EDI X12 00404 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 (4)
- NNo
- UUnknown
- WNot Applicable
- YYes
INS02 1069 Individual Relationship Code
ID
M必须(Mandatory)
Code indicating the relationship between two individuals or entities
Codes (154)
- 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
- 16Stepparent
- 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
- 55Adopted Daughter
- 56Adopted Son
- 57Adoptive Father
- 58Adoptive Mother
- 59Adoptive Parents
- 60Annuitant
- 61Aunt
- 62Brother
- 63Brother-in-Law
- 64Business
- 65Business Associate
- 66Business Insurance Trust
- 67Business Partner
- 68Charity
- 70Children of Marriage
- 71Company
- 72Corporation
- 73Creditor
- 74Daughter
- 75Daughter-in-Law
- 76Dependent
- 78Estate
- 79Ex-wife
- 80Family Member
- 81Father-in-Law
- 82Fiancé (Male)
- 83Financée (Female)
- 84Fiduciary
- 86Foster Daughter
- 87Foster Father
- 88Foster Mother
- 90Foster Son
- 91God Daughter
- 92God Father
- 93God Parents
- 94God Son
- 95Grandchildren
- 96Granddaughter
- 97Grandfather
- 98Grandmother
- 99Grandparents
- 01Spouse
- 02Son or Daughter
- 03Father or Mother
- 04Grandfather or Grandmother
- 05Grandson or Granddaughter
- 06Uncle or Aunt
- 07Nephew or Niece
- 08Cousin
- 09Adopted Child
- A1Grandson
- A2Great Aunt
- A3Ex-husband
- A4Half Brother
- A5Half Sister
- A6Husband
- A7Institution
- A8Mortgage Holder
- A9Mother-in-Law
- B1Nephew
- B2Niece
- B3Parents-in-Law
- B4Partnership
- B5Partner
- B6Personal Insurance Trust
- B7Sister
- B8Sister-in-Law
- B9Sole Proprietorship
- C1Son
- C2Son-in-Law
- C3Step Brother
- C4Step Children
- C5Step Daughter
- C8Step Sister
- C9Step Son
- D1Trust
- D2Trustee
- D3Uncle
- D4Wife
- D5Teacher
- D6School Counselor
- D7School Principal
- D8Other School Administrator
- D9Coach
- E1Activity Sponsor
- E2Supervisor
- E3Co-worker
- E4Minister or Priest
- E5Ecclesiastical or Religious Leader
- E6God Mother
- E7Probation Officer
- E8Accountant
- E9Advisor
- F1Alma Mater
- F2Applicant
- F3Banker
- F6Clergyman
- F7Client
- F8Club or Organization Officer
- F9Doctor
- G2Educator/Teacher/Instructor
- G3Betrothed
- G4Insured
- G5Lawyer
- G6Medical Care Provider
- G7Neighbor
- G8Other Relationship
- G9Other Relative
- H1Owner
- H4Payor
- N1None
- OTNon-applicable Individual Relationship Category
- ZZMutually Defined
INS03 875 Maintenance Type Code
ID
O可选(Optional)
Code identifying the specific type of item maintenance
Codes (123)
- 100Sale of Mortgage Change
- 101Servicer Change
- 102Mortgagor Change
- 104Prepayment Termination
- 105Non-conveyance Termination
- 106Voluntary Action Termination
- 107Loan Refinanced Termination
- 108Transfer Due to Interest and Servicing Sold
- 109Retain Servicing
- 110Transfer Servicing
- 111Assign Servicing
- 112Servicer Loan Number Change
- 113Merger
- 114Acquisition
- 115Receivership
- 116Loan Maturity Maintenance
- 117Binder
- 118New Policy
- 119Renewal Policy
- 123Canceled by Administrator
- 124Canceled by Insured
- 125Re-Write
- 126Non-renewal
- 127Termination of All Endorsements
- 128Termination of Lessor Interest
- 129Termination of Additional Insured Interest
- 130Termination of Lienholder or Loss Payee
- 131Addition of Lessor Endorsement
- 132Addition of Lienholder Endorsement
- 133Addition of Additional Insured Endorsement
- 134Change of Lessor Endorsement
- 135Change of Lienholder Endorsement
- 136Change of Additional Insured Endorsement
- 137Acquired Unallocated
- 138Acquired Payment
