EDI X12 00304 LC Segment Schema | 知行 EDI 规范查询平台

Elements

LC01 875 Maintenance Type Code
ID
M必须(Mandatory)
Code identifying the specific type of item maintenance.
Codes (41)
- 001Change
- 002Delete
- 003Add Full Item Detail
- 004Withdraw Item (Temporary)
- 005Restore Item
- 006Membership Type
- 007Purchase Eligibility
- 008Verified
- 009Not Verified
- 010Periodic Report
- 021Addition
- 022Change in Status
- 023Change in Rate Factors
- 024Cancellation or Termination
- 025Reinstatement
- 026Correction
- 028Policy Adjustment
- 029Inquiry
- 030Audit or Compare
- 032Employee Information Not Applicable
- 050Original
- 051Denial
- 052Initial Payment
- 053Change in Benefit Amount
- 054Change in Benefit Type
- 055Reinstatement of Benefit
- 056Reduced Earnings
- 057Final
- 058
- 059Suspension Medically Determined or Qualified to Return to Work
- 060Non-compliance of Medical Requirements
- 061Non-compliance of Administrative Requirements
- 062Compensable Death
- 063Incarceration
- 064Claimant's Whereabouts Unknown
- 065Volunteer
- 066Status Request
- 067Benefits Exhausted
- 068Jurisdictional Change
- 069Payment Notification
- ZZZMutually Defined
LC02 1203 Maintenance Reason Code
ID
O可选(Optional)
Code identifying the reason for the maintenance change.
Codes (56)
- 10Consolidation Omnibus Budget Reconciliation Act (COBRA) Premium Paid
- 11Surviving Spouse
- 12Lay Off
- 13Leave of Absence
- 14Voluntary Withdrawal
- 15Primary Care Provider (PCP) Change
- 16Quit
- 17Fired
- 18Suspended
- 19Sabbatical
- 20Active
- 21Disability
- 22Plan Change
- 23Furloughed
- 24Resigned
- 25Change in Identifying Data Elements
- 26Declined Coverage
- 27Pre-Enrollment
- 28Initial Enrollment
- 29Benefit Selection
- 30Discrimination Test
- 31Legal Separation
- 32Marriage
- 33Personnel Data
- 34Investment Elections and Contribution Rates
- 35Loan Repayment
- 36Contribution or Plan Allocation
- 37Leave of Absence with Benefits
- 38Leave of Absence without Benefits
- 39Lay Off with Benefits
- 40Lay Off without Benefits
- 41Re-enrollment
- 42New Entity
- 43Change of Location
- 44Change of Telephone Number
- 45Went Out of Business
- 46Current Customer Information File in Error
- 47Account Balance Reporting
- 48Fees Processing
- 49Interfund Transfer
- 01Divorce
- 02Birth
- 03Death
- 04Retirement
- 05Adoption
- 06Strike
- 07Termination of Benefits
- 08Termination of Employment
- 09Consolidation Omnibus Budget Reconciliation Act (COBRA)
- XBBecame Medical Only
- XIIndemnity
- XLBecame Lost Time
- XMMedical Only
- XNNotification Only
- XTTransfer
- ZZMutually Defined
LC03 1205 Insurance Line Code
ID
O可选(Optional)
Code identifying a group of insurance products.
Codes (34)
- 403403(B) Tax Sheltered Annuity
- ACBasic Life
- AFSupplemental Life
- APPaid Up Life
- ARDependent Life
- BCDeath and Dismemberment
- BESupplemental Death and Dismemberment
- BHWeekly Indemnity
- BKWeekly Indemnity - New York Employees
- CVEmployee Comprehensive
- LLLifestyle Life (Individualized Basic Life)
- NQNon-Qualified
- ULUniversal Life
- URUtilization Review
- ADDAccidental Death or Dismemberment
- CLFContributory Life
- DENDental
- FSAFlexible Spending
- GDC457(B) Government Deferred Compensation
- HLTHealth
- HMOHealth Maintenance Organization
- IRAGroup Individual Retirement Account
- IRC408(B) Individual Retirement Account (IRA) Annuity Contract
- LTCLong-Term Care
- LTDLong-Term Disability
- MODMail Order Drug
- NGD457(F) Non-Government Deferred Compensation
- PDGPrescription Drug
- PSPProfit-Sharing Plan
- QDA401(K) Qualified Cash or Deferred Arrangement
- QDC401(A) Qualified Defined Contribution
- STDShort-Term Disability
- VISVision
- ZZZMutually Defined
LC04 1204 Plan Coverage Description
AN
O可选(Optional)
Min 1 / Max 50
A description or number that identifies the plan or coverage.
LC05 380 Quantity
R
O可选(Optional)
Min 1 / Max 15
Numeric value of quantity.
LC06 1161 Product Option Code
ID
O可选(Optional)
Code indicating an option chosen for the product
Codes (8)
- 1Pretax
- 2Post-tax
- CChild Rider
- DDiscontinue One-Bill Submission
- NBenefit Continuation
- OOne-Bill Submission
- SSalary Continuation
- NCOne-Bill Submission Not Chosen
LC07 1073 Yes/No Condition or Response Code
ID
O可选(Optional)
Code indicating a Yes or No condition or response.
Codes (3)
- NNo
- UUnknown
- YYes