Code identifying eligibility or benefit information

EB01 qualifies EB06 through EB10.

Code indicating the level of coverage being provided for this insured

Code indicating a code from a specific industry code list

Position of data in the repeating data element conveys no significance.

EB03 is the Service Type (Code Source 958).

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

A description or number that identifies the plan or coverage

Code specifying periods

Monetary amount

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

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.

Position of data in the repeating composite data element conveys no significance.

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

The first pointer designates the primary diagnosis and remaining diagnosis pointers indicate declining level of importance.