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Sub-Field: 365.02

Package: Integrated Billing

IIV RESPONSE(#365)-->365.02

Sub-Field: 365.02


Information

Parent File Name Number Package
IIV RESPONSE(#365) ELIGIBILITY/BENEFIT 365.02 Integrated Billing

Details

Field # Name Loc Type Details
.01 EB NUMBER 0;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  SEP 11, 2009
  • HELP-PROMPT:  Type a number between 1 and 999, 0 Decimal Digits.
  • DESCRIPTION:  
    This is a sequential number corresponding to the Set-ID for all of the eligibility/benefit (X.12 EB segments) segments coming into VISTA.
  • CROSS-REFERENCE:  365.02^B
    1)= S ^IBCN(365,DA(1),2,"B",$E(X,1,30),DA)=""
    2)= K ^IBCN(365,DA(1),2,"B",$E(X,1,30),DA)
.02 ELIGIBILITY/BENEFIT INFO 0;2 POINTER TO X12 271 ELIGIBILITY/BENEFIT FILE (#365.011) X12 271 ELIGIBILITY/BENEFIT(#365.011)

  • LAST EDITED:  MAR 07, 2013
  • HELP-PROMPT:  Enter an eligibility/benefit code from the list.
  • DESCRIPTION:  
    This field contains a code identifying the eligibility status of the individual or the benefit returned by the Payer.
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB01 data element.
.03 COVERAGE LEVEL 0;3 POINTER TO X12 271 COVERAGE LEVEL FILE (#365.012) X12 271 COVERAGE LEVEL(#365.012)

  • LAST EDITED:  MAR 07, 2013
  • HELP-PROMPT:  Enter a coverage level code from the list.
  • DESCRIPTION:  
    This field identifies the level of coverage of benefits.
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB02 data element.
.04 *SERVICE TYPE 0;4 POINTER TO X12 271 SERVICE TYPE FILE (#365.013) X12 271 SERVICE TYPE(#365.013)

  • LAST EDITED:  NOV 22, 2010
  • HELP-PROMPT:  Enter the service type code from the list.
  • DESCRIPTION:  
    This field is a code identifying the classification of service.
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB03 data element. This field is deprecated via IB*2.0*438. Replaced with 365.02/14 which is a multiple with #365.292/.01.
.05 INSURANCE TYPE 0;5 POINTER TO X12 271 INSURANCE TYPE FILE (#365.014) X12 271 INSURANCE TYPE(#365.014)

  • LAST EDITED:  MAR 07, 2013
  • HELP-PROMPT:  Enter the insurance type code from the list.
  • DESCRIPTION:  
    This is a code identifying the type of insurance policy within a specific insurance program.
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB04 data element.
.06 PLAN COVERAGE DESCRIPTION 0;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
  • LAST EDITED:  OCT 13, 2009
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  
    This code is a description or number that identifies the plan or coverage.
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB05 data element.
.07 TIME PERIOD QUALIFIER 0;7 POINTER TO X12 271 TIME PERIOD QUALIFIER FILE (#365.015) X12 271 TIME PERIOD QUALIFIER(#365.015)

  • LAST EDITED:  MAR 07, 2013
  • HELP-PROMPT:  Enter the type of time period code from the list.
  • DESCRIPTION:  
    This is a code for the time period category that determines for how long the benefits are available.
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB06 data element.
.08 MONETARY AMOUNT 0;8 FREE TEXT

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(+X>999999999999999)!(+X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  JUN 12, 2013
  • HELP-PROMPT:  Type a dollar amount between 0 and 999999999999999, 2 decimal digits.
  • DESCRIPTION:  
    This field is populated if eligibility or benefit must be qualified by a monetary amount.
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB07 data element.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.09 PERCENT 0;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>100)!(X<0)!(X?.E1"."6.N) X
  • LAST EDITED:  OCT 13, 2009
  • HELP-PROMPT:  Type a number between 0 and 100, 5 Decimal Digits.
  • DESCRIPTION:  
    This field is used if eligibility or benefit must be qualified by a percentage.
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB08 data element.
.1 QUANTITY QUALIFIER 0;10 POINTER TO X12 271 QUANTITY QUALIFIER FILE (#365.016) X12 271 QUANTITY QUALIFIER(#365.016)

