EQ Eligibility or Benefit Inquiry

To specify inquired eligibility or benefit information

Position
Element
Name
Type
Requirement
Min
Max
Repeat
EQ01
Service Type Code
Identifier (ID)
Conditional
1
2
-
Code identifying the classification of service
R0102: At least one of EQ-01 or EQ-02 is required
EQ02
Composite Medical Procedure Identifier
Composite (composite)
Conditional
01
Product/Service ID Qualifier
Identifier (ID)
Mandatory
2
2
-
Code identifying the type/source of the descriptive number used in Product/Service ID (234)
02
Product/Service ID
String (AN)
Mandatory
1
48
-
Identifying number for a product or service
03
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-03 modifies the value in C003-02.
04
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-04 modifies the value in C003-02.
05
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-05 modifies the value in C003-02.
06
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-06 modifies the value in C003-02.
07
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content
C003-07 is the description of the procedure identified in C003-02.
EQ03
Coverage Level Code
Identifier (ID)
Optional
3
3
-
Code indicating the level of coverage being provided for this insured
EQ04
Insurance Type Code
Identifier (ID)
Optional
1
3
-
Code identifying the type of insurance policy within a specific insurance program

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