Segment
X12 EDI Release 00404
To provide benefit information on insured entities
Elements
  • INS011073Yes/No Condition or Response Code
    ID
    M必须(Mandatory)

    Code indicating a Yes or No condition or response

    Codes (4)
  • INS021069Individual Relationship Code
    ID
    M必须(Mandatory)

    Code indicating the relationship between two individuals or entities

    Codes (154)
  • INS03875Maintenance Type Code
    ID
    O可选(Optional)

    Code identifying the specific type of item maintenance

    Codes (123)
  • INS041203Maintenance Reason Code
    ID
    O可选(Optional)

    Code identifying the reason for the maintenance change

    Codes (116)
  • INS051216Benefit Status Code
    ID
    O可选(Optional)

    The type of coverage under which benefits are paid

    Codes (6)
  • INS06C052Medicare Status CodeO可选(Optional)
    1218170117011701
    • INS06011218Medicare Plan Code
      ID
      M必须(Mandatory)

      Code identifying the Medicare Plan

      Codes (5)
    • INS06021701Eligibility Reason Code
      ID
      O可选(Optional)

      Code specifying reason for eligibility

      Codes (3)
    • INS06031701Eligibility Reason Code
      ID
      O可选(Optional)

      Code specifying reason for eligibility

      Codes (3)
    • INS06041701Eligibility Reason Code
      ID
      O可选(Optional)

      Code specifying reason for eligibility

      Codes (3)
  • INS071219Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code
    ID
    O可选(Optional)

    A Qualifying Event is any of the following which results in loss of coverage for a Qualified Beneficiary

    Codes (11)
  • INS08584Employment Status Code
    ID
    O可选(Optional)

    Code showing the general employment status of an employee/claimant

    Codes (87)
  • INS091220Student Status Code
    ID
    O可选(Optional)

    Code indicating the student status of the patient if 19 years of age or older, not handicapped and not the insured

    Codes (3)
  • INS101073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • INS111250Date Time Period Format Qualifier
    ID
    O可选(Optional)

    Code indicating the date format, time format, or date and time format

    Codes (41)
  • INS121251Date Time Period
    AN
    O可选(Optional)
    Min 1 / Max 35

    Expression of a date, a time, or range of dates, times or dates and times

  • INS131165Confidentiality Code
    ID
    O可选(Optional)

    Code indicating the access to insured information

    Codes (3)
  • INS1419City Name
    AN
    O可选(Optional)
    Min 2 / Max 30

    Free-form text for city name

  • INS15156State or Province Code
    ID
    O可选(Optional)
    Min 2 / Max 2

    Code (Standard State/Province) as defined by appropriate government agency

  • INS1626Country Code
    ID
    O可选(Optional)
    Min 2 / Max 3

    Code identifying the country

  • INS171470Number
    N
    O可选(Optional)
    Min 1 / Max 9

    A generic number