- 139Investigation Pending
- 140Concurrent Benefit
- 141Abbreviated First Report on an Acquired Claim
- 142Employer Paid
- 143Employer Reinstatement
- 144Suspension Directed by Agency
- 145Occupational Safety and Health Administration Injury and Illness Log (OSHA-300)
- 146Occupational Injury Survey
- 147Bureau of Labor and Statistics Survey
- 148First Payment on an Acquired Claim
- 149First Report on an Acquired Claim
- 150Impairment Report
- 151Return to Work Report
- 152Office of Workers Compensation Program Injury Claim Report (OWCP CA-1)
- 153Office of Workers Compensation Program Illness Claim Report (OWCP CA-2)
- 154Occupational Safety and Health Administration Injury and Illness Record (OSHA-301)
- 155First Aid Injury Only
- 001Change
- 002Delete
- 003Add Full Item Detail
- 004Withdraw Item (Temporary)
- 005Restore Item
- 006Membership Type
- 007Purchase Eligibility
- 008Verified
- 009Not Verified
- 010Periodic Report
- 011All Items Refresh
- 012Medical Noncompliance
- 013Administrative Noncompliance
- 014Suspended Pending Settlement Approval
- 015Suspended Pending Appeal or Judicial Review
- 016Injury Report Creation
- 017Illness Report Creation
- 018Transfer of Beneficial Rights
- 019Record Security Instrument
- 020Assignment
- 021Addition
- 022Change in Status
- 023Change in Rate Factors
- 024Cancellation or Termination
- 025Reinstatement
- 026Correction
- 028Policy Adjustment
- 029Inquiry
- 030Audit or Compare
- 031Medical Examination Authorization
- 032Employee Information Not Applicable
- 033Release of Interim Funding Interest
- 050Original
- 051Denial
- 052Initial Payment
- 053Change in Benefit Amount
- 054Change in Benefit Type
- 055Reinstatement of Benefit
- 056Reduced Earnings
- 057Final
- 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
- 070Status Request Response
- 071Re-issue Identification Card(s)
- 072Suspension Due to Claimant Death
- 073Partial Denial
- 074Partial Suspension, Returned to Work, or Medically Determined or Qualified to Return to Work
- 075Partial Suspension, Medical Non-compliance
- 076Partial Suspension, Administrative Non-compliance
- 077Partial Suspension, Claimant Death
- 078Partial Suspension, Incarceration
- 079Partial Suspension, Claimant's whereabouts Unknown
- 080Partial Suspension, Benefits Exhausted
- 081Partial Suspension, Jurisdiction Change
- 082Partially Suspended, Benefits Pending Settlement Approval
- 083Partially Suspended, Pending Appeal or Judicial Review
- 084Lump Sum Benefit Payment
- 085Suspension Denial
- CEPChange Excluding Price
- PRIPrice Change Only
- TBVTo Be Verified
- ZZZMutually Defined
INS04 1203 Maintenance Reason Code
ID
O可选(Optional)
Code identifying the reason for the maintenance change
Codes (116)
- 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
- 50Loan Request
- 51Enrollment in Subsequent Benefit Plan
- 52Health Care Facility Change
- 53Name Synonym Add
- 54Sub Location Add
- 55Sub Location Change
- 56Sub Location Expire
- 57Buyout
- 58Merger
- 59Non Payment
- 60Coverage Placed Elsewhere
- 61Duplicate Coverage
- 62Change in Ownership
- 63Business Sold
- 64Underwriting Reason
- 65No Employees, Exposure or Operations
- 66Revocation of Voluntary Market Acceptance
- 67Include Primary Business Management
- 68Exclude Primary Business Management
- 69Failure to Pay Deductible
- 70Misrepresented Information
- 71Rewritten
- 72Adding a Jurisdiction
- 73Deleting a Jurisdiction
- 75Occupational Illness
