Segment
X12 EDI Release 00405
To specify the claim service detail for drug services that have been adjudicated
Elements
Code indicating the level of coverage being provided for this insured
Codes (25)- 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
- S1CSubscriber and 1 child
- S5CSubscriber and 1 or more children
- S6CSubscriber and 2 or more children
- SPCSpouse and Children
- SPOSpouse Only
- SS1Subscriber, spouse, and 1 child
- SS5Subscriber, spouse, and 1 or more children
- SS6Subscriber, spouse, and 2 or more children
- SSPSubscriber and spouse
- TWOTwo Party
Code identifying the general class of a product or process characteristic
Codes (236)- 10Major Grade
- 11Society, Government, Customer Specifications
- 12Type and/or Process
- 13Quality (Quality Level)
- 14Finish or Surface Roughness
- 15Heat Treat/Anneal
- 16Temper
- 17Coating
- 18Surface Treatment, Chemical
- 19Surface Treatment, Mechanical
- 20Ends: Slitting, Splitting, Cutting
- 21Forming
- 22Edge Treatment
- 23Welds/Splices
- 25End Treatment
- 28Test Sample Frequency
- 29Test Sample Location
- 30Test Sample Direction
- 32Type of Test/Inspection
- 33Testing and Inspection Agencies
- 34Filament
- 35Color
- 36Denier
- 37Fiber
- 38Grade
- 39Luster
- 40Shade
- 41Tint
- 42Tow
- 43Twist
- 44Bacteriology
- 45Whole Effluent Toxicity
- 46Sediment Toxicity
- 54Section Profile
- 55Alloy
- 56Special Processing
- 58Winding Instructions
- 59Surface Protection
- 60Machine Run
- 61End Use Application
- 62Corrosion Resistance
- 63Product Life Cycle
- 64Package Integrity
- 65Visual
- 66Electrical
- 67Functional Performance
- 68Chemistry
- 69Physical
- 70Magnetic
- 71Mechanical
- 72Metallography
- 73Vendor color description
- 74Vendor size description
- 75Buyer's Color Description
- 76Dye Lot Description
- 77Finish Description
- 78Pattern Description
- 79Put-up Description
- 80MILSPEC (Military Specification)
- 81FEDSPEC (Federal Specification)
- 82FED-STD (Federal Standard)
- 83CID (Commercial Item Description)
- 84Special Specification
- 85Appearance
- 86Dispersion
- 87Fluid
- 88Flow
- 89Moisture
- 90Density
- 91Buyer's Item Size Description
- 92Fabric Description
- 93Shipping Unit Component
- 94Type Spinning
- 95Wax Code
- 96Electronically Cleaned
- 97Conditioned Code
- 99Precautionary Instructions
- 01Limiting Operation
- 02General Product Form
- 03Preservative
- 04Parameter
- 05Category
- 06Sub-category
- 08Product
- 09Sub-product
- 9AManufacturing Method
- 9BProduct Application
- 9CEngine
- 9DTransmission
- AAAssembly Required
- ABConstruction
- ACConsumer Instructions
- ADShelf Tag
- AEFragrance
- AFEditor
- AGTranslator
- AHMaterial
- AINutrition
- AJRecycle
- AKSilhouette
- ALDischarge
- ATProcess Action Taken
- B8Bureau of Alcohol, Tobacco and Firearms Class Code
- BCBehind-the-Counter Drugs
- BWBasis Weight Size
- C2Controlled Substance - Class 2
- C3Controlled Substance-Class 3 (Narcotic)
- C4Controlled Substance - Class 4
- C5Controlled Substance - Class 5
- C6Controlled Substance-Class 3N (Non-narcotic)
- CDCollateral Description
- CHChassis
- CLColor - Lower Body
- CMCompliance Method
- COCollection Method Code
- CPCoupling
- CSCoating or Paint System Code
- CUColor - Upper Body
- CWCoating or Paint System Name
- DEDrug Efficacy Study Implementation
- DFDosage Form
- DMDimensional
- ECEscrow Code
- ENEngine with Transmission
- FAFailure Analysis Process
- FCFold Configurations
- FLFuel
- FQQuality
- GDGrain Direction
- GMGeneral Merchandise
- GSGoods
- HBHealth and Beauty Aids
- HYHydraulics
- HZHazardous Material
- KIKit
- LCLead/Copper Sample Type
- LOCoordinate Description Code
- MAMaterial Status, Outside Processor
- MBMarking
- MMMulti-Media
- MSMedical Supplies
- NHNon-Hazardous Material
- OCOptions
- ODOdorized
- OROrientation
- OTOver-the-Counter Drug
- P6Percentage of Alcohol
- PDPhysical Form: As Diluted
- PFPhysical Form: Concentrate
- PGProgram
- PPProcess/Production Unit
- PRManufacturing Process
- R3Proof
- RARoute of Administration
- RMResults Method Code
- RRRejection Reason
- RXPrescription Drug
- SCSource
- SEServices
- SFService Feature
- STSample Type
- TCTherapeutic Class
- TETherapeutic Equivalency Evaluation
- TFFiltering
- TPTypeface
- TRTrimming
- TZBureau of Alcohol, Tobacco and Firearms Type Code
- VAVehicle
- VCVolatile Organic Compound Control
- VIVintage
- WDWarranty Description
- WFWine Fruit
- WTWaste
- ZZMutually Defined
- AGEAge
- BCCBeverage Contents Characteristics, (e.g., Kosher, No Sulfites, etc. (Industry List)
- BESBeverage Segment
- BEVBeverage Category
- BLMBottomhole Location Method Code
- BNDBrand Group
- BPIBottomhole Pressure Method Indicator Code
- BRGBrand Group: A grouping of similar brands, (e.g., Johnnie Walker)
- CCNCommon Chemical Name
- CFCCompany Field Code
- CHFChemical Family
- CLTCasing/Liner/Tubing Type
- CMSCommercial Status
- DACDamage Code
- DAFDamage Fault
- DIRDirectional Indicator
- FCDField Code (EIA/DOD)
- FDDForecast Deviation
- FLVFlavor
- FMRFormula
- GENGeneral Description
- HZRHazard Rating System
- INGIngredient
- INJInjectables
- MACMaterial Classification
- MBUMinerals Management Service/Bureau of Land Management (Indian Land) Property/Unit Number
- MSGMarket Segment
- ODROdor
- PFAPhysical Form
- PFCPerforation Continuity Indicator
- PFGPhysical Form: Gas
- PFIPerforation Interval(s)
- PFKPhysical Form: Aerosol
- PFLPhysical Form: Liquid
- PFMPhysical Form: Emulsion
- PFNPhysical Form: Semisolid
- PFPPhysical Form: Powder
- PFSPhysical Form: Solid
- PFTPerforation Type
- PRIGrape Variety
- PROProprietary
- PSCPipeline Stream
- PUBPublic Information
- PURPure Form
- QASQuality Assurance Status
- RCCReservoir Code (Company)
- RSDRegulatory (State) District
- RSERegulatory (State) Entity Code
- SECSecret or Confidential Information
- SIZSizing
- SLMSurface Location Method Code
- SOLSolubility
- STLState Controlled
- SYNSynonym
- THRThreshold
- TIFTitle Insurance Form
- TIRTire
- TRMTest Remarks
- TRNTrade Name
- TWFTheoretical Weight Formula
- WLCWell Classification
- WTTWell Test Type