Segment
X12 EDI Release 00603
To specify inquired eligibility or benefit information
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 type of insurance policy within a specific insurance program
Codes (63)- 12Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan
- 13Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan
- 14Medicare Secondary, No-fault Insurance including Auto is Primary
- 15Medicare Secondary Worker's Compensation
- 16Medicare Secondary Public Health Service (PHS)or Other Federal Agency
- 17Dental
- 18Vision
- 19Prescription Drugs
- 41Medicare Secondary Black Lung
- 42Medicare Secondary Veteran's Administration
- 43Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)
- 47Medicare Secondary, Other Liability Insurance is Primary
- DDisability
- EMedicare - Point of Service (POS)
- MMedicare Advantage Point of Service (POS) Plan that excludes Part D coverage
- UMultiple Options Health Plan
- APAuto Insurance Policy
- C1Commercial
- COConsolidated Omnibus Budget Reconciliation Act (COBRA)
- CPMedicare Conditionally Primary
- DBDisability Benefits
- EPExclusive Provider Organization
- FFFamily or Friends
- GPGroup Policy
- HMHealth Maintenance Organization (HMO)
- HNHealth Maintenance Organization (HMO) - Medicare Risk
- HSSpecial Low Income Medicare Beneficiary
- INIndemnity
- IPIndividual Policy
- LCLong Term Care
- LDLong Term Policy
- LILife Insurance
- LTLitigation
- MAMedicare Part A
- MBMedicare Part B
- MCMedicaid
- MDMedicare Part D
- MEMedicare Advantage Preferred Provider Organization (PPO) Plan that excludes Part D Coverage
- MFMedicare Advantage Private Fee for Service
- MHMedigap Part A
- MIMedigap Part B
- MJMedicare Advantage Health Maintenance Organization (HMO) Plan that includes Part D Coverage
- MKMedicare Advantage Health Maintenance Organization (HMO) Risk Plan that includes Part D Coverage
- MLMedicare Advantage Indemnity Plan that includes Part D Coverage
- MMMedicare Advantage Preferred Provider Organization (PPO) Plan that includes Part D Coverage
- MNMedicare Advantage Indemnity Plan that excludes Part D coverage
- MOMedicare Advantage Point of Service (POS) Plan that includes Part D Coverage
- MPMedicare Primary
- MRMedicare Advantage Health Maintenance Organization (HMO) Risk Plan that excludes Part D coverage
- MTMedicare Advantage Health Maintenance Organization (HMO) Plan that excludes Part D coverage
- MVMedicare Advantage
- OTOther
- PEProperty Insurance - Personal
- PLPersonal
- PPPersonal Payment (Cash - No Insurance)
- PRPreferred Provider Organization (PPO)
- PSPoint of Service (POS)
- QMQualified Medicare Beneficiary
- RPProperty Insurance - Real
- SPSupplemental Policy
- TFTax Equity Fiscal Responsibility Act (TEFRA)
- WCWorkers Compensation
- WUWrap Up Policy