  • LAST EDITED:  MAR 07, 2013
  • HELP-PROMPT:  Enter the type of quantity code from the list.
  • DESCRIPTION:  
    This field is used to identify the type of units that are being conveyed in the QUANTITY field (#.11).
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB09 data element.
.11 QUANTITY 0;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  OCT 13, 2009
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    This field number is used for the quantity value as qualified by the QUANTITY QUALIFIER field.
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB10 data element.
.12 AUTHORIZATION/CERTIFICATION 0;12 POINTER TO X12 271 YES/NO RESPONSE CODE FILE (#365.033) X12 271 YES/NO RESPONSE CODE(#365.033)

  • LAST EDITED:  MAR 26, 2013
  • HELP-PROMPT:  Enter YES if authorization or certification is required.
  • DESCRIPTION:  
    This field indicates that an authorization or certification is required per plan provisions.
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB11 data element.
.13 IN PLAN 0;13 POINTER TO X12 271 YES/NO RESPONSE CODE FILE (#365.033) X12 271 YES/NO RESPONSE CODE(#365.033)

  • LAST EDITED:  MAR 26, 2013
  • HELP-PROMPT:  Enter YES if the benefits identified are In-Plan-Network.
  • DESCRIPTION:  This field indicates the plan network indicator. A YES value indicates the benefits identified are considered In-Plan-Network. A NO value indicates that the benefits identified are considered Out-Of-Plan-Network. A
    "U" value indicates it is unknown whether the benefits identified are part of the Plan Network.
  • TECHNICAL DESCR:  
    It corresponds to X.12 271 EB12 data element.
1.01 PROCEDURE CODING METHOD 1;1 POINTER TO X12 271 PROCEDURE CODING METHOD FILE (#365.035) X12 271 PROCEDURE CODING METHOD(#365.035)

  • LAST EDITED:  MAR 07, 2013
  • HELP-PROMPT:  Enter the code describing procedure coding method.
  • DESCRIPTION:  
    Two character code describing procedure coding method.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZEB.14.1
1.02 PROCEDURE CODE 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>48!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-48 characters in length.
  • DESCRIPTION:  
    Identification code for the procedure.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZEB.15
1.03 PROCEDURE MODIFIER 1 1;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    Identifies special circumstances related to the procedure; first modifier.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZEB.16 (repetition 1)
1.04 PROCEDURE MODIFIER 2 1;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    Identifies special circumstances related to the procedure; second modifier.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZEB.16 (repetition 2)
1.05 PROCEDURE MODIFIER 3 1;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    Identifies special circumstances related to the procedure; third modifier.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZEB.16 (repetition 3)
1.06 PROCEDURE MODIFIER 4 1;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    Identifies special circumstances related to the procedure; fourth modifier.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZEB.16 (repetition 4)
2 NOTES 2;0 WORD-PROCESSING #365.22

  • DESCRIPTION:  
    This field contains any additional text about the eligibility benefit information. It is transcribed from X.12 271 MSG segments.
3.01 ENTITY ID CODE 3;1 POINTER TO X12 271 ENTITY IDENTIFIER CODE FILE (#365.022) X12 271 ENTITY IDENTIFIER CODE(#365.022)

  • LAST EDITED:  MAR 05, 2013
  • HELP-PROMPT:  Select X12 code for entity identifier.
  • DESCRIPTION:  
    X12 Entity Identifier Code.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.2.1
3.02 ENTITY TYPE 3;2 POINTER TO X12 271 ENTITY TYPE QUALIFIER FILE (#365.043) X12 271 ENTITY TYPE QUALIFIER(#365.043)

  • LAST EDITED:  MAR 05, 2013
  • HELP-PROMPT:  Select type of the entity.
  • DESCRIPTION:  
    Describes the type of Entity.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.3.1
3.03 NAME 3;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>98!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-98 characters in length.
  • DESCRIPTION:  
    Name of person or organization.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, combined elements ZTY.4.1.1 (last name or organization name), ZTY.4.2 (first name) , ZTY.4.3 (middle name), and ZTY.4.4 (suffix).
3.04 ENTITY ID 3;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-80 characters in length.
  • DESCRIPTION:  
    Entity identifier.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.6
3.05 ENTITY ID QUALIFIER 3;5 POINTER TO X12 271 IDENTIFICATION QUALIFIER FILE (#365.023) X12 271 IDENTIFICATION QUALIFIER(#365.023)

