Segment
X12 EDI Release 00601
To supply information on coordination of benefits
Elements
Code identifying the insurance carrier's level of responsibility for a payment of a claim
Codes (14)- APayer Responsibility Four
- BPayer Responsibility Five
- CPayer Responsibility Six
- DPayer Responsibility Seven
- EPayer Responsibility Eight
- FPayer Responsibility Nine
- GPayer Responsibility Ten
- HPayer Responsibility Eleven
- NUnconfirmed
- ONoncapitated Agreement
- PPrimary
- SSecondary
- TTertiary
- UUnknown
Code identifying whether there is a coordination of benefits
Codes (9)- 1Coordination of Benefits
- 2Coordination of Benefits applies to Spouse Only
- 3Coordination of Benefits applies to Spouse and Dependents
- 4Coordination of Benefits applies to Dependents Only
- 5Unknown
- 6No Coordination of Benefits
- 7Coordination of Benefits Applies to Subscriber Only
- 8Conflict in Coordination of Benefit
- 9Coordination of Benefits Applies to Whole Family
Code identifying the classification of service
Codes (192)- 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
- 22Social Work
- 23Diagnostic Dental
- 24Periodontics
- 25Restorative
- 26Endodontics
- 27Maxillofacial Prosthetics
- 28Adjunctive Dental Services
- 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
- BNon-escrow or Non-impound Service
- CEscrow or Impound Service
- 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
- AQNonmedically Necessary Physical
- ARExperimental Drug Therapy
- B1Burn Care
- B2Brand Name Prescription Drug - Formulary
- B3Brand Name Prescription Drug - Non-Formulary
- BAIndependent Medical Evaluation
- BBPartial Hospitalization (Psychiatric)
- BCDay Care (Psychiatric)
- BDCognitive Therapy
- BEMassage Therapy
- BFPulmonary Rehabilitation
- BGCardiac Rehabilitation
- BHPediatric
- BINursery
- BJSkin
- BKOrthopedic
- BLCardiac
- BMLymphatic
- BNGastrointestinal
- BPEndocrine
- BQNeurology
- BREye
- BSInvasive Procedures
- BTGynecological
- BUObstetrical
- BVObstetrical/Gynecological
- BWMail Order Prescription Drug: Brand Name
- BXMail Order Prescription Drug: Generic
- BYPhysician Visit - Office: Sick
- BZPhysician Visit - Office: Well
- C1Coronary Care
- CAPrivate Duty Nursing - Inpatient
- CBPrivate Duty Nursing - Home
- CCSurgical Benefits - Professional (Physician)
- CDSurgical Benefits - Facility
- CEMental Health Provider - Inpatient
- CFMental Health Provider - Outpatient
- CGMental Health Facility - Inpatient
- CHMental Health Facility - Outpatient
- CISubstance Abuse Facility - Inpatient
- CJSubstance Abuse Facility - Outpatient
- CKScreening X-ray
- CLScreening laboratory
- CMMammogram, High Risk Patient
- CNMammogram, Low Risk Patient
- COFlu Vaccination
- CPEyewear and Eyewear Accessories
- CQCase Management
- DGDermatology
- DMDurable Medical Equipment
- DSDiabetic Supplies
- GFGeneric Prescription Drug - Formulary
- GNGeneric Prescription Drug - Non-Formulary
- GYAllergy
- ICIntensive Care
- MHMental Health
- NINeonatal Intensive Care
- ONOncology
- PEPositron Emission Tomography (PET) Scan
- PTPhysical Therapy
- PUPulmonary
- RNRenal
- RTResidential Psychiatric Treatment
- TCTransitional Care
- TNTransitional Nursery Care
- UCUrgent Care