LSLeave of Absence: Sickness
- LULeave of Absence: Union
- LWLeave of Absence: Without Permission, Unauthorized
- NENot Employed
- OSOn Strike
- PTPart-time
- RAResigned: Retired
- RIResigned: Injury
- RMRetired Military - Overseas
- RPResigned: Personal Reasons
- RTRetired
- RURetired Military - USA
- RWDual Retired Status
- SAResigned: Accepted Separation Allowance
- SESelf-Employed
- SLSeasonal
- SUSuspended
- TETerminated
- UKUnknown
- VOVolunteer
- ZZMutually Defined
INS09 1220 Student Status Code
ID
O可选(Optional)
Code indicating the student status of the patient if 19 years of age or older, not handicapped and not the insured
Codes (3)
- FFull-time
- NNot a Student
- PPart-time
INS10 1073 Yes/No Condition or Response Code
ID
O可选(Optional)
Code indicating a Yes or No condition or response.
Codes (3)
- NNo
- UUnknown
- YYes
INS11 1250 Date Time Period Format Qualifier
ID
O可选(Optional)
Code indicating the date format, time format, or date and time format.
Codes (22)
- CCFirst Two Digits of Year Expressed in Format CCYY
- CMDate in Format CCYYMM
- CYYear Expressed in Format CCYY
- D6Date Expressed in Format YYMMDD
- D8Date Expression in Format CCYYMMDD
- DDDay of Month in Numeric Format
- DTDate and Time Expressed in Format CCYYMMDDHHMM
- MDMonth of Year and Day of Month Expressed in Format MMDD
- ME
- MMMonth of Year in Numeric Format
- TMTime Expressed in Format HHMM
- TSTime Expressed in Format HHMMSS
- YMYear and Month Expressed in Format YYMM
- YYLast Two Digits of Year Expressed in Format CCYY
- RD2Range of Years Expressed in Format YY-YY
- RD4Range of Years Expressed in Format CCYY-CCYY
- RD6Range of Dates Expressed in Format YYMMDD-YYMMDD
- RD8Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD
- RDMRange of Dates Expressed in Format YYMMDD-MMDD
- RDTRange of Date and Time, Expressed in Format CCYYMMDDHHMM-CCYYMMDDHHMM
- RMDRange of Months and Days Expressed in Format MMDD-MMDD
- RTMRange of Time Expressed in Format HHMM-HHMM
INS12 1251 Date Time Period
AN
O可选(Optional)
Min 1 / Max 35
Expression of a date, a time, or range of dates, times or dates and times.
INS13 1165 Confidentiality Code
ID
O可选(Optional)
Code indicating the access to insured information.
Codes (3)
- OOther Restrictions
- RRestricted Access
- UUnrestricted Access
INS14 19 City Name
AN
O可选(Optional)
Min 2 / Max 30
Free-form text for city name.
INS15 156 State or Province Code
ID
O可选(Optional)
Min 2 / Max 2
Code (Standard State/Province) as defined by appropriate government agency.
INS16 26 Country Code
ID
O可选(Optional)
Min 2 / Max 3
Code identifying the country.