- 76Change Insured Federal Employer Identification Number (FEIN)
- 77Change Employer Federal Employer Identification Number (FEIN)
- 78Change Employer Unemployment Insurance (UI) Code
- 79Change Policy Number
- 80Modification without a Specific Operating Unit Location in Jurisdiction
- 81Change Policy Effective Date
- 82Change Policy Expiration Date
- 83Change Insurer Federal Employer Identification Number (FEIN)
- 84No Eligible Employees
- 85Reinstatement - Canceled in Error
- 86Change in Insured Information
- 87Change in Employer Information
- 88Parent Identification Change
- 89Change to Expiration Date
- 90Phone Verify Only
- 91Name Synonym Delete
- 92Duplicate Entry on Customer Identification File
- 93Removal of the Customer Identification File Merge ID
- 94Removal of the Customer Identification File Buyout ID
- 95Removal of the Customer Identification File in Error ID
- 96Re-activation of an Out-of-Business Customer
- 97Sub-location Reinstatement
- 01Divorce
- 02Birth
- 03Death
- 04Retirement
- 05Adoption
- 06Strike
- 07Termination of Benefits
- 08Termination of Employment
- 09Consolidation Omnibus Budget Reconciliation Act (COBRA)
- 4ABusiness Name Change
- 4BBusiness Name Correction
- 4CPhysical or Mailing Address Correction
- AADissatisfaction with Office Staff
- ABDissatisfaction with Medical Care/Services Rendered
- ACInconvenient Office Location
- ADDissatisfaction with Office Hours
- AEUnable to Schedule Appointments in a Timely Manner
- AFDissatisfaction with Physician's Referral Policy
- AGLess Respect and Attention Time Given than to Other Patients
- AHPatient Moved to a New Location
- AINo Reason Given
- AJAppointment Times not Met in a Timely Manner
- 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 (6)
- AActive
- CConsolidated Omnibus Budget Reconciliation Act (COBRA)
- IInvoluntary
- SSurviving Insured
- TTax Equity and Fiscal Responsibility Act (TEFRA)
- VVoluntary
INS06C052Medicare Status CodeO可选(Optional)
1218170117011701
- INS0601 1218 Medicare Plan Code
  ID
  M必须(Mandatory)
  Code identifying the Medicare Plan
  Codes (5)
- INS0602 1701 Eligibility Reason Code
  ID
  O可选(Optional)
  Code specifying reason for eligibility
  Codes (3)
- INS0603 1701 Eligibility Reason Code
  ID
  O可选(Optional)
  Code specifying reason for eligibility
  Codes (3)
- INS0604 1701 Eligibility Reason Code
  ID
  O可选(Optional)
  Code specifying reason for eligibility
  Codes (3)
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 (11)
- 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))
- 9Layoff
- 10Leave of Absence
- ZZMutually Defined
INS08 584 Employment Status Code
ID
O可选(Optional)
Code showing the general employment status of an employee/claimant
Codes (87)
- 00Substitute
- AALeave of Absence with Pay
- ABLeave of Absence without Pay
- ACActive
- ADApprenticeship Full-time
- AEActive Reserve
- AFFlexible Work Plan
- AGAlerted
- AHAssigned
- AIAffiliated with Outside Organization
- AJAdjunct
- AOActive Military - Overseas
- APApprenticeship Part-time
- AQApprenticeship
- AUActive Military - USA
- CANon-applicable Employment Status Category
- COConsolidated Omnibus Budget Reconciliation Act (COBRA)
- CTContinued
- DCDischarged or Terminated for Cause
- DDDishonorably Discharged
- DIDeceased
- DQDisqualified: Medical or Physical Condition
- DRDisqualified: Other
- DSDisabled
- EOEmployed by Outside Organization
- FAFurloughed: Job Abolished, Force Reduction
- FBFurloughed: Bumped or Displaced
- FCFurloughed: Facility Closed
- FOFurloughed: Other
- FTFull-time
- HDHonorably Discharged
- IAInactive
- IRInactive Reserves
- L1Leave of Absence
- L2Administrative Leave of Absence
- L3Annual Leave of Absence
- L4Leave of Absence due to Bereavement
- L5Jury Duty
- L6Suspension
- L7Sabbatical Leave of Absence
- LALeave of Absence: Personal
- LELeave of Absence: Education
- LFLeave of Absence: Family Medical Leave Act (FMLA)
- LMLeave of Absence: Maternity
- LOLeave of Absence for Non-Military Government Request Other Than Jury Duty
- LSLeave of Absence: Sickness
- LULeave of Absence: Union
- LWLeave of Absence: Without Permission, Unauthorized
- LXLeave of Absence: Military
- NENot Employed
- OSOn Strike
- OTOther
- PAPromoted
- PCPart-time Contractual
- PEPlan to Enlist
- PMPermanent
- PNPart-time Noncontractual
- PRProbationary
- PTPart-time
- PVPrevious
- PWPiece Worker
- RAResigned: Retired
- RBRelocated
- RCReassigned
- RDResigned: Moved
- RERecommissioned
- RIResigned: Injury
- RMRetired Military - Overseas
- RPResigned: Personal Reasons
- RTRetired
- RURetired Military - USA
- RWDual Retired Status
- SAResigned: Accepted Separation Allowance
- SBSeparated
- SESelf-Employed
- SLSeasonal
- SUSuspended
- TETerminated
- TFTemporary Full-Time
- TMTemporary
- TNTenured
- TPTemporary Part-Time
- TRTransferred
- UKUnknown
- VOVolunteer
- XDExtra Duties Not Requiring Certification
- 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 (4)
- NNo
- UUnknown
- WNot Applicable
- 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 (41)
- CCFirst Two Digits of Year Expressed in Format CCYY
- CDMonth and Year Expressed in Format MMMYYYY
- CMDate in Format CCYYMM
- CQDate in Format CCYYQ
- CYYear Expressed in Format CCYY
- D6Date Expressed in Format YYMMDD
- D8Date Expression in Format CCYYMMDD
- DARange of Dates within a Single Month Expressed in Format DD-DD
- DBDate Expressed in Format MMDDCCYY
- DDDay of Month in Numeric Format
- DTDate and Time Expressed in Format CCYYMMDDHHMM
- EHLast Digit of Year and Julian Date Expressed in Format YDDD
- KADate Expressed in Format YYMMMDD
- MDMonth of Year and Day of Month Expressed in Format MMDD
- MMMonth of Year in Numeric Format
- RDRange of Dates Expressed in Format MMDDCCYY-MMDDCCYY
- TCJulian Date Expressed in Format DDD
- TMTime Expressed in Format HHMM
- TQDate Expressed in Format MMYY
- TRDate and Time Expressed in Format DDMMYYHHMM
- TSTime Expressed in Format HHMMSS
- TTDate Expressed in Format MMDDYY
- TUDate Expressed in Format YYDDD
- UNUnstructured
- YMYear and Month Expressed in Format YYMM
- YYLast Two Digits of Year Expressed in Format CCYY
- DDTRange of Dates and Time, Expressed in CCYYMMDD-CCYYMMDDHHMM
- DTDRange of Dates and Time, Expressed in CCYYMMDDHHMM-CCYYMMDD
- DTSRange of Date and Time Expressed in Format CCYYMMDDHHMMSS-CCYYMMDDHHMMSS
- RD2Range of Years Expressed in Format YY-YY
- RD4Range of Years Expressed in Format CCYY-CCYY
- RD5Range of Years and Months Expressed in Format CCYYMM-CCYYMM
- 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
- RMYRange of Years and Months Expressed in Format YYMM-YYMM
- RTMRange of Time Expressed in Format HHMM-HHMM
- RTSDate and Time Expressed in Format CCYYMMDDHHMMSS
- YMMRange of Year and Months, Expressed in CCYYMMM-MMM Format
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
INS17 1470 Number
N
O可选(Optional)
Min 1 / Max 9
A generic number