EDI
API DocsTerminal

SBI Specific Benefit Information

To specify specifc benefit scenarios

Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
1390
Eligibility or Benefit Information Code
Identifier (ID)
Mandatory
1
2
1
Code identifying eligibility or benefit information
Codes (53)
02
Time Period Qualifier
Identifier (ID)
Conditional
1
2
1
Code specifying periods
Codes (45)
03
Number of Periods
Numeric (N0)
Optional
1
3
1
Total number of periods
C0302: If SBI-03 is present, then SBI-02 is required
04
Percentage as Decimal
Decimal number (R)
Optional
1
10
1
Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)
05
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
SBI05 represents a single benefit amount or minimum benefit amount dependent upon the code sent in SBI01.
06
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
SBI06 represents a remaining benefit amount or maximum benefit amount dependent upon the code sent in SBI01.
07
Tier identifier
Numeric (N0)
Optional
1
2
1
Number identifying the level to which the benefits are assigned or limited
08
Plan Coverage Description
String (AN)
Optional
1
50
1
A description or number that identifies the plan or coverage
09
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
1
Code indicating a Yes or No condition or response
SBI09 is the triggering event indicator. A "Y" indicates that a triggering event has occurred, an "N" indicates no triggering event has occurred, a "U" indicates it cannot be determined if a triggering event occurred.
Codes (9)
10
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
1
Code indicating a Yes or No condition or response
SBI10 is the single use benefit indicator. A "Y" indicates that the benefit is a single use per period (one time use), an "N" indicates an exhaustive benefit (used until benefit or benefit amount is '0') a "U" indicates it's unknown if the benefit is of single use or exhaustive type.
Codes (9)
11
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
SBI11 amount represents the tiered benefit dollar amount.

Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.

Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.