知行 EDI 规范查询平台™
Segment
X12 EDI Release 00504
EBEligibility or Benefit Information
To supply eligibility or benefit information
Elements
  • EB011390Eligibility or Benefit Information Code
    ID
    M必须(Mandatory)

    Code identifying eligibility or benefit information

    Codes (41)
  • EB021207Coverage Level Code
    ID
    O可选(Optional)

    Code indicating the level of coverage being provided for this insured

    Codes (25)
  • EB031365Service Type Code
    ID
    O可选(Optional)

    Code identifying the classification of service

    Codes (191)
  • EB041336Insurance Type Code
    ID
    O可选(Optional)

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

    Codes (51)
  • 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 (38)
  • EB07782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • EB08954Percentage as Decimal
    R
    O可选(Optional)
    Min 1 / Max 10

    Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)

  • EB09673Quantity Qualifier
    ID
    O可选(Optional)

    Code specifying the type of quantity

    Codes (1132)
  • 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 (4)
  • EB121073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • EB13C003Composite Medical Procedure IdentifierO可选(Optional)
    23523413391339133913393522341339133913391339
    • 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 (511)
    • EB1302234Product/Service ID
      AN
      M必须(Mandatory)
      Min 0 / Max 48

      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

    • EB1308234Product/Service ID
      AN
      O可选(Optional)
      Min 1 / Max 48

      Identifying number for a product or service

    • EB13091339Procedure 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

    • EB13101339Procedure 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

    • EB13111339Procedure 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

    • EB13121339Procedure 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

  • EB14C004Composite Diagnosis Code PointerO可选(Optional)
    1328132813281328
    • EB14011328Diagnosis Code Pointer
      N
      M必须(Mandatory)
      Min 0 / Max 2

      A pointer to the diagnosis code in the order of importance to this service

    • EB14021328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the diagnosis code in the order of importance to this service

    • EB14031328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the diagnosis code in the order of importance to this service

    • EB14041328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the diagnosis code in the order of importance to this service

知行 EDI 规范查询平台™ 2023 - 3.1.18
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