  • LAST EDITED:  MAR 06, 2013
  • HELP-PROMPT:  Select X12 code for ID qualifier.
  • DESCRIPTION:  
    Code designating the system/method used for Identification.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.5.1
3.06 ENTITY RELATIONSHIP CODE 3;6 POINTER TO X12 271 ENTITY RELATIONSHIP CODE FILE (#365.031) X12 271 ENTITY RELATIONSHIP CODE(#365.031)

  • LAST EDITED:  MAR 18, 2013
  • HELP-PROMPT:  Enter the code that represents the relationship to the patient.
  • DESCRIPTION:  
    Benefit Related Entity's relationship to the patient.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message ZTY.13
4.01 ADDRESS LINE 1 4;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-55 characters in length.
  • DESCRIPTION:  
    Entity address, line 1.
  • TECHNICAL DESCR:  
    Source: 271 HL message, ZTY.7.1.1
4.02 ADDRESS LINE 2 4;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-55 characters in length.
  • DESCRIPTION:  
    Entity address, line 2.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.7.2
4.03 CITY 4;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Entity address, city.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.7.3
4.04 STATE 4;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Select state/province code.
  • DESCRIPTION:  
    Entity address, state or province code.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.7.4
4.05 ZIP 4;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    Entity address, zip or postal code.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.7.5
4.06 COUNTRY CODE 4;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<2) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 2-3 characters in length.
  • DESCRIPTION:  
    Entity address, country code.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.7.6
4.07 LOCATION 4;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUL 10, 2009
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Entity address, location identifier.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.9
4.08 LOCATION QUALIFIER 4;8 POINTER TO X12 271 LOCATION QUALIFER FILE (#365.034) X12 271 LOCATION QUALIFER(#365.034)

  • LAST EDITED:  MAR 06, 2013
  • HELP-PROMPT:  Select location qualifier.
  • DESCRIPTION:  
    Entity address, location qualifier.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.8
4.09 SUBDIVISION CODE 4;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  AUG 10, 2010
  • HELP-PROMPT:  Answer must be 1-3 characters in length.
  • DESCRIPTION:  
    Entity address, country subdivision code.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.7.8.
5.01 PROVIDER CODE 5;1 POINTER TO X12 271 PROVIDER CODE FILE (#365.024) X12 271 PROVIDER CODE(#365.024)

  • LAST EDITED:  MAR 06, 2013
  • HELP-PROMPT:  Select provider code.
  • DESCRIPTION:  
    Code identifying the type of provider.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.10.1
5.02 REFERENCE ID 5;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUL 13, 2009
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Reference identifier.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.12
5.03 REFERENCE ID QUALIFIER 5;3 POINTER TO X12 271 REFERENCE IDENTIFICATION FILE (#365.028) X12 271 REFERENCE IDENTIFICATION(#365.028)

  • LAST EDITED:  MAR 06, 2013
  • HELP-PROMPT:  Select reference id qualifier.
  • DESCRIPTION:  
    Reference identifier type.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZTY.11.1
6 CONTACT INFORMATION 6;0 Multiple #365.26 365.26

  • DESCRIPTION:  
    This multiple contains contact information for an eligibility/benefit entity.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, CTD segment within G2O group.
7 HEALTHCARE SERVICES DELIVERY 7;0 Multiple #365.27 365.27

  • DESCRIPTION:  
    Healthcare services delivery multiple.
  • TECHNICAL DESCR:  
    Source: 271 HL7 ZHS segment.
8 SUBSCRIBER DATES 8;0 Multiple #365.28 365.28

  • DESCRIPTION:  
    Subscriber dates multiple.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZSD segment.
9 SUBSCRIBER ADDITIONAL INFO 9;0 Multiple #365.29 365.29

  • DESCRIPTION:  
    Additional subscriber information multiple.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZII segment.
10 SUBSCRIBER REFERENCE ID 10;0 Multiple #365.291 365.291

  • DESCRIPTION:  
    Subscriber reference id multiple.
  • TECHNICAL DESCR:  
    Source: 271 HL7 message, ZRF segment.
14 SERVICE TYPES 14;0 POINTER Multiple #365.292 365.292

  • DESCRIPTION:  
    Contains the Service type codes returned from eligibility inquiry.
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