Code identifying eligibility or benefit information

EB01 qualifies EB06 through EB10.

Code indicating the level of coverage being provided for this insured

Code identifying the classification of service

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

A description or number that identifies the plan or coverage

Code defining periods

Monetary amount

Percentage expressed as a decimal

Code specifying the type of quantity

Numeric value of quantity

Code indicating a Yes or No condition or response

EB11 is the authorization or certification indicator. A "Y" value indicates that an authorization or certification is required per plan provisions. An "N" value indicates that an authorization or certification is not required per plan provisions. A "U" value indicates it is unknown whether the plan provisions require an authorization or certification.

Code indicating a Yes or No condition or response

EB12 is the plan network indicator. A "Y" value indicates the benefits identified are considered In-Plan-Network. An "N" value indicates that the benefits identified are considered Out-Of-Plan-Network. A "U" value indicates it is unknown whether the benefits identified are part of the Plan Network.