IDC Identification Card

To provide notification to produce replacement identification card(s)

Sequence

Element

Name

Type

Requirement

Min

Max

Repeat

01

1204

Plan Coverage Description

String (AN)

Mandatory

1

50

1

A description or number that identifies the plan or coverage

02

1215

Identification Card Type Code

Identifier (ID)

Mandatory

1

1

1

Code identifying the type of identification card

Codes (5)

03

380

Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

IDC03 is the number of cards being requested.

04

306

Action Code

Identifier (ID)

Optional

1

2

1

Code indicating type of action

IDC04 is the reason for the card being requested, i.e., add or a change.

Codes